Page 886 - Cardiac Nursing

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862 PA R T V / Health Promotion and Disease Prevention
The Prevalence of Obesity Worldwide
50
45
Female
Prevalence (%) 40 Male ■ Figure 38-1 Age-standardized esti-
35
30
25
mates for obesity by country for persons
20
15
tistics taken from http://www.who.int/
10 aged 15 years in 2005. (Prevalence sta-
ncd_sur veillance/infobase/web/
5 InfoBasePolicyMaker/reports/Reporter.
0 aspx?id 1.)
Australia Canada China Egypt Finland France Germany India Japan Mexico Nigeria Turkey United States
Russian Federation United Kingdom
2
2
25.00 to 29.99 kg/m , and obese as a BMI of 30 kg/m or marker to monitor progress in weight loss and provide feedback to
more. 15,17 Further information specified that Asian populations the patient.
have a higher amount of body fat than Caucasian populations at Waist circumference is a clinically acceptable method to assess
the same BMI. This information led the WHO to suggest that per- the patient’s visceral or abdominal fat content from baseline
sons of Asian descent may have increasing but tolerable health risks through weight loss treatment. Gender-specific cutoffs have been
2
at a BMI range of 18.50 to 23 kg/m , an elevated risk with a BMI established to identify relative risk for development of obesity-as-
2
between 23 and 27.5 kg/m , and a high risk at a BMI 27.5 sociated risks factors. Men with a waistline circumference greater
2 19
kg/m . An evidence-based review concluded that BMI should be than 40 in. (102 cm) and women with a waistline circumference
considered as another vital sign to screen for obesity and over- greater than 35 in. (88 cm) are at high risk for development of
6
weight and to decide upon treatment options (see Display 38-1). obesity-related morbidity (e.g., type 2 diabetes, dyslipidemia, and
cardiovascular disease). 23 Because of an increased health risk asso-
ciated with a smaller waist circumference in Asian populations,
Waist (Abdominal) Circumference
these cutoff points have been lowered for persons of Asian de-
Central or visceral obesity is an excess accumulation of fat in the scent. South Asian and Chinese individuals have an increased risk
abdomen that is out of proportion to total body fat. 15 Intra-ab- at a waist circumference of 90 cm (35.5 in.) for men and 80 cm
dominal obesity is considered more sensitive and specific than (31.5 in.) for women. Japanese men and women are at higher risk
BMI as a predictor of obesity-related morbidity and mortal- with a waist circumference of 85 cm (33.5 in.) and 90 cm (35.5
ityy 20,21 ; a large waist circumference increases the risk of myocar- in.), respectively. 24,25 For Korean adults the suitable cutoff for
dial infarction, heart failure, and death from all causes in patients waist circumference is 85 cm (33.5 in.) for women and 90 cm
with cardiovascular disease. 22 Visceral obesity can be measured (35.5 in.) for men. 26 Patients of normal weight with increased
more accurately by computed tomography or magnetic resonance waist circumference measurements may be at increased risk of car-
imaging, but these are expensive and impractical for clinical assess- diovascular disease. Because patients with a BMI of more than
2
ment in a practitioner’s office. NHLBI’s evidence-based report rec- 35 kg/m exceed the waist circumference cutoffs, these indicators
ommended that waist circumference be included with the BMI in of relative risk lose their predictive power, making it unnecessary to
the clinical assessment. 15 Whether to use these criteria to deter- measure waist circumference in this group 15 (Table 38-1) for the
mine treatment may be a clinical decision made on an individual classification of overweight and obesity with waist circumference
patient basis. In addition, waist circumference can be a valuable incorporated in the relative risk assessment. See also Display 38-2.
Assessment of Cardiovascular
DISPLAY 38-1 BMI Measurement Procedure
Disease Risk Factors
Weight and height measurements, required for the BMI de- Having established the patient’s relative risk based on the over-
termination, should be taken with the patient wearing un- weight/obesity and abdominal obesity criteria, the third part of
dergarments and no shoes. Using the height and weight the assessment is determination of the patient’s absolute risk sta-
values, the BMI can be calculated or determined by avail- tus in terms of comorbid conditions or risk factors for cardiovas-
able normograms. 15 The BMI is calculated as follows:
cular disease.
BMI weight (kg)/height (m) 2
The BMI can be estimated in pounds and inches as follows: Very High Absolute Risk
2
[weight (pounds)/height (inches) ] 704.5 Patients who are overweight or obese or have abdominal obesity
are considered at very high risk if they have the following disease