Obesity screening

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USPSTF Recommendations and Guidelines on Management of Obesity

2017 Guidelines for Screening of Obesity in Children and Adolescents

2012 Guidelines for Screening of Obesity in Adults

AHA/ACC/TOS Guidelines on Management of Overweight and Obesity

2013 AHA/ACC/TOS Guidelines on Management of Overweight and Obesity

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [2]; Associate Editor(s)-in-Chief:  Karol Gema Hernandez, M.D. [3] Usama Talib, BSc, MD [4]

## Overview

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Screening for obesity is recommended among children more than 6 years of age, and at least once a year among adults. Screening strategies include calculation of the body mass index (BMI), measurement of waist circumference, and measurement of body fat.

## Screening

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### Body Mass Index (BMI)

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#### Adults

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Screening for obesity should be performed at least once a year among adults. The cut-off values of BMI to define obesity and overweight among adults are as follows:

* Overweight: BMI >25.0-29.9 kg/m2
* Obesity: BMI≥30 kg/m2

#### Pediatric Screnning: BMI Percentile

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Clinical practice guidelines and systematic review[1][2] by the United States Preventive Services Task Force in 2010 stated:[3][4]

* "Clinicians screen children aged 6 years and older for obesity and offer them or refer them to comprehensive, intensive behavioral intervention to promote improvement in weight status."
* "Overweight = age- and gender-specific BMI at ≥85th to 94th percentile"
* "Obesity = age- and gender-specific BMI at ≥95th percentile"

The review included a meta-analysis of trials of weight management programs and concluded that weighted mean BMI decrease of 2.4 with comprehensive, medium- to high-intensity programs.[2]

### Waist Circumference

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BMI does not take into account differing ratios of adipose to lean tissue; nor does it distinguish between differing forms of adiposity, some of which may correlate more closely with cardiovascular risk. Increasing understanding of the biology of different forms of adipose tissue has shown that visceral fat or central obesity (male-type or apple-type obesity) has a much stronger correlation, particularly with cardiovascular disease, than the BMI alone.[5]

The absolute waist circumference (>102 cm in men and >88 cm in women) or waist-hip ratio (>0.9 for men and >0.85 for women)[5] are both used as measures of central obesity.

In a cohort of almost 15,000 subjects from the National Health and Nutrition Examination Survey (NHANES) III study, waist circumference explained obesity-related health risk significantly better than BMI when metabolic syndrome was taken as an outcome measure.[6]

### Body Fat Measurement

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An alternative way to determine obesity is to assess percent body fat. Doctors and scientists generally agree that men with more than 25% body fat and women with more than 30% body fat are obese. However, it is difficult to measure body fat precisely. The most accepted method has been to weigh a person underwater, but underwater weighing is a procedure limited to laboratories with special equipment. Two simpler methods for measuring body fat are the skinfold test, in which a pinch of skin is precisely measured to determine the thickness of the subcutaneous fat layer; or bioelectrical impedance analysis, usually only carried out at specialist clinics. Their routine use is discouraged.[7]

Other measurements of body fat include computed tomography (CT/CAT scan), magnetic resonance imaging (MRI/NMR), and dual energy X-ray absorptiometry (DXA).[8]

## 2013 AHA/ACC/TOS Guideline for the Management of Overweight and Obesity in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society (DO NOT EDIT) [9]

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### Identifying Patients Who Need to Lose Weight (BMI and Waist Circumference (DO NOT EDIT)

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Class I

"1. Measure height and weight and calculate BMI at annual visits or more frequently. (Level of Evidence: E)"
"2. Use the current cutpoints for overweight (BMI >25.0-29.9 kg/m2) to identify adults who may be at elevated risk of CVD and the current cut points for obesity (BMI≥30) to identify adults who may be at elevated risk of mortality from all causes. (Level of Evidence: A)"
"3. Advise overweight and obese adults that the greater the BMI, the greater the risk of CVD, type 2 diabetes, and all-cause mortality. (Level of Evidence: A)"
Class IIa

"1. Measure waist circumference at annual visits or more frequently in overweight and obese adults. Advise adults that the greater the waist circumference, the greater the risk of CVD, type 2 diabetes, and all-cause mortality. The cutpoints currently in common use (from either NIH/NHLBI or WHO/IDF) may continue to be used to identify patients who may be at increased risk until further evidence becomes available. (Level of Evidence: B)"

## 2017 USPSTF Guideline on the Screening of Obesity in Children and Adolescents 6 Years and older[10]

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### Recommendations for Screening of Obesity

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USPSTF Obesity Guidelines for Children and Adolescents 6 years and older

"1. The USPSTF recommends that clinicians screen for obesity in children and adolescents 6 years and older and offer or refer them to comprehensive, intensive behavioral interventions to promote improvements in weight status.(Recommendation Grade: B)"

## 2012 USPSTF Guideline on the Screening of Obesity in Adults[11]

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### Recommendations for Screening of Obesity in Adults

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USPSTF Obesity Guidelines for Adults

"1. The USPSTF recommends screening all adults for obesity. Clinicians should offer or refer patients with a body mass index (BMI) of 30 kg/m2 or higher to intensive, multicomponent behavioral interventions.(Recommendation Grade: B)"

## References

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1. ↑ USPSTF (2010. Final Evidence Summary: Obesity in Children and Adolescents: Screening
2. ↑ 2.0 2.1 Whitlock EP, O'Conner EA, Williams SB, Beil TL, Lutz KW. Effectiveness of Primary Care Interventions for Weight Management in Children and Adolescents: An Updated, Targeted Systematic Review for the USPSTF [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2010 Jan. Available from http://www.ncbi.nlm.nih.gov/books/NBK36416/ PMID: [1].
3. ↑ United States Preventive Service Task Force (2010). Effectiveness of Primary Care Interventions for Weight Management in Children and Adolescents: An Updated, Targeted Systematic Review for the USPSTF
4. ↑ US Preventive Services Task Force. Barton M (2010). "Screening for obesity in children and adolescents: US Preventive Services Task Force recommendation statement". Pediatrics. 125 (2): 361–7. doi:10.1542/peds.2009-2037. PMID 20083515.
5. ↑ 5.0 5.1 Yusuf S, Hawken S, Ounpuu S, Dans T, Avezum A, Lanas F, McQueen M, Budaj A, Pais P, Varigos J, Lisheng L, INTERHEART Study Investigators. (2004). "Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study". Lancet. 364: 937–52. PMID 15364185.CS1 maint: Multiple names: authors list (link)
6. ↑ Janssen I, Katzmarzyk PT, Ross R (2004). "Waist circumference and not body mass index explains obesity-related health risk". Am. J. Clin. Nutr. 79 (3): 379–84. PMID 14985210.CS1 maint: Multiple names: authors list (link)
7. ↑ National Institute for Health and Clinical Excellence. Clinical guideline 43: Obesity: the prevention, identification, assessment and management of overweight and obesity in adults and children. London, 2006.
8. ↑ Vanhecke TE, Franklin BA, Lillystone MA, Sandberg KR, deJong AT, Krause KR, Chengelis DL, McCullough PA. Caloric expenditure in the morbidly obese using dual energy X-ray absorptiometry. J Clin Densitomet 2006;9:438-444. PMID 17097530.
9. ↑ Jensen MD, Ryan DH, Apovian CM, Ard JD, Comuzzie AG, Donato KA; et al. (2013). "2013 AHA/ACC/TOS Guideline for the Management of Overweight and Obesity in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society". Circulation. doi:10.1161/01.cir.0000437739.71477.ee. PMID 24222017.CS1 maint: Explicit use of et al. (link) CS1 maint: Multiple names: authors list (link)
10. ↑ US Preventive Services Task Force. Grossman DC, Bibbins-Domingo K, Curry SJ, Barry MJ, Davidson KW; et al. (2017). "Screening for Obesity in Children and Adolescents: US Preventive Services Task Force Recommendation Statement". JAMA. 317 (23): 2417–2426. doi:10.1001/jama.2017.6803. PMID 28632874.CS1 maint: Explicit use of et al. (link) CS1 maint: Multiple names: authors list (link)
11. ↑ Moyer VA, U.S. Preventive Services Task Force (2012). "Screening for and management of obesity in adults: U.S. Preventive Services Task Force recommendation statement". Ann Intern Med. 157 (5): 373–8. doi:10.7326/0003-4819-157-5-201209040-00475. PMID 22733087.

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