BMI: The elephant in the exam room

Elevated body mass index, or BMI, has been called the “elephant in the exam room” because often it is overlooked by clinicians, despite overwhelming evidence suggesting that weight loss reduces risk factors for diabetes and cardiovascular disease. Obesity is a complex chronic disease, and BMI is a useful, objective measure to identify patients whose weight puts them at risk for such health problems as hypertension, Type 2 diabetes, heart disease, stroke and certain cancers.

Most electronic medical records automatically calculate BMI once height and weight measures are inputted. BMI appears in the vital signs section of the medical record and is an objective indicator. In the same way that few retail clinicians rarely would fail to discuss an elevated blood pressure reading with a patient, abnormal BMI should be addressed similarly.

Obesity is a complex chronic disease affecting an estimated 100 million American adults. BMI classifications are as follows:  BMI less than 18.5 indicates a person is underweight; BMI between 18.5 and 24.9 indicates a person is within the normal range; BMI between 25 and 29.9 indicates a person is overweight; BMI between 30 and 34.9 indicates a person is obese; BMI between 35 and 39.9 indicates a person falls within the obesity II range; and a BMI greater than 40 indicates extreme obesity. For various reasons, including the social stigma associated with obesity, often it is a difficult topic for clinicians to discuss with patients, thus it is an overlooked opportunity to intervene and help patients reduce their morbidity/mortality risk.

Research indicates that patients are three times more likely to engage in behavior change when the advice comes from a trusted healthcare provider. A majority of patients who utilize retail health operators report that they do not have a consistent primary health provider. This makes each retail health visit an important opportunity to impact the patient’s health status above and beyond the presenting complaint. Healthcare providers hold a unique role in the lives of patients. Retail clinicians should acknowledge that their expertise and accessibility, coupled with trust, put them in a unique position to influence change.

With practice, clinicians can develop strategies to address issues around overweight and obesity in the same matter-of-fact manner with which one addresses other vital signs that are out of the normal range. Once the elevated BMI is acknowledged in a non-judgmental way, the conversation can begin about barriers and strategies to affect the necessary lifestyle changes.  Many excellent patient teaching tools exist. Exam room posters and brochures can be utilized along with direct clinician/patient interaction. 

Patients with elevated BMI need our help. Even small changes in behavior and weight can lead to significant health improvements. Retail health providers must get on board and give our patients the chance to succeed.

 

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