Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan – Achieving and maintaining a healthy weight includes healthy eating, physical activity, optimal sleep, and stress reduction. Several other factors may also affect weight gain.
Healthy eating features a variety of healthy foods. Fad diets may promise fast results, but such diets limit your nutritional intake, can be unhealthy, and tend to fail in the long run.
How much physical activity you need depends partly on whether you are trying to maintain your weight or lose weight. Walking is often a good way to add more physical activity to your lifestyle.
Managing your weight contributes to good health now and as you age. In contrast, people who have obesity, compared to those with a healthy weight, are at increased risk for many serious diseases and health conditions.
Body mass index or BMJ is a statistical index using a person’s weight and height to calculate body fat in males and females of any age. It is also widely used as a risk factor for developing several health problems (Weir & Jan, 2020). The typical interpretation is that it represents an index of an individual’s fatness. It is calculated by taking a person’s kilogram weight, divided by their height, in meters squared, or BMI = weight (in kg)/ height^2 (in m^2). The number generated from this equation is then the individual’s BMI number (Nuttall, 2015).
The National Institute of Health (NIH) now uses BMI to define a person as underweight, average weight, overweight, or obese.
Severely underweight – BMI less than l 6.5kg/m^2
Underweight – BMI under 18.5 kg/m^2
Normal weight – BMI greater than or equal to 18.5 to 24.9 kg/m^2
Overweight – BMI greater than or equal to 25 to 29.9 kg/m^2
Obesity-BM! greater than or equal to 30 kg/m^2
Obesity class I -BMI 30 to 34.9 kg/m
Obesity class II -BMI 35 to 39.9 kg/m^2
Obesity class III – BMI greater than or equal to 40 kg/m^2 (also referred to as severe, extreme, or massive obesity)
Asian and South Asian population
overweight – BMI between 23 and 24.9 kg/m^2
obesity – BMI greater than 25 kg/m^2
Individual divergences exist, and BMI is inadequate as the exclusive norms of classifying a person as obese or malnourished. In specific populations, like elite athletes and bodybuilders, an elevated BMI does not relate to their health status due to their increased muscle mass and weight falsely increasing their BMI. Moreover, BMI lets comparison between children of the same sex and age in the pediatric population. A BMI below the fifth percentile is underweight for children, and above the 95th percentile is considered obese (Weir & Jan, 2020).
Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan
A follow-up plan is established during the encounter or the previous twelve months if a patient’s most recent documented BMI is outside normal parameters. The documented follow-up plan must be based on the most recent documented BMI outside normal parameters.
Follow-Up Plan – Suggested treatment outline due to a BMI outside of standard parameters. A follow-up plan may include, but is not limited to:
- Documentation of education
- Referral (for example, a Registered Dietitian Nutritionist (RDN), o occupational therapist, exercise physiologist, mental health professional, or surgeon), lifestyle/behavioral therapy Pharmacological interventions
- Dietary supplements, Exercise counseling, Nutrition counseling
BMI Above Normal Parameters
Obesity is a chronic, multifactorial disease with complex psychological, environmental (social and cultural), genetic, physiologic, metabolic, and behavioral causes and consequences. The prevalence of overweight and obese people is rising worldwide at an alarming rate in both developing and developed countries. Behavioral weight management treatment has been identified as an effective first-line treatment for obesity. Dietary counseling performed by a Registered Dietitian Nutritionist (RDN) for 6-12 months shows a significant mean weight loss of up to 10% of body weight, maintained over one year (Khanna et al., 2022)
BMI below Normal Parameters
On the other end of the body weight range is underweight (BMI<18.5kg/m2), which is harmful to population health. Poor nutrition or underlying health conditions can result in being underweight. The National Health ·· and Nutrition Examination Survey (NHANES) outcomes reveal that women are more likely to be underweight than men. Consequently, patients should be equally screened for underweight and followed up with nutritional counseling to decrease mortality and morbidity associated with underweight.
BMI continues to be a typical and reasonably reliable measurement to identify underweight, overweight, and obese adults who may be at an increased risk for future morbidity. Thus, screening for BMI a1: d follow-up are critical to completing this gap and contribute to quality goals of population health and cost reduction. The US preventive health Services Task Force (USPSTF) suggests that clinicians screen all adults (18 years and older). Clinicians should offer or refer patients with a BMI of 30 or higher to intensive, multicomponent behavioral interventions (Weir & Jan, 2020).
CLINICAL RECOMMENDATION STATEMENTS
Lifestyle/Behavioral Therapy for Overweight and Obesity should include behavioral interventions that improve compliance to prescriptions for a reduced calorie meal plan and increased physical activity (behavioral interventions can consist of self-monitoring of weight, food intake, and physical activity; straightforward and reasonable goal setting; education about obesity, nutrition, and physical activity; face-to-face and group meetings; stimulus control; systematic approaches for problem-solving; stress reduction; cognitive restructuring. Motivational interviewing; behavioral contracting; psychological counseling; and mobilization of social support structures. Behavioral lifestyle intervention should be tailored to a patient’s ethnic, cultural, socioeconomic, and educational background (Weir & Jan, 2020).
- Khanna, D., Peltzer, C., Kahar, P., & Parmar, M. S. (2022). Body Mass Index (BMI): A Screening Tool Analysis. Cureus. https://doi.org/10.7759/cureus.22119
- Nuttall, F. Q. (2015). Body Mass Index. Nutrition Today, 50(3), 117-128. https://doi.org/10.1097/nt.0000000000000092
- Weir, C. B., & Jan, A. (2020). BM! Classification Percentile And Cut Off Points. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK541070/
- CDC: https://www.cdc.gov/healthyweight/index.html