published Thursday, July 19th, 2012

More doctors focusing on BMI to battle obesity

Haley Johnson adjusts the scale while weighing Ronald Cutting in an Erlanger hospital medical office.
Haley Johnson adjusts the scale while weighing Ronald Cutting in an Erlanger hospital medical office.
Photo by Angela Lewis.

WAIST RISKS

Your health risks for developing obesity-related conditions may be increased if you have a waist size that is greater than:

Women: 35 inches

Men: 40 inches

Source: Centers for Disease Control and Prevention

Weight-loss tips from local doctors

• Cut out all sugary drinks, including sweet tea.

• Exercise 150 minutes a week.

• Skip carbs as much as possible.

• Use a salad plate to serve food instead of a dinner plate.

2010 Adult Obesity

Tennessee: 30.8 percent

Georgia: 29.6 percent

Alabama: 32.2 percent

Source: Centers for Disease Control and Prevention

Height // Weight range // BMI // Considered

• 5 foot 9 // 124 pounds or less // Below 18.5 // Underweight

• 5 foot 9 // 125-168 pounds // 18.5 to 24.9 // Healthy weight

• 5 foot 9 // 169-202 pounds // 25.0 to 29.9 // Overweight

• 5 foot 9 // 203 pounds or more // 30 or higher // Obese

Source: Centers for Disease Control and Prevention

Poll
Would you want your doctor to tell you you're too heavy?

About a year ago, Elizabeth Billups had the weight conversation with her doctor.

The 68-year-old had been diagnosed with Type 2 diabetes and was faced with taking insulin. But there was another option — losing weight.

"She discussed it with me. She always discusses everything with us and talked about what I should weigh based on my height," Billups said.

Billups listened, lost nearly 50 pounds in the last year and keeps her diabetes under control with her diet.

She and her husband, Bobby Billups, said doctors should discuss weight and body mass index — a calculation for an appropriate weight that uses a person's height — with their patients.

A BMI between 25 to 29 is considered overweight and 30 or higher is considered obese, according to the U.S. Centers for Disease Control and Prevention.

A specific number or target, such as an appropriate BMI, helps them know where they should be, the Billups said this week while visiting Academic Internal Medicine at Erlanger hospital.

A recent recommendation, issued by the U.S. Preventive Services Task Force, advises doctors to screen all adult patients for obesity by using the body mass index (BMI) and to refer patients to some type of intervention program depending on their BMI. The task force is an independent panel of experts that conducts reviews of scientific evidence on preventive health care.

The recommendation also notes that obesity is associated with Type 2 diabetes, cancer, heart disease and other health problems.

Local doctors, for the most part, said they calculate BMI and discuss it with their patients if it is an issue. But also important is to provide patients with concrete steps to implement a weight-loss program, they said.

"There isn't anybody that comes in who is obese that doesn't already know it," said Dr. Stephen Adams, an associate professor and the program director of the Department of Family Medicine at the University of Tennessee at Chattanooga. "The best way I've found to have the discussion is to ask them what their goals are for their health."

FOCUS ON BMI

Over the nearly 20 years he has been in practice, Adams said there have been changes in how doctors approach obesity. There is now more focus on BMI rather than an ideal weight, he said, and with the implementation of electronic records, a patient's BMI can be automatically calculated.

He teaches medical residents to break down things in bits of information that patients can understand, Adams said, and the BMI is one easy calculation — a concrete number that people can understand.

A second is recommending that overweight patients eliminate 100 calories a day, which translates to about 10 pounds a year.

"A gradual downward trend is more sustainable," Adams said.

At Academic Internal Medicine at Erlanger, patients are weighed at every visit, and their BMI is automatically calculated so when Dr. Tracy Dozier opens a patient's files, the number is right in front of her.

"Having that number might trigger us to pay more attention," Dozier said. "It's not a perfect measurement, but it's a place to start."

Weight can be a difficult subject, but most patients want to discuss it with their doctors and will often bring it up themselves, she said.

Another reason doctors use BMI more frequently these days is because many insurance plans and workplaces include it as part of their annual wellness exam, said Dr. Eugene Ryan at Parkridge Medical Group Diagnostic Center.

As someone who began his career as an Army doctor, calculating a person's BMI and discussing weight with patients has always been a part of his routine, Ryan said.

When broaching a subject that can be difficult like weight, Ryan said he tries "to use a little humor,"

"If you are too dogmatic you can turn them off," he said.

QUESTIONABLE CALCULATION

Patients at the Hixson Pike Medical Center also have their BMI calculated during office visits, but two doctors there said they do not always discuss the number during a visit.

Dr. Jerry Selzer, with the Memorial Health Partners Foundation, said he doesn't think BMI is a good weight measurement. Even if he discusses a patient's weight, he doesn't necessarily use the BMI.

"BMI isn't very helpful. It doesn't take into account a patient's muscle," Selzer said. "It's such a rough estimate."

Waist circumference is another good measurement and can sometimes be a better indication of health issues, said Dr. Mike Ozborn, also with the foundation. Health risks increase with a waist size that is greater than 35 inches for women and more than 40 for men, according to the CDC.

With all the recent publicity about health risks associated with obesity, people are increasingly aware of obesity and BMI, Ozborn said. As someone who recently had a coronary bypass, he said his approach to his patients has also changed.

"I'm much more quick to bring it up," he said.

The latest recommendation is a good practice for doctors, but Adams warned it's like sending him to repair a leak in the Chickamauga Dam with a bucket of concrete.

"It's a public health problem at this point," he said. "If we don't get a handle on it the quality and length of life will go down."

about Mariann Martin...

Mariann Martin covers healthcare in Chattanooga and the surrounding region. She joined the Times Free Press in February 2011, after covering crime and courts for the Jackson (Tenn.) Sun for two years. Mariann was born in Indiana, but grew up in Pennsylvania, Tennessee and Belize. She graduated from Union University in 2005 with degrees in English and history and has master’s degrees in international relations and history from the University of Toronto. While attending Union, ...

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