Section 1.4 Clinical Evaluation

Key Points

  • Clinical evaluation of obese patients should include a complete history and physical examination
  • Comorbidities and obesity complications should also be assessed
  • Treatment plans should be designed according to severity of comorbidities and complications as well as body mass index (BMI)

AACE/ACE Comprehensive Clinical Practice Guidelines for Medical Care of Patients with Obesity Recommendations1

Overall

  • R29. All patients with overweight or obesity should be clinically evaluated for weight-related complications because BMI alone is not sufficient to indicate the impact of excess adiposity on health status; therefore, the diagnostic evaluation of patients with obesity should include an anthropometric assessment of adiposity and a clinical assessment of weight-related complications. Patients with overweight or obesity should be reevaluated at intervals to monitor for any changes in adiposity and adiposity-related complications over time.

Metabolic Complications Screening

  • R9. Patients with overweight or obesity and patients experiencing progressive weight gain should be screened for prediabetes and type 2 diabetes (T2D) and evaluated for metabolic syndrome by assessing waist circumference, fasting glucose, A1C, blood pressure, and lipid panel, including triglycerides and HDL-C.
  • R10. Due to variable risk for future diabetes, patients with overweight or obesity should be evaluated for risk of T2D, which can be estimated or stratified using indices or staging systems that employ clinical data, glucose tolerance testing, and/or metabolic syndrome traits.
  • R11. Patients with T2D should be evaluated for the presence of overweight or obesity.

Cardiovascular Disease and Cardiovascular Risk Factors

  • R12. All patients with overweight or obesity and individuals experiencing progressive weight gain should be screened for dyslipidemia with a lipid panel that includes triglycerides, HDL-C, calculated LDL-C, total cholesterol, and non-HDL-C; all patients with dyslipidemia should be evaluated for the presence of overweight or obesity.
  • R13. Blood pressure should be measured in all patients with overweight or obesity as a screen for the presence of hypertension or prehypertension; all patients with hypertension should be evaluated for the presence of overweight or obesity.
  • R14. Risk factors for cardiovascular disease should be assessed in patients with overweight or obesity.
  • R15. Patients with overweight or obesity should be screened for active cardiovascular disease by history, physical examination, and with additional testing or expert referral based on cardiovascular disease risk status.

Nonalcoholic Fatty Liver Disease and Nonalcoholic Steatohepatitis

  • R16. Screening for nonalcoholic fatty liver disease should be performed in all patients with overweight or obesity, T2D, or metabolic syndrome with liver function testing, followed by ultrasound or other imaging modality if transaminases are elevated; all patients with nonalcoholic fatty liver disease should be evaluated for the presence of overweight or obesity.

Polycystic Ovary Syndrome (PCOS)

  • R17. Premenopausal female patients with overweight or obesity and/or metabolic syndrome should be screened for PCOS by history and physical examination; all patients with PCOS should be evaluated for the presence of overweight or obesity.

Female Infertility

  • R18. Women with overweight or obesity should be counseled when appropriate that they are at increased risk for infertility and, if seeking assisted reproduction, should be informed of lower success rates of these procedures regarding conception and the ability to carry the pregnancy to live birth. All female patients with infertility should be evaluated for the presence of overweight or obesity.

Male Hypogonadism

  • R19. All men who have an increased waist circumference or who have obesity should be assessed for hypogonadism by history and physical examination and be tested for testosterone deficiency if indicated; all male patients with hypogonadism should be evaluated for the presence of overweight or obesity.
  • R20. All male patients with T2D should be evaluated to exclude testosterone deficiency.

Obstructive Sleep Apnea

  • R21. All patients with overweight or obesity should be evaluated for obstructive sleep apnea during medical history and physical examination; this is based on the strong association between these disorders. Polysomnography and other sleep studies, at home or in a sleep lab, should be considered for patients at high risk for sleep apnea based on clinical presentation, severity of excess adiposity, and symptomatology. All patients with obstructive sleep apnea should be evaluated for the presence of overweight or obesity.

Asthma/Reactive Airway Disease

  • R22. All patients with overweight or obesity should be evaluated for asthma and reactive airway disease based on the strong association between these disorders. Medical history, symptomatology, physical examination, and spirometry and other pulmonary function tests should be considered for patients at high risk for asthma and reactive airway disease. All patients with asthma should be evaluated for the presence of overweight or obesity.

Osteoarthritis (OA)

  • R23. All patients with overweight or obesity should be screened by symptom assessment and physical examination for OA of the knee and other weight-bearing joints. All patients with OA should be evaluated for the presence of overweight or obesity.

Urinary Stress Incontinence

  • R24. All female patients with overweight or obesity should be screened for urinary incontinence by assessing symptomatology, based on the strong association between these disorders; all patients with urinary stress incontinence should be evaluated for the presence of overweight or obesity.

Gastroesophageal Reflux Disease (GERD)

  • R25. Patients with overweight or obesity or who have increased waist circumferences should be evaluated for symptoms of GERD; all patients with GERD should be evaluated for the presence of overweight or obesity.
  • R26. Patients with obesity and GERD symptoms should be evaluated by endoscopy if medical treatment fails to control symptoms.
  • R27. Endoscopy should be considered in patients with obesity and GERD symptoms prior to bariatric surgery.

Depression

  • R28. Patients with overweight or obesity should be screened for depression; all patients with depression should be evaluated for the presence of overweight or obesity.
  • R103. Patients with overweight or obesity who are being considered for weight-loss therapy should be screened for binge eating disorder and night eating syndrome.

Reference


  1. Garvey WT, Mechanick JL, Brett EM, et al. American Association of Clinical Endocrinologists and American College of Endocrinology Comprehensive Clinical Practice Guidelines for Medical Care of Patients With Obesity. Endocr Pract. 2016;22(suppl 3);1-205.