Manual of Clinical Nutrition

Obesity and Weight Management

Manual of Clinical Nutrition Management III- 82 Copyright © 2013 Compass Group, Inc.

Table III- 22 : Classification of Overweight and Obesity and Associated Disease Riska by BMI and Waist
Circumference

(^) BMI
(kg/m^2 )
Obesity
Class
Disease Riska
(Relative to Normal Weight and Waist Circumference)
Men <40 inches (<102 cm)
Women <35 inches (<88 cm)

40 inches (>102 cm)
35 inches (>88 cm)
Underweight <18.5 (^)
Normalb 18.5-24.9 (^)
Overweight 25.0-29.9 Increased High
Obesity 30.0-34.9 I High Very high
35.0-39.9 II Very high Very high
Extreme Obesity >40.0 III Extremely high Extremely high
aDisease risk for type 2 diabetes, hypertension, and cardiovascular disease
bIncreased waist circumference can also be a marker for increased risk in persons of normal weight.
Table III- 23 : A Guide to Selecting Treatment for Obesity and Overweight
BMI (kg/m^2 )
<24.9 25.0-26.9 27.0-29.9 30.0-34.9 35.0-39.9 >40.0
Treatment
Diet, exercise, and
behavior therapy
With
comorbidities
With
comorbidities

+ + +

Pharmacotherapy With
comorbidities

+ + +

Surgery With
comorbidities

+

• Options for treatment (Note that when the BMI is >29.9 kg/m^2 , adjunctive treatment options should be considered.)

 Prevention of weight gain with lifestyle therapy is indicated in any patient with a BMI >25 kg/m^2 , even without

comorbidities. However, weight loss is not necessarily recommended for patients with a BMI of 25.0 to 29.9

kg/m^2 or a high waist circumference, unless they have two or more comorbidities.

 Combined therapy with a low-energy diet, increased physical activity, and behavior therapy provides the most

successful intervention for weight loss and weight management.

 Consider pharmacotherapy only if a patient has not lost 1 lb/week after 6 months of combined lifestyle

therapy.

Source for Table III- 22 and Table III- 23 : The Practical Guide to the Identification, Evaluation, and Treatment of Overweight and Obesity in

Adults. The National Institutes of Health, National Heart, Lung, and Blood Institute, and the North American Association for the Study of

Obesity; October 2000. NIH publication No. 00-4084.

Children and Adolescents

Overweight children have a greater risk for becoming overweight adults (3). Whether or not the child is

obese, obesity of at least one parent more than doubles the risk of a child being obese as an adult (8). The

latest statistics indicate that obesity is more prevalent among non-Hispanic black and Mexican-American

adolescents (2). Weight gain among children and adolescents is attributed to a combination of poor dietary

habits, family lifestyle, physical inactivity, ethnicity, socioeconomic status, and genetic makeup (9,10). Early

intervention is recommended to prevent overweight and obesity from continuing later in life (9).

Recommendations have been established for the intervention and treatment of overweight and obesity in

children and adolescents (9). The Expert Committee recommends evaluation and possible treatment for

children with a BMI greater than or equal to the 85th percentile with complications of obesity and children

with a BMI greater than the 95th percentile with or without complications of obesity (9). The classification of

overweight for children is determined by calculating the BMI and plotting it on the appropriate BMI-for-age

chart developed by the Centers for Disease Control and Prevention (11). The Centers for Disease Control and

Prevention recommends that the BMI-for-age charts be used for all children and adolescents aged 2 to 20

years, instead of the weight-for-stature charts previously developed by the National Center for Health

Statistics (11). Complications of obesity include hypertension, dyslipidemia, orthopedic disorders, sleep

disorders, gallbladder disease, and insulin resistance (9). The use of weight maintenance vs weight loss to