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What are obesity assessments?

Obesity assessments need to be handled with sensitivity and tact, as the patient may not always be expecting them.

Sometimes patients who seek treatment or support for a chronic disease may not be expecting weight loss to be a topic for discussion with their clinician. Depending on your specific healthcare profession, and the perceptions the patient holds towards the scope of your profession, they may also be uncertain about your credibility when discussing weight and weight loss.

For this reason, it may be helpful to highlight to your patient that you have training and experience in weight management in order to build credibility and a positive therapeutic relationship.

For example:

Building credibility is key in a positive therapeutic relationship. "You might not associate weight management with our profession, however, I have done some additional training in this space and worked with other patients to support their weight loss goals as part of a holistic management plan for their chronic disease."..."I'm going to ask you some questions to get an understanding of what might be appropriate for us to start with, and any medical support we might need"...."It's a special area of interest for me and I have undertaken courses to help me support my patients with weight management if that is the path they wish to take."

Why conduct an obesity assessment?

The aim of an assessment of obesity-related lifestyle, behavioural and medical factors in an opportunistic clinical encounter with a patient with chronic disease is to determine the appropriateness of engaging in weight management with the patient, as well as identify factors that could affect their weight loss efforts and the need for any additional referrals.

How obesity assessments work

Assessment of body weight or body mass index is the least relevant component of this assessment. As covered previously, body mass index gives limited information about obesity severity. Weight is only appropriate to collect if a patient wishes to engage in a weight loss intervention. Even then, this can be collected and monitored by the patient instead and used as feedback as opposed to being measured by the clinician. A more important assessment of obesity is to use the Edmondton Obesity Staging System (Week 2) in order to capture obesity-related health issues that are much more relevant for morbidity and mortality. This system is based on the medical, mental and functional impact of obesity and is a measure of how healthy the patient is.

EOSS: Edmonton Obesity Staging System - Staging Tool. Stage 0: No sign of obesity-related risk factors, No physical symptoms, No psychological symptoms, No functional limitations. Stage 1: Patient has obesity-related subclinical risk factors - OR - , MILD physical symptoms - patient currently not requiring medical treatment for comorbidities - OR -, MILD obesity-related psychology and/or mild impairment of well-being. Stage 2: Patient has an ESTABLISHED obesity-related comorbidities requiring medical intervention -OR-, MODERATE obesity-related psychological symptoms -OR-, MODERATE functional limitations in daily activities. Stage 3: Patient has significant obesity-related end-organ damage -OR-, SIGNIFICANT obesity-related psychological symptoms -OR-, SIGNIFICANT functional imitations -OR-, SIGNIFICANT impairment of well-being. Stage 4: SEVERE (potential end stage) from obesity-related chronic disease -OR-, SEVERE disabling psychological symptoms -OR-, SEVERE functional limitations

From: Sharma and Kushner Int J Obesity 2009

Factors that can be explored in the assessment include:

  • History of weight development
  • History of weight loss attempts
  • Past medical history and medications – review co-morbidity risks
  • Psychosocial and lifestyle factors

 

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EduWeight: Weight Management for Adult Patients with Chronic Disease

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