How Doctors Actually Diagnose Obesity

The obesity crisis in America is a hotly debated topic. According to the Centers for Disease Control and Prevention, more than 35% of adults in the U.S. are considered to be obese, and this disease can lead to chronic health problems such as diabetes. The need for new ways to fight this disease has led VIVUS  (NASDAQ: VVUS  ) , Arena Pharmaceuticals  (NASDAQ: ARNA  ) , and Orexigen Therapeutics (NASDAQ: OREX  ) to develop medications for the treatment of obesity. VIVUS' drug Qsymia is already on the U.S. market, though sales have not impressed investors so far, Arena is nearing the launch of its medicine Belviq, and Orexigen's drug is in late-stage clinical trials.

As investors assess the merits of each stock, many may not fully understand the complexities of treating this disease. For instance, what role do drugs actually play in treatment? Are lifestyle changes more important? Is obesity even considered to be a disease?

To help demistify these topics, Motley Fool health care analyst Max Macaluso spoke with Dr. Domenica Rubino, a weight-management expert and representative of The Obesity Society. In the following segment from their discussion, Dr. Rubino discusses how physicians actually diagnose obesity. A transcript follows the video.

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The relevant video segment can be found between 3:03 and 5:18.

Max Macaluso: As a doctor, how do you go about diagnosing obesity?

Dr. Domenica Rubino: In terms of diagnosis the first thing really is the basic thing that everyone talks about -- which is probably the most complicated for the average person to understand -- is the BMI, the body mass index, which is just a way of looking at your weight, how it's related to your height.

We do know that higher BMIs -- BMIs greater than 25, and especially BMIs greater than 30 -- are associated with increased risk of heart disease and comorbidities.

The difficulty with BMI is I think your average person doesn't really relate to it very well. It's also complicated that it is affected by age, affected by gender, and also affected by extreme differences in height.

Someone who's very tall will have a much higher BMI, or someone who's very short... it's hard to actually get a good assessment of what does that mean in terms of actual fat.

Macaluso: For instance, if you're a body builder you could have a BMI well above 30, but you may not be obese.

Rubino: Exactly. Although I would say people would argue, once your BMI hits 30 you can't really say it's because of athleticism and probably you have some excess fat, but it may not be such a good correlation for if you had a BMI of 27 or something like that.

We look at waist circumference, and I think most people can relate to waist circumference. We all know when our clothes are getting too tight. For women, a waist circumference greater than 35" and men greater than 40", there's a definite increase in risk of developing both diabetes and heart disease.

Waist circumference has been shown to relate to these, but it's something we can identify with. As a field, we're starting to look at that. We know if you have a certain BMI and you have a certain waist circumference, your risk is much higher.

Now we're trying to really stratify, how is someone really at risk?

They may be at risk metabolically. They may have these conditions that we talked about, like diabetes or high blood pressure. They also may be at risk because their weight is also affecting their mood. They may be depressed or anxious, but it's also affecting their function, their mobility. They're not able to walk; they're feeling short of breath.

We're trying now to get a better assessment of what are the patients who are at the most risk, versus those who might be 40 pounds overweight but actually not have any of those problems. We're trying to sort through that right now.


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  • Report this Comment On April 06, 2013, at 2:39 PM, worksatit wrote:

    BadBoy has it right. The people are responsible for what they put in their mouth. It is not a disease. It is the fact that people don't want to be denied anything. It is time we made people responsible once again for their choices instead of trying to find excuses.

  • Report this Comment On April 06, 2013, at 3:01 PM, MrsRMG wrote:

    The trouble with obesity is that it's complex. Not all obesity cases are a matter of eating too much and moving too little.

    I have an auto-immune disease called Hashimoto's Thyroiditis. My body thinks my thyroid is a foreign object and my immune system has killed off my thyroid. The thyroid is a master gland in the throat that controls many things in the human body, including metabolism. Often the symptoms of Hashimoto's Thyroiditis go for a long time before doctors diagnose it because the symptoms can mimic other diseases. I kept gaining weight and no matter how much I exercised and dieted, the weight kept coming on. I was gaining like 5 pounds a day! Sounds physically impossible, but it did happen. I was doing an hour of aerobics every day and an hour of weight training every day. I also walked an hour a day. I was on a whole foods, organic diet eating lots of fruits and veggies and lean meats and lots of tofu. I didn't smoke or drink alcohol. Before my thyroid went bad I had a body fat percentage of 11 which is very low. I'm only 5 feet tall and I was at the time wearing a size 0, sometimes a size 1 depending on the clothes manufacturer. Anywho...when my thyroid went bad, suddenly I was gaining weight like crazy and I couldn't get it to stop. My doctor thought it was my fault even though I kept on exercising and eating right. I ballooned up from 95 pounds at 5 feet tall to almost 300 pounds in a year. I ended up with high blood pressure, high cholesterol and diabetes and chronic back, knee and joint pain. I wasn't diagnosed with Hashimoto's Thyroiditis until 10 years later. I'm now on Armour Thyroid, a medication for Hashimoto's Thyroiditis. However, even being on the medication, I still am unable to lose the weight. I continue to exercise and eat healthy but I'm stuck in this obese body. People look at me and just assume I'm a fat sloppy lazy pig that can't put the fork down and won't get off the couch. This assumption couldn't be farther from the truth. If anyone doubts me, they can read Mary J. Shomon's book, "Living Well with Hypothyroidism: What Your Doctor Doesn't Tell You...That You Need to Know". In Mary's book she explains just how bad a thyroid condition is and how it can cause you to become obese and struggle with weight issues your whole life.

  • Report this Comment On April 06, 2013, at 3:15 PM, Lara71 wrote:

    No diet drug has ever worked in the long run and some of them such as fen-phen and merida have caused health problems including death. Using BMI as a factor for health is arcane and stupid. It doesn't measure a person's health. Several studies have shown that people at the "overweight" BMI live longer than those in the "normal" BMI. With a cult of thinness, diet drugs are pushed on us to be thin or else and have nothing to do with being healthy.

  • Report this Comment On April 06, 2013, at 11:39 PM, Crisby wrote:

    I agree with Lara71 in that diet drugs in general don't work in the long run (yes, I remember fen-phen). But I disagree with that user that BMI is not a valid measure of health. It is simply one of many measures that while imperfect, is still a relatively good measure.

    I think most doctors actually don't "push" any diet drugs on patients, but actually encourage them to pursue healthy lifestyles.

    I would like to read the "several studies" you refer to, Lara71. Would you report these sources so that I, as well as others could read them so as to judge whether they are reputable studies? If they are reputable, then I may be convinced, but until then, I'll go with the current conventional medical understanding of BMI.

    I disagree with worksatit's statement that obesity is not a disease. It is a disease, and a serious one at that. It is associated with diabetes, and subsequent cardiovascular disease. I do agree though that having any disease, including obseity, does not absolve the patient their responsibility to take care of him/herself. Thus, having a disease does not equal "an excuse" to either just pop pills, or avoid responsibility in taking care of oneself.

  • Report this Comment On June 01, 2013, at 5:43 PM, kingbossj40 wrote:

    Hello I'm not trying to come off as a salesperson I just know our company has solutions for weigh-loss, energy and performance, and healthy aging. All natural no harmful stimulants SUPERFOOD so i wanted to refer you to my page. www.johnhelem7.isagenix.com Please take a look at those 3 videos on my webpage starting with Why Isagenix its very DETAILED. This will be GREAT for you and your clients. My Doctor just got started also. Thank you and I can answer all questions. 100% of people that put this SUPERFOOD in their body sees results!

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