Identifying patients for weight-loss treatment: an empirical evaluation of the NHLBI obesity education initiative expert panel treatment recommendations.
BACKGROUND
The NHLBI (National Heart, Lung, and Blood Institute) Obesity Education Initiative Expert Panel recently proposed that clinicians and other health care professionals use a new treatment algorithm to identify patients for weight-loss treatment. In addition to the usual assessment of body mass index (BMI, calculated as weight in kilograms divided by the square of height in meters), the new algorithm includes the assessment of abdominal obesity (as measured by waist circumference) and other cardiovascular disease (CVD) risk factors.


METHODS
We examined the percentage of adults meeting the criteria of the panel's treatment algorithm: BMI > or =30 or ¿[BMI, 25.0-29.9 or waist circumference >88 cm (women) >102 cm (men)] and > or = 2 CVD risk factors¿ in a sample of 2844 black, 2754 Mexican American, and 3504 white adults, aged 25 to 64 years, from the Third National Health and Nutrition Examination Survey, 1988-1994.


RESULTS
Across ethnic groups, more than 98% of adults (normal weight, overweight, and obese) received the same treatment recommendations using the panel's algorithm and an algorithm based only on BMI and CVD risk factors, without waist circumference. For normal-weight adults, almost none (0.0%-1.8%) had a large waist circumference as defined above and 2 or more CVD risk factors. Using the usual criterion of a BMI of 30 or higher, a substantial percentage of at-risk overweight women and men (BMI, 25.0-29.9) with 2 or more CVD risk factors were missed (8.4% and 19.3%, respectively).


CONCLUSIONS
Despite the potential importance of abdominal obesity as a CVD risk factor, these results challenge the clinical utility of including waist circumference in this new algorithm and suggest that using BMI and CVD risk factors may be sufficient.
Kiernan
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Stanford Center for Research in Disease Prevention, Stanford University School of Medicine, 730 Welch Rd, Suite B, Palo Alto, CA 94304 USA. mkiernan@scrdp.stanford.edu.
Winkleby
M A
MA
D000328:Adult; D000465:Algorithms; D044383:Black People; D001824:Body Constitution; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009749:Nutrition Surveys; D009765:Obesity / Q000150:complications / Q000453:epidemiology / Q000534:rehabilitation*; D010353:Patient Education as Topic / Q000592:standards*; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D015397:Program Evaluation / Q000592:standards*; D018570:Risk Assessment / Q000379:methods; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology; D015431:Weight Loss; D044465:White People; D001741:Black or African American