Cleveland Clinic authors urge physicians to use staging models to manage obesity-related problems

American Osteopathic AssociationJun 1 2016

Authors from the Cleveland Clinic's Bariatric and Metabolic Institute recommend physicians use obesity staging models to recognize and manage weight-related health issues that may not be captured by traditional diagnosis criteria. The review article was published in the Journal of the American Osteopathic Association.

The authors urge physicians to take a broader view of what constitutes obesity, which is traditionally defined as a body mass index (BMI) of 30 or greater.

"BMI doesn't differentiate between lean muscle mass and fat mass, which can skew perceptions of weight in different patients," said lead author Derrick Cetin, DO. "For example, a younger athlete may have high muscle mass and lower body fat at a BMI of 27, while an older person with a BMI of 25 may have lost muscle due to aging and have higher body fat."

Ethnic differences were also noted, including studies that found Asians had more than the double the risk of Type 2 diabetes than Caucasians with the same BMI and were at risk when BMI measured 22 to 25. The findings increase the potential usefulness of waist circumference measurements to identify metabolically obese and overweight patients whose BMI is normal.

"Waist circumference is a surrogate marker for intra-abdominal fat and can indicate metabolic syndrome, which affects about one of three adults in the United States. But you can't properly diagnose metabolic syndrome without considering the ethnicity of the patient. Even with a condition as seemingly straightforward as obesity, physicians need to take a whole-person approach to understand the patient," said Dr.Cetin, DO.

The staged approach to obesity treatment allows for intensive lifestyle modification and weight management at Obesity Stage 0, when patients are metabolically normal, to prevent disease progression which can lead to increased risk for negative physical and psychological health effects as well as limitation in daily activities.

A five percent to 10 percent weight loss through diet and increased physical activities is shown to result in a 30 percent greater loss of fat around internal organs, which substantially reduces the risk of adverse consequences, researchers noted.