Practical Tips for Clinical Evaluation of Obesity

Hi, I’m Dr. Jeanne O’Connell and I am an endocrinologist with a subspecialty interest in obesity management based in Dublin, Ireland.

In this five-minute CPD, we’re going to look at how to clinically evaluate obesity using the latest evidence-based frameworks and guidelines, so that assessment goes beyond simple calculations of body mass index, or BMI, to true person-centered care.

BMI is useful as a quick screening tool, but current clinical practice guidelines and frameworks remind us that diagnosis should include two components, anthropometric and clinical.

For most adults of European descent, obesity is diagnosed when BMI is greater than or equal to 30 kg/m2 or when BMI is greater than or equal to 25 kg/m2 with a waist to height ratio of greater than 0.5 and accompanying health impairments.

In practice, you should measure waist circumference in anyone with a BMI less than 35 kg/m2 as it’s a key marker of visceral fat and cardiometabolic risk. In Ireland we use thresholds of greater than 102 centimeters for men and greater than 89 centimeters for women but remember lower cutoff supply in Asian populations.

Anthropometric assessments should be measured by an empathetic trained health professional in a non-judgmental stigma free environment. This includes ensuring that your clinic’s equipment is suitable for all body sizes and always asking permission before doing any measurements.

Now let’s move from measuring to holistic assessment. The clinical practice guideline in Ireland in adults emphasizes a comprehensive stigma-free assessment of the medical, mental and functional impact of obesity, which is also aligned with EASO’s framework for the diagnosis, staging and management of obesity in adults.

Start by taking a structured obesity-centered history. The 4Ms framework helps us here.

Metabolic. This includes checking for conditions such as diabetes, dyslipidemia, hypertension or muscle.

Mechanical examples are screening for sleep apnea, osteoarthritis, reflux disease.

Mental health. This includes assessment of mood, looking for evidence of internalized weight bias, or eating behaviors.

Monetary includes consideration of social determinants, affordability of obesity treatments, and access to care.

Use tools like the Edmonton an obesity staging system to stage severity from 0 to 4 and to guide treatment intensity. Stage 0 or 1 may need monitoring and behavioral support.

Stage 2 to 4 may require additional interventions such as psychological support, pharmacotherapy, or bariatric and metabolic surgery or a combination of these therapies. This is just a guide and will very much depend on the person sitting in front of you.

Always align findings with the patient’s goals. Current evidence-based clinical practice guidelines encourage individualized targets, not just weight loss, but seeking improved function, mental and emotional well-being, and quality of life.

So to summarize, an evidence-based clinical evaluation of obesity looks like this. The waist height ratio. And the second step is a clinical assessment to determine presence or absence of health impairments.

The clinical assessment involves assessing health impacts of obesity based on medical, functional, and psychosocial impacts using structured clinical history tools such as the 4Ms framework for obesity.

The third step is to use structured tools such as the Admin to Obesity Staging System, EOSS, to guide and support long-term management.

When you integrate these frameworks, you’re not treating to a number on a scale. You’re partnering with a person on a lifelong journey of health improvement.

By merging the precision of diagnosing and staging tools, clinicians can transform obesity assessment into a truly holistic and compassionate medical process.

I’m Dr. Gina Connold for 5 Minute CPD. Be sure to check out additional resources on this page and more learning at easo.org.