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Chapter 075. Evaluation and Management of Obesity (Part 2)

Excess abdominal fat, assessed by measurement of waist circumference or waist-to-hip ratio, is independently associated with higher risk for diabetes mellitus and cardiovascular disease. Measurement of the waist circumference is a surrogate for visceral adipose tissue and should be performed in the horizontal plane above the iliac crest. Cut points that define higher risk for men and women based on ethnicity have been proposed by the International Diabetes Federation (Table 75-3). Table 75-3 Ethnic-Specific Values for Waist Circumference Ethnic Group Waist Circumference Europeans Men 94 cm (37 in) Women 80 cm (31.5 in) South Asians and Chinese Men 90 cm (35 in) Women 80 cm (31.5 in) Japanese Men 85 cm (33.5 in) Women 90 cm (35. | Chapter 075. Evaluation and Management of Obesity Part 2 Excess abdominal fat assessed by measurement of waist circumference or waist-to-hip ratio is independently associated with higher risk for diabetes mellitus and cardiovascular disease. Measurement of the waist circumference is a surrogate for visceral adipose tissue and should be performed in the horizontal plane above the iliac crest. Cut points that define higher risk for men and women based on ethnicity have been proposed by the International Diabetes Federation Table 75-3 . Table 75-3 Ethnic-Specific Values for Waist Circumference Ethnic Group Waist Circumference Europeans Men 94 cm 37 in Women 80 cm 31.5 in South Asians and Chinese Men 90 cm 35 in Women 80 cm 31.5 in Japanese Men 85 cm 33.5 in Women 90 cm 35 in Ethnic south and central Americans Use south Asian recommendations until more specific data are available. Sub-Saharan Africans Use European data until more specific data are available. Eastern Mediterranean and Middle East Arab populations Use European data until more specific data are available. Source From KGMM Alberti et al for the IDF Epidemiology Task Force Consensus Group The metabolic syndrome a new worldwide definition. Lancet 366 1059 2005 Physical Fitness Several prospective studies have demonstrated that physical fitness reported by questionnaire or measured by a maximal treadmill exercise test is an important predictor of all-cause mortality independent of BMI and body composition. These observations highlight the importance of taking an exercise history during examination as well as emphasizing physical activity as a treatment approach. Obesity-Associated Comorbid Conditions The evaluation of comorbid conditions should be based on presentation of symptoms risk factors and index of suspicion. All patients should have a fasting lipid panel total LDL and HDL cholesterol and triglyceride levels and blood glucose measured at presentation along with blood pressure .