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USING THE ASBP

OBESITY ALGORITHM

Presented byDeborah Bade Horn, DO, MPH, FASBP

J ennifer Seger, MD

October 2013

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ASBP Obesity Algorithm: Executive Summary

Assess for the Presence of Obesity, Adiposopathy, Fat

Mass Disease

Prevention

BMI 18.5 24.9

Referral to an Obesity Medicine Specialist

NoObesity

OverweightObesity

BMI 30.0-34.9 Class I

BMI 35-39.9 Class IIBMI > 40.0 Class III

BMI 25.0-29.9Body Mass Index

Fat Percentmale < 25%

female < 32%

Waist Circumferencemale < 40 in

female < 35 in

If treatment ineffective

Primary Care Provider or Dietitian

male > 40 infemale > 35 in

BMI > 30.0

Edmonton Obesity

Staging System

Stage 0, 1, 2, 3, 4

male > 25%female >32%

Obesity may be assessed using several criteria: presence of adiposity-related disease, fatpercent, waist circumference or body mass index. Thresholds vary based on ethnicity.

Consider

Criteria

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STAGE 0: No apparent risk factors (e.g., blood pressure, serum lipid and fasting glucose levels within normal range),physica l symptoms, psychopathology, functional limitations and/or impairment of well-being related to obesitySTAGE 1: Presence of obesity-related subclinical risk fac tors (e.g., borderline hypertension, impaired fasting glucoselevels, elevated levels of liver enzymes), mild physica l symptoms (e.g. dyspnea on moderate exertion, occasionalaches and pains, fatigue), mild psychopathology, mild functional limitations and/or mild impairment of well-being

STAGE 2:Presence of established obesity-related chronic disease (e.g., hypertension, type 2 diabetes, sleepapnea, osteoarthritis), moderate limitations in activities of da ily living and/or well-being )STAGE 3:Established end-organ damage such as myocardial infarction, heart failure, stroke, significantpsychopathology, significant functional limitations and/or impairment of well-beingSTAGE 4: Severe (potentially end-stage) disabilities from obesity-related chronic diseases, severe disablingpsychopathology, severe functional limitations and/or severe impairment of well-being

[Sharma AM, Kushner RF. A proposed clinical staging system for obesity. Int J Obesity 2009;33:289-295.]

Body Mass Index

Fat Percent

Waist Circumference

Edmonton Obesity StagingSystem

Body Mass Index = (weight in kg) / (height in m)2 OR703 x (weight in pounds) / (height in inches)2

Body Fat Percent can be calculated using bioimpedance, near infraredreactance, DEXA scan or whole-body-air-displacement plethysmography.

Waist circumference can be measured by tape measure around theabdomen at the level of the anterior superior iliac crests, parallel to thefloor. Tape should be snug against skin without compressing.

Ob esity Me d ic ine Sp ec ia lists, ce rtified b y the Am er ic a n Boa rd of Ob esity Me d ic ine, d ed ic a te a

p or tion or al l of the ir p ra c t ic e to the t rea tme nt of ob esity . The y p er form a m ed ic a l ev a lua t ion (history,

p hysic a l, la b oratory , bo d y c om p osition) a nd p rov ide m ed ic a l supe rv ision for lifesty le c ha nge

(nutrit ion , a c t iv i ty , be ha vior c ha ng e) , me d ic a t ion s, or very low c a lor ie d iets. Ob esity is a c hron ic

m ed ic a l d isea se, and m a y req uire l ife long trea tm ent .

ASBP Obesity Algorithm: Executive Summary

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Obesity Medicine Specialist Evaluation may

include:

History

PhysicalExamination

Laboratory Tests

Individualized Treatment Plan may include:

Diagnostic Testing

Weight history, past medical history, family history, social history, screening

for weight promoting medications, food intake, activity, review ofsystemsHeight, weight, blood pressure, body composition analysis, waistmeasurement, complete physical examination

Complete blood count, elec trolytes, liver function, kidney function, fasting

lipid profile, thyroid tests, hemoglobin A1c, uric acid, vitamin D

EKG, Echocardiogram, exercise stress test, sleep study, barium swallow oresophagoduodenoscopy

Diet

Activity

Counseling

Pharmacotherapy

Caloric restriction, carbohydrate restriction, food journalingVery Low Calorie Diet (VLCD) programs

Give exercise prescription, use pedometers, limit TV and computer time,goal of 150 minutes/week of moderate intensity physical ac tivity

Eliminate provider bias/stigma, identify self-sabotage, develop strongsupport, stress management, sleep optimization, other psychologicalsupport

Use medications as part of a comprehensive program

If ine f fe c t ive , c o nsid e r re ferra l to a M e ta b o lic a nd Ba ria t ric Surg e o n.O p t im a l p re- a nd p ost -o p era t ive b a ria t ric surg ery c a re inc lud es a n O b esity Med ic ine Sp ec ia list .

ASBP Obesity Algorithm: Executive Summary

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Understanding Obesity as a Disease

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Emphasis on Early Intervention

Disease

remission/reversaland avoidance ofcomplications

Healthcare CostSavings

Improved morbidity,mortality, and qualityof life

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Understanding Appropriate andResponsible Use of Medications

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Direct Clinical Use

Outline Diagnostic

Tools & TreatmentPathways

Explain DiagnosticCriteria, RiskAssessment &Treatment Decisions to

Patients

Expand YourTreatment Options

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Referrals & Colleague Education

Colleague

awareness &reputation building.

Highlighting yourexpertise!

Create abidirectional referralpathway

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Advocacy

Patient Level

Best PracticesTreatment

Practice Level

Clinical Efficiency &Effectiveness

Policy LevelEffect Local &Statewide Change

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A Bright Future in Obesity Medicine

Obesity Medicine

Specialists

Shaping a recognized

Subspecialty

Training the Next

Generation

ABOM Delegates

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Getting the ASBP Obesity Algorithm

Visit: www.obesityalgorithm.org

Algorithm may be downloaded from this site

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Presenting the Algorithm Spread the Message

Among your Team

Within other Medical Organizations

Local/State Meetings

Permissions The Obesity Algorithm is protected by

copyright and may not be altered in any form.This copyrighted material may be accessed forpersonal research, scientific and/or information

purposes only. No part of this algorithm may bedistributed for sale or sold in any form or by anymeans without prior written permission from theSociety.

Ordering Reprints and/or RequestingPermissions for use of ASBP ObesityAlgorithm For reprints or other permissions, please

contact:

E-mail: info@asbp.org

Phone: 303.770.2526

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QUESTIONS?How can we help you dig in & use your new tool?