Operational Medicine 2001
Overweight

History

Weight is medically assessed by a calculation called the Body Mass Index, or BMI.  The BMI is equal to the patient’s weight (in kilograms) divided by the patient’s height (in meters) squared (multiplied by itself). A BMI of greater than 25 is defined as being overweight, while a BMI of over 30 is consistent with obesity.  Being overweight is associated with a higher mortality rate than people who are not overweight. 

If a patient is overweight, a history should be taken to ascertain how long the problem has been going on. Most people who are overweight have had a long-term, slow weight gain.  A common statement by patients is that being overweight runs in the family and that they have a “glandular problem.”  While being overweight can run in families, it is rarely a glandular problem.  

The formula for weight gain is simple: if a person consumes more calories than they burn, weight will be gained.  There are some medical conditions that can make a person gain weight, in particular hypothyroidism and hyperadrenalism.  A history of dry skin, edema, hair thinning or constipation could further suggest hypothyroidism.  Central obesity with thin extremities, a “buffalo hump” moon-like facies, very high blood pressure and purple stretch marks on the abdomen may suggest hyperadrenalism.  Fortunately, these problems are fairly rare and will seldom need evaluation while underway.

Physical Exam

Accurate height and weight is essential in making the diagnosis. Some people will have a BMI of over 25 but will not be "overweight," especially if the patient is a muscular young sailor.  To ascertain if this is the case, body fat measurements should be done.  Some physical exam findings suggest hypothyroidism: edema, hair loss, dry skin.  Other findings may suggest hyperadrenalism: abdominal obesity with very thin extremities, moon-like face, a “buffalo hump” on the upper back, purple striae on the abdomen, high blood pressure.

Laboratory

No labs are necessary to diagnose being overweight, but certain labs should be checked long-term.  Overweight patients are more prone to diabetes and hyperlipidemia than people of ideal body weight.  If chemistries are available, low serum sodium can be present in severe hypothyroidism, but this will probably be of little practical value while underway.

Treatment

For every 3500 calories under a person’s bodily requirements that are consumed, one pound of body weight will be lost.  Likewise, for every 3500 calories extra consumed, one pound will be gained.  A good rule of thumb for caloric needs is 30 calories per kilogram body weight per day to maintain that body weight.  

The safest way to lose weight is to reduce caloric intake by 500 calories per day. This will result in a weight loss of one pound per week.  Cardiovascular exercise has been shown to be of benefit in keeping weight off, but exercise alone will probably not cause significant long-term weight loss.  However, overweight patients who are physically fit have fewer health problems overall than those who are not physically fit, so exercise should be prescribed to everyone.  

A daily diary of everything that is consumed is often helpful. The difference in one pound a week is only the caloric equivalent of a few sliders from the galley!  Screening for conditions exacerbated by being overweight should be done (check blood pressure, check lipids).  People who are overweight are at higher risk for obstructive sleep apnea.

Medevac

Medevac for patients simply because they are overweight should seldom, if ever, be indicated.

This section provided by LT Daniel A. Rakowski, MC, USNR, Naval Medical Center Portsmouth

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Operational Medicine 2001
Health Care in Military Settings

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