Assessment

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The diagnosis and classification of obesity has come to focus on the evaluation of the body mass index, (BMI). BMI is a practical approach for assessing body fat in a clinical setting. The BMI provides a more accurate measurement of total body fat compared with assessment by weight alone. However, the BMI can be an overesti-mation of adiposity in persons of short stature or who are very muscular, and an underestimation in persons who have lost muscle mass. BMI disregards gender, age, and ethnicity, but these factors do not markedly influence the validity of BMI for classifying individuals into broad categories of overweight and obesity. Overweight is categorized by a BMI of 25-29.9 kg/m2 and obesity as BMI > 30 kg/m2. The BMI can quickly be determined by using a BMI table or calculated by multiplying weight in lbs. by 703 and dividing by height in inches, squared, which gives a BMI as kg/ m2. There are two physical classifications of body fat distribution; gynecoid and android. Gynecoid is usually seen in women of reproductive age and has a more favorable prognosis. Gynecoid describes a "pear-shaped" distribution where the fat is concentrated on the hips and buttocks. Android type is more common in meno-pausal women as fat is redistributed to the trunk and abdomen, "apple-shaped". The waist: hip ratio is >0.8. The android type is associated with increased complications from obesity.

Assessment of associated risk for obesity-related diseases and mortality includes determination of degree of obesity and overall health status. Three factors are involved in assessment.

2. Waist circumference. Waist circumference has been found to be an independent risk factor for disease and is a good evaluation of those categorized as normal or overweight. A waist circumference >40 in for men and 35 in for women is associated with an increased risk of diabetes, dyslipidemia and cardiovascular disease secondary to excess abdominal fat.

3. Overall medical risk. High absolute risk of mortality occurs when there is coexisting heart disease or other atherosclerotic disease, type 2 diabetes mel-litus, sleep apnea, hypertension, cigarette smoking, high LDL cholesterol, impaired fasting glucose (>110-125), family history of early cardiovascular disease or age >55 in women, or postmenopausal status. Obesity is also associated with a greater risk of several non-lethal conditions including: os-teoarthritis, gallstones, stress incontinence and menstrual disturbances.

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