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Defining Overweight and Obesity


Dr Harold Edward Bays shares important insight on appropriately defining overweight versus obesity in terms of a medical diagnosis.

Chris Mazzolini: Hello. Welcome to this Medical Economics® Insight titled “Innovations in Weight Loss Management.” I’m Chris Mazzolini, the editorial director of Medical Economics®. We have with us today Dr Elena Christofides, board certified in endocrinology, diabetes, and metabolism, as well as internal medicine. She’s affiliated with Mount Carmel Hospitals in Columbus, Ohio. We’re also joined by Dr Harold Edward Bays, the medical director and president at Louisville Metabolic and Atherosclerosis Research Center in Louisville, Kentucky. Thanks to both of you for joining us.

Harold Edward Bays, MD, FOMA, FTOS, FACC, FNLA, FASPC: Thank you.

Elena A. Christofides, MD, FACE: Thank you.

Chris Mazzolini: Let’s start with the basics. Let’s define overweight and obese. Dr Bays, would you like to kick us off?

Harold Edward Bays, MD, FOMA, FTOS, FACC, FNLA, FASPC: Sure. Thanks, Chris, for having us here. This is a very important topic. It’s really good that you’re starting with diagnosis. You’d think that diagnosis would be something that pretty obvious for any disease—sometimes I’m not sure that applies to many clinicians when they evaluate patients with obesity. Historically, a lot of our patients, and certainly a lot of clinicians, rely on body weight for diagnosis of obesity. Most people know that it’s really difficult to do so unless you also assess the height, and that’s the reason we measure the body mass index [BMI].

The challenge is that there are a lot of patients who have increased muscle mass, or maybe they have a decrease in muscle mass, so the body mass index falls apart in many of those patients. At our research site, in Louisville, Kentucky, we routinely perform DEXA [dual-energy x-ray absorptiometry] scans on a lot of folks. We also have people who are in physique competitions or bodybuilder competitions. If you just went by their BMI, diagnosis can be way off.

The next manner to perform in the diagnostic procedure would be measurement of the percentage of body fat. The Obesity Medicine Association has a classification of body mass index, and its cutoff points include things like preobesity, obesity, and such. For the people who are interested, that’s available as well. The challenge with percentage of body fat is that it’s more descriptive than it is prognostic, especially when it comes to cardio-metabolic risk factors or cardiac risk. What you want to do is focus on the waist circumference, or the android and visceral fat. It’s not a terribly complicated or technologically advanced measure, but waist circumference is an amazing tool that clinicians can use to assess cardio-metabolic risk in their patients. 

If you want to get more granular, as I mentioned, we do a lot of DEXA scans. If you looked at android and visceral fat, again, the Obesity Med Association has cutoff points: less than 1 lb of visceral fat is considered to be optimal and less than 3 lb of android fat is considered to be optimal. Those cutoff points seem to correlate well with cardiovascular disease risk. 

In summary, I would say that when you diagnose obesity, it’s not just about measuring the body weight. There are many layers to this. The clinician has to decide the degree, or the intensity, of which of these diagnostic procedures should be employed.

Transcript edited for clarity.

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