Dr Elena A. Christofides reacts to various disparities among patients who are overweight or obese that impact how patients are managed in the United States.
Chris Mazzolini: Dr Christofides, is there anything that you want to add? I’m curious about the difference between overweight, obesity, preobesity, and some of the other stuff that Dr Bays had mentioned?
Elena A. Christofides, MD, FACE: Yes, of course. Thank you, Chris. I appreciate the opportunity. I appreciate Dr Bays being on this call as well because he and I are simpatico in how we think about obesity and overweight. This is going to be a great dove tail. His point is extraordinarily important because overweight starts at a BMI [body mass index] of 25 kg/m2, meaning the patient’s weight and height. That’s what a BMI is, and that’s what Dr Bays was getting at with measuring the weight and height of a person, because when you look at the effect of gravity on your body, kilograms divided by your height in square meters, this gives you a number. The World Health Organization defines it as a BMI greater than 25 to 30 kg/m2 as overweight, and over 30 kg/m2 is obese. There are also classifications within those classifications in terms of class of obesity, meaning class 1 is mild obesity, all the way up to class 4, which is severe obesity. That’s the definition.
When you look at the number of kilograms per meter squared, people are really surprised by that number. As a society, in the United States in particular, people have a little weight blindness, meaning that when you ask somebody if they think they’re overweight or obese, and they say no, and you give them their BMI, they’re usually surprised. They think a BMI of 25 isn’t high enough to classify as overweight. The point is, as Dr Bays mentioned, BMI is a prognostic indicator. It isn’t a hard-core number that’s the end of the world. Overweight is defined as a BMI between 25 and 30 kg/m2, and obesity is 30 kg/m2 and greater. BMI is a reflection of your weight and height. The classifications of obesity are above that.
Treatment recommendations are geared toward overweight and obesity, with or without other conditions associated with obesity or associated with long-term consequences. That’s an important distinction. You may or may not treat somebody for overweight or obesity with medications or surgery, depending on what else is going on. That’s a personal and professional decision that you may engage in with your patient. But it doesn’t mean that you shouldn’t classify or diagnose correctly. That’s an important point, in my teaching tools, when I’m teaching students and residents. It’s fine if you determine you’re not going to intervene, but don’t insult your intelligence, and the patient’s intelligence, by ignoring the diagnosis. You may give somebody a diagnosis of overweight or obesity and intervene modestly with lifestyle interventions. You may intervene with medications. You may intervene with surgery. You may do nothing because the patient is determined and that’s their preference. But don’t fool anybody by pretending the diagnosis doesn’t exist.
As Dr Bays alluded to in the opening statement, getting a diagnosis is important. It’s the most important point in this conversation. If you don’t have a diagnosis, you have nothing to talk about. If you don’t have a diagnosis, whatever happens with the patient is irrelevant. They’ll never associate their medical needs with their obesity or overweight diagnosis, so they’ll never have that educational point, moving forward, to address it. The BMI of an overweight person, 25 kg/m2, is a pretty low number. In the United States, it’s important to recognize racial differences, because the prognostic indicator of a BMI isn’t strictly the Caucasian population. There are differences, in terms of risk of overweight and obesity, in the Indian subcontinent population and in the African American population, that are different from the Caucasian population. Those are points that need to be respected in a patient’s journey in your office.
Transcript edited for clarity.