The U.S. Preventive Services Task Force recommends that clinicians screen all adults for obesity and offer obese patients intensive counseling and behavioral interventions to lose weight (Clinical Guidelines, p. 930). The Task Force recommends using body mass index to determine weight category. A BMI between 25 and 29.9 is considered overweight and a BMI over 30 is considered obese. BMI is arrived at by a formula involving height and weight. A simple BMI calculator is available on an American College of Physicians Web site: http://www.doctorsforadults.com/topics/dfa_obes.htm. Obesity is associated with many significant health problems, including high blood pressure, diabetes, heart disease, premature death and limited quality of life.
Centrally-located body weight (the apple vs. the pear body shape) is an independent risk factor for cardiovascular disease. The Task Force suggests using waist measurement as an indicator of stomach fat. For men, a waist measurement greater than 40 inches and for women a waist measurement greater than 35 inches can indicate a risk factor for cardiovascular disease.
(NOTE: The USPSTF recommendations are the subject of an ACP Internal Medicine Report video news release. Call for coordinates.
Physician-Patient Racial Match Improves Patient Satisfaction with Care
Patients rated their doctors' care higher when both were of the same race, a new study found (Article, p. 907). Matched-race visits were also longer. But a tape recording of actual doctor-patient interaction did not find the racial concordant visits had better patient–centered communication. Researchers studied 252 adults and 31 doctors, all either African-American or white, in 16 primary care practices. An editorial writer says that minorities are vastly under-represented among primary care physicians and clinicians compared to the one in four adults who are minorities, and the disparity is not likely to change soon (Editorial, p.952). The writer offers suggestions for improving the way physicians work with all patients, regardless of race, and advocates shared decision-making.
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Journal
Annals of Internal Medicine