Waist Circumference, Body Composition, Lifetime Risk, Genetic &
Environmental Etiology, Metabolic & Secondary Obesity, Weight Loss Benefits,
Lifestyle Intervention, Dietary Caloric Reduction, Physical Activity Guidelines,
Behavioral Therapy, Pharmacotherapy, Bariatric Surgery, Follow-up &
Maintenance, Coronary Artery Disease Pathophysiology, Risk Factor
Stratification, Acute Coronary Syndrome, Stable & Unstable Angina, Nitrates,
Beta-blockers, ACE Inhibitors, Calcium Channel Blockers, Ranolazine, Cardiac
Rehabilitation, Imaging & Stress Testing, Diagnostic Biomarkers, Atrial
Fibrillation Mechanisms, Stroke Risk Assessment, CHADS2 & CHA2DS2-VASc
Scoring, Anticoagulation Therapy, Rhythm & Rate Control, MAZE Procedure,
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Graded Rationales Latest Updated 2026
Obesity
Patients and providers must realize that obesity is a chronic disease and requires lifelong effort
Must develop strategies to manage
Obesity measures of body composition
Body mass index (BMI), defined as the weight in kilograms divided by the height in meters squared
(kg/m2), is the most widely used measure of obesity due to its low cost and simplicity.
The World Health Organization (WHO) and the National Institutes of health (NIH) define overweight as
having a BMI between 25.0 and 29.9 kg/m2; and obesity as having a BMI greater than 30.0 kg/m2.
In the United States, criteria for overweight in children are based on the 2000 U.S. Centers for Disease
Control and Prevention (CDC) BMI-for-age growth charts. Overweight is defined as at or above the age-
specific 95% BMI percentile. At risk for overweight is defined as having a BMI between 85th-95th
percentiles of the BMI-for-age growth charts.
Increasing evidence suggests that abdominal obesity, rather than total body fat, is also a useful,
independent predictor of several cardiovascular- and cancer-related outcomes.
,lifetime risk
significant in US
Framingham heart study calculated four-year risk of becoming overweight
30 year risk:
Over 30-year interval, risks were similar in men and women, and varied somewhat with age, being lower
if you were under 50 years of age.
The 30-year risk was 50 percent for developing BMI >25 kg/m2,
25 percent of developing a BMI >30 kg/m2
10 percent of developing a BMI >35 kg/m2
long-term (10 to 30 year) risk of becoming overweight (Bray, 2012)
causes
Complex interaction between the following:
Genetic predisposition
Environment
Human behavior
Cultural, metabolic, social, & psychological factors
Secondary Obesity: Cushing's disease, hypothyroidism, insulinoma, side effect of medication
benefits of weight loss
reduction in blood pressure
lowers blood glucose
improving dyslipidemias
reduces risk of many chronic conditions
Reduces morbidity and mortality
, where to start?
Gather a good history - what diets have they tried, medications, social, family history
Measure height and weight - calculate BMI
Measure waist circumference
Assess comorbidities
Is patient motivated to lose weight - stages of change
Classifications for BMI
Underweight <18.5 kg/m2
Normal weight 18.5-24.9 kg/m2
Overweight 25-29.9 kg/m2
Obesity (Class 1) 30-34.9 kg/m2
Obesity (Class 2) 35-39.9 kg/m2
Extreme obesity (Class 3) ≥40 kg/m2
Waist circumference
Independent risk factor for disease
Increased risk factors for
men with weight circumference >40 in & women >35 in
Risk factors:
HTN
Hyperlipidemia
CVD
DM
Risk factors