RE: Super Obese --> RE: language question

December 3, 2008

I like the term

Jolly obese ...

> I agree with megan.

> Once they are Morbidly Obese -- you could differentiate w/ Mild, Moderate,

> and Severe Morbid Obesity.

>

> Although the argument could be made -- Are there varying degrees of

> Morbidly?

>

> Or is that like -- Mild, Moderate, and Severe Death?

> There really is not gradation for some problems.

>

> If nothing else, as long as the phrasing makes sense to you, it probably

> doesn't matter whether it is " correct " or not -- it just reminds you of the

> patient's situation.

>

> Did stumble on this...

>

> Technically, I guess there is a classification for the BMI > 50 - super

> obese.

>

> Some sites suggested that those w/ BMI >60 are -- super super obese.

>

> http://www.asbs.org/Newsite07/media/fact-sheet4_morbid-obesity.pdf

>

> Weight classifications for adults:

>

> o Super obese: A person with a BMI of 50 or more

>

> 50,000 adults are super obese in the U.S.

>

> o Morbidly obese: A person with a BMI of 40 or more, or a BMI of 35 or more

> with an obesity-related disease, such as type 2 diabetes, heart disease or

> sleep apnea

>

> 15 million adults are morbidly obese in the U.S.

>

> o Obese: A person with a BMI of 30 – 39.9

>

> 64 million adults are obese in the U.S.

>

> o Overweight: A person with a BMI of 25 – 29.9

>

> 134 million adults are overweight or obese in the U.S.

>

> http://www.asbs.org/html/pdf/2004_ASBS_Consensus_Conference_Statement.pdf

>

> Between 1986 and 2000, prevalence of obesity (BMI > 30 kg/m2) doubled,

> morbid obesity (BMI > 40 kg/m2) quadrupled, and super obesity (BMI > 50

> kg/m2) increased fivefold in US adults.

>

> http://www.drmartin-duce.com/html_en/obesity_frame.html

>

> Classification of obesity according to BMI and severity of risk factors:

>

> Categories BMI Values

> A: Normal weight < 25

> B: Overweight 25-27

> C: Overweight + 27-30

> D: Obese

> (Class 1) 30-35

> E: Obese

> (Class 2) 35-40

> F: Morbid Obesity 40-50

> G: Super Obesity 50-60

> H: Super-Super Obesity > 60

> Advisory Committee: American Society for Bariatric Surgery.

> Obes. Surg. 7:523, 1997.

>

> ===========================

>

> Here is an interesting related story.

>

http://news.yahoo.com/s/afp/healthchinausoffbeat;_ylt=AuE.fKD4K1xxqEI_v1UHi1wDW7\

oF

>

> To shed pounds, three Americans head to China

>

> by nne Barriaux nne Barriaux – Tue Dec 2, 3:14 pm ET

> Play Video AFP – Americans losing weight the Chinese way

>

> Slideshow: Americans try living in China to lose weight

>

> AFP/File – R-L: Three American men - Alonzo Bland and brothers Walt

> and - walk in the Chinese …

>

> TIANJIN, China (AFP) – Three American men have taken the unusual step of

> moving to China in an extreme attempt to shed huge amounts of weight at a

> fat reduction clinic -- and have become surprise local celebrities.

>

> Alonzo Bland, 33, and brothers Walt and , 56 and 50, have

> lived in the northern Chinese city of Tianjin since the middle of this year

> as part of an effort to break away from their unhealthy lifestyles back

> home.

>

> Together, they have lost a combined 192 kilogrammes (427 pounds) and are

> aiming to shed over 100 more.

>

> snip/snip

>

> Locke, MD

>

> ________________________________

> From:

> [mailto: ] On Behalf Of Skaggs

> Sent: Tuesday, December 02, 2008 7:38 PM

> To: practiceimprovement1

> Subject: language question

>

> I am finding myself without a good descriptive term to use in my exams. How

> do you guys describe obesity that is " beyond morbid " ? For body habitus, I

> usually choose from lean, muscular, well developed and well nourished,

> overweight (applied to BMI 26-30), obese (BMI 31-33) and morbidly obese (BMI

>> 33)

>

> Problem is, I have more and more patients with BMIs that are A LOT more than

> 33....like 46 to 56...and I haven't been able to think of a term that sounds

> nonjudgmental and still conveys the reality.

>

> Any suggestions?

>

> --

> Annie Skaggs

> Lexington, KY

>

--

Graham Chiu

http://www.synapsedirect.com

Synapse - the use from anywhere EMR.

December 3, 2008

I like the term

Jolly obese ...

> I agree with megan.

> Once they are Morbidly Obese -- you could differentiate w/ Mild, Moderate,

> and Severe Morbid Obesity.

>

> Although the argument could be made -- Are there varying degrees of

> Morbidly?

>

> Or is that like -- Mild, Moderate, and Severe Death?

> There really is not gradation for some problems.

>

> If nothing else, as long as the phrasing makes sense to you, it probably

> doesn't matter whether it is " correct " or not -- it just reminds you of the

> patient's situation.

>

> Did stumble on this...

>

> Technically, I guess there is a classification for the BMI > 50 - super

> obese.

>

> Some sites suggested that those w/ BMI >60 are -- super super obese.

>

> http://www.asbs.org/Newsite07/media/fact-sheet4_morbid-obesity.pdf

>

> Weight classifications for adults:

>

> o Super obese: A person with a BMI of 50 or more

>

> 50,000 adults are super obese in the U.S.

>

> o Morbidly obese: A person with a BMI of 40 or more, or a BMI of 35 or more

> with an obesity-related disease, such as type 2 diabetes, heart disease or

> sleep apnea

>

> 15 million adults are morbidly obese in the U.S.

>

> o Obese: A person with a BMI of 30 – 39.9

>

> 64 million adults are obese in the U.S.

>

> o Overweight: A person with a BMI of 25 – 29.9

>

> 134 million adults are overweight or obese in the U.S.

>

> http://www.asbs.org/html/pdf/2004_ASBS_Consensus_Conference_Statement.pdf

>

> Between 1986 and 2000, prevalence of obesity (BMI > 30 kg/m2) doubled,

> morbid obesity (BMI > 40 kg/m2) quadrupled, and super obesity (BMI > 50

> kg/m2) increased fivefold in US adults.

>

> http://www.drmartin-duce.com/html_en/obesity_frame.html

>

> Classification of obesity according to BMI and severity of risk factors:

>

> Categories BMI Values

> A: Normal weight < 25

> B: Overweight 25-27

> C: Overweight + 27-30

> D: Obese

> (Class 1) 30-35

> E: Obese

> (Class 2) 35-40

> F: Morbid Obesity 40-50

> G: Super Obesity 50-60

> H: Super-Super Obesity > 60

> Advisory Committee: American Society for Bariatric Surgery.

> Obes. Surg. 7:523, 1997.

>

> ===========================

>

> Here is an interesting related story.

>

http://news.yahoo.com/s/afp/healthchinausoffbeat;_ylt=AuE.fKD4K1xxqEI_v1UHi1wDW7\

oF

>

> To shed pounds, three Americans head to China

>

> by nne Barriaux nne Barriaux – Tue Dec 2, 3:14 pm ET

> Play Video AFP – Americans losing weight the Chinese way

>

> Slideshow: Americans try living in China to lose weight

>

> AFP/File – R-L: Three American men - Alonzo Bland and brothers Walt

> and - walk in the Chinese …

>

> TIANJIN, China (AFP) – Three American men have taken the unusual step of

> moving to China in an extreme attempt to shed huge amounts of weight at a

> fat reduction clinic -- and have become surprise local celebrities.

>

> Alonzo Bland, 33, and brothers Walt and , 56 and 50, have

> lived in the northern Chinese city of Tianjin since the middle of this year

> as part of an effort to break away from their unhealthy lifestyles back

> home.

>

> Together, they have lost a combined 192 kilogrammes (427 pounds) and are

> aiming to shed over 100 more.

>

> snip/snip

>

> Locke, MD

>

> ________________________________

> From:

> [mailto: ] On Behalf Of Skaggs

> Sent: Tuesday, December 02, 2008 7:38 PM

> To: practiceimprovement1

> Subject: language question

>

> I am finding myself without a good descriptive term to use in my exams. How

> do you guys describe obesity that is " beyond morbid " ? For body habitus, I

> usually choose from lean, muscular, well developed and well nourished,

> overweight (applied to BMI 26-30), obese (BMI 31-33) and morbidly obese (BMI

>> 33)

>

> Problem is, I have more and more patients with BMIs that are A LOT more than

> 33....like 46 to 56...and I haven't been able to think of a term that sounds

> nonjudgmental and still conveys the reality.

>

> Any suggestions?

>

> --

> Annie Skaggs

> Lexington, KY

>

--

Graham Chiu

http://www.synapsedirect.com

Synapse - the use from anywhere EMR.

December 3, 2008

Considering time management, I gotta be truthful, this discussion isn't good use of

our time. Semantics won't change a thing for how the patient is cared for. We

have the height and weight noted, we say " morbidly obese " (there is no

high end of that description) and we perhaps add other points like " abdominal

exam limited by obesity. " The point is made clear. Then we get to the

real clear issue at hand, making a plan for the patient's conditions/health.Don't waste time even thinking of other " better " words, it's a useless

effort and no one benefits.IMHOTim > On Wed, December 3, 2008 1:11 am EST, Graham Chiu

wrote:> > > I like the

term> > Jolly obese ...> > On Wed, Dec 3, 2008

at 7:02 PM, Locke wrote:> > I agree with megan.> >

Once they are Morbidly Obese -- you could differentiate w/ Mild, Moderate,>

> and Severe Morbid Obesity.> >> > Although the argument

could be made -- Are there varying degrees of> > Morbidly?>

>> > Or is that like -- Mild, Moderate, and Severe Death?>

> There really is not gradation for some problems.> >> >

If nothing else, as long as the phrasing makes sense to you, it probably>

> doesn't matter whether it is " correct " or not -- it just reminds you

of the> > patient's situation.> >> > Did stumble

on this...> >> > Technically, I guess there is a

classification for the BMI > 50 - super> > obese.> >> > Some sites suggested that those w/ BMI >60 are -- super super

obese.> >> >

http://www.asbs.org/Newsite07/media/fact-sheet4_morbid-obesity.pdf> >> >> > Weight classifications for adults:> >> > o Super obese: A person with a BMI of 50 or more> >> > 50,000 adults are super obese in the U.S.> >> >

o Morbidly obese: A person with a BMI of 40 or more, or a BMI of 35 or more> > with an obesity-related disease, such as type 2 diabetes, heart disease

or> > sleep apnea> >> > 15 million adults are

morbidly obese in the U.S.> >> > o Obese: A person with a

BMI of 30 – 39.9> >> > 64 million adults are obese in

the U.S.> >> > o Overweight: A person with a BMI of 25

– 29.9> >> > 134 million adults are overweight or

obese in the U.S.> >> >> >

http://www.asbs.org/html/pdf/2004_ASBS_Consensus_Conference_Statement.pdf>

>> >> > Between 1986 and 2000, prevalence of obesity (BMI

> 30 kg/m2) doubled,> > morbid obesity (BMI > 40 kg/m2)

quadrupled, and super obesity (BMI > 50> > kg/m2) increased fivefold

in US adults.> >> >> >

http://www.drmartin-duce.com/html_en/obesity_frame.html> >>

> Classification of obesity according to BMI and severity of risk factors:> >> > Categories BMI Values> > A: Normal weight

<25> B: Overweight 25-27> > C: Overweight + 27-30> >

D: Obese> > (Class 1) 30-35> > E: Obese> >

(Class 2) 35-40> > F: Morbid Obesity 40-50> > G: Super

Obesity 50-60> > H: Super-Super Obesity > 60> > Advisory

Committee: American Society for Bariatric Surgery.> > Obes. Surg. 7:523,

1997.> >> > ===========================> >> > Here is an interesting related story.> >> >

http://news.yahoo.com/s/afp/healthchinausoffbeat;_ylt=AuE.fKD4K1xxqEI_v1UHi1wDW7oF> >> >> > To shed pounds, three Americans head to

China> >> > by nne Barriaux nne Barriaux –

Tue Dec 2, 3:14 pm ET> > Play Video AFP – Americans losing weight

the Chinese way> >> > Slideshow: Americans try living in

China to lose weight> >> > AFP/File – R-L: Three

American men - Alonzo Bland and brothers Walt > > and

- walk in the Chinese …> >> > TIANJIN, China

(AFP) – Three American men have taken the unusual step of> >

moving to China in an extreme attempt to shed huge amounts of weight at a>

> fat reduction clinic -- and have become surprise local celebrities.>

>> > Alonzo Bland, 33, and brothers Walt and , 56 and

50, have> > lived in the northern Chinese city of Tianjin since the

middle of this year> > as part of an effort to break away from their

unhealthy lifestyles back> > home.> >> >

Together, they have lost a combined 192 kilogrammes (427 pounds) and are>

> aiming to shed over 100 more.> >> > snip/snip>

>> > Locke, MD> >> >> >

________________________________> >> From:

> >

[mailto: ] On Behalf Of Skaggs>

> Sent: Tuesday, December 02, 2008 7:38 PM> > To:

practiceimprovement1> > Subject: language

question> >> > I am finding myself without a good

descriptive term to use in my exams. How> > do you guys describe

obesity that is " beyond morbid " ? For body habitus, I> >

usually choose from lean, muscular, well developed and well nourished,>

> overweight (applied to BMI 26-30), obese (BMI 31-33) and morbidly obese (BMI> >> 33)> >> > Problem is, I have more and more

patients with BMIs that are A LOT more than> > 33....like 46 to 56...and

I haven't been able to think of a term that sounds> > nonjudgmental and

still conveys the reality.> >> > Any suggestions?>

>> > --> > Annie Skaggs> > Lexington, KY> >> >> > > > -->

Graham Chiu> http://www.synapsedirect.com> Synapse - the use from

anywhere EMR.> > ------------------------------------>

>

December 3, 2008

Considering time management, I gotta be truthful, this discussion isn't good use of

our time. Semantics won't change a thing for how the patient is cared for. We

have the height and weight noted, we say " morbidly obese " (there is no

high end of that description) and we perhaps add other points like " abdominal

exam limited by obesity. " The point is made clear. Then we get to the

real clear issue at hand, making a plan for the patient's conditions/health.Don't waste time even thinking of other " better " words, it's a useless

effort and no one benefits.IMHOTim > On Wed, December 3, 2008 1:11 am EST, Graham Chiu

wrote:> > > I like the

term> > Jolly obese ...> > On Wed, Dec 3, 2008

at 7:02 PM, Locke wrote:> > I agree with megan.> >

Once they are Morbidly Obese -- you could differentiate w/ Mild, Moderate,>

> and Severe Morbid Obesity.> >> > Although the argument

could be made -- Are there varying degrees of> > Morbidly?>

>> > Or is that like -- Mild, Moderate, and Severe Death?>

> There really is not gradation for some problems.> >> >

If nothing else, as long as the phrasing makes sense to you, it probably>

> doesn't matter whether it is " correct " or not -- it just reminds you

of the> > patient's situation.> >> > Did stumble

on this...> >> > Technically, I guess there is a

classification for the BMI > 50 - super> > obese.> >> > Some sites suggested that those w/ BMI >60 are -- super super

obese.> >> >

http://www.asbs.org/Newsite07/media/fact-sheet4_morbid-obesity.pdf> >> >> > Weight classifications for adults:> >> > o Super obese: A person with a BMI of 50 or more> >> > 50,000 adults are super obese in the U.S.> >> >

o Morbidly obese: A person with a BMI of 40 or more, or a BMI of 35 or more> > with an obesity-related disease, such as type 2 diabetes, heart disease

or> > sleep apnea> >> > 15 million adults are

morbidly obese in the U.S.> >> > o Obese: A person with a

BMI of 30 – 39.9> >> > 64 million adults are obese in

the U.S.> >> > o Overweight: A person with a BMI of 25

– 29.9> >> > 134 million adults are overweight or

obese in the U.S.> >> >> >

http://www.asbs.org/html/pdf/2004_ASBS_Consensus_Conference_Statement.pdf>

>> >> > Between 1986 and 2000, prevalence of obesity (BMI

> 30 kg/m2) doubled,> > morbid obesity (BMI > 40 kg/m2)

quadrupled, and super obesity (BMI > 50> > kg/m2) increased fivefold

in US adults.> >> >> >

http://www.drmartin-duce.com/html_en/obesity_frame.html> >>

> Classification of obesity according to BMI and severity of risk factors:> >> > Categories BMI Values> > A: Normal weight

<25> B: Overweight 25-27> > C: Overweight + 27-30> >

D: Obese> > (Class 1) 30-35> > E: Obese> >

(Class 2) 35-40> > F: Morbid Obesity 40-50> > G: Super

Obesity 50-60> > H: Super-Super Obesity > 60> > Advisory

Committee: American Society for Bariatric Surgery.> > Obes. Surg. 7:523,

1997.> >> > ===========================> >> > Here is an interesting related story.> >> >

http://news.yahoo.com/s/afp/healthchinausoffbeat;_ylt=AuE.fKD4K1xxqEI_v1UHi1wDW7oF> >> >> > To shed pounds, three Americans head to

China> >> > by nne Barriaux nne Barriaux –

Tue Dec 2, 3:14 pm ET> > Play Video AFP – Americans losing weight

the Chinese way> >> > Slideshow: Americans try living in

China to lose weight> >> > AFP/File – R-L: Three

American men - Alonzo Bland and brothers Walt > > and

- walk in the Chinese …> >> > TIANJIN, China

(AFP) – Three American men have taken the unusual step of> >

moving to China in an extreme attempt to shed huge amounts of weight at a>

> fat reduction clinic -- and have become surprise local celebrities.>

>> > Alonzo Bland, 33, and brothers Walt and , 56 and

50, have> > lived in the northern Chinese city of Tianjin since the

middle of this year> > as part of an effort to break away from their

unhealthy lifestyles back> > home.> >> >

Together, they have lost a combined 192 kilogrammes (427 pounds) and are>

> aiming to shed over 100 more.> >> > snip/snip>

>> > Locke, MD> >> >> >

________________________________> >> From:

> >

[mailto: ] On Behalf Of Skaggs>

> Sent: Tuesday, December 02, 2008 7:38 PM> > To:

practiceimprovement1> > Subject: language

question> >> > I am finding myself without a good

descriptive term to use in my exams. How> > do you guys describe

obesity that is " beyond morbid " ? For body habitus, I> >

usually choose from lean, muscular, well developed and well nourished,>

> overweight (applied to BMI 26-30), obese (BMI 31-33) and morbidly obese (BMI> >> 33)> >> > Problem is, I have more and more

patients with BMIs that are A LOT more than> > 33....like 46 to 56...and

I haven't been able to think of a term that sounds> > nonjudgmental and

still conveys the reality.> >> > Any suggestions?>

>> > --> > Annie Skaggs> > Lexington, KY> >> >> > > > -->

Graham Chiu> http://www.synapsedirect.com> Synapse - the use from

anywhere EMR.> > ------------------------------------>

>

December 3, 2008

Considering time management, I gotta be truthful, this discussion isn't good use of

our time. Semantics won't change a thing for how the patient is cared for. We

have the height and weight noted, we say " morbidly obese " (there is no

high end of that description) and we perhaps add other points like " abdominal

exam limited by obesity. " The point is made clear. Then we get to the

real clear issue at hand, making a plan for the patient's conditions/health.Don't waste time even thinking of other " better " words, it's a useless

effort and no one benefits.IMHOTim > On Wed, December 3, 2008 1:11 am EST, Graham Chiu

wrote:> > > I like the

term> > Jolly obese ...> > On Wed, Dec 3, 2008

at 7:02 PM, Locke wrote:> > I agree with megan.> >

Once they are Morbidly Obese -- you could differentiate w/ Mild, Moderate,>

> and Severe Morbid Obesity.> >> > Although the argument

could be made -- Are there varying degrees of> > Morbidly?>

>> > Or is that like -- Mild, Moderate, and Severe Death?>

> There really is not gradation for some problems.> >> >

If nothing else, as long as the phrasing makes sense to you, it probably>

> doesn't matter whether it is " correct " or not -- it just reminds you

of the> > patient's situation.> >> > Did stumble

on this...> >> > Technically, I guess there is a

classification for the BMI > 50 - super> > obese.> >> > Some sites suggested that those w/ BMI >60 are -- super super

obese.> >> >

http://www.asbs.org/Newsite07/media/fact-sheet4_morbid-obesity.pdf> >> >> > Weight classifications for adults:> >> > o Super obese: A person with a BMI of 50 or more> >> > 50,000 adults are super obese in the U.S.> >> >

o Morbidly obese: A person with a BMI of 40 or more, or a BMI of 35 or more> > with an obesity-related disease, such as type 2 diabetes, heart disease

or> > sleep apnea> >> > 15 million adults are

morbidly obese in the U.S.> >> > o Obese: A person with a

BMI of 30 – 39.9> >> > 64 million adults are obese in

the U.S.> >> > o Overweight: A person with a BMI of 25

– 29.9> >> > 134 million adults are overweight or

obese in the U.S.> >> >> >

http://www.asbs.org/html/pdf/2004_ASBS_Consensus_Conference_Statement.pdf>

>> >> > Between 1986 and 2000, prevalence of obesity (BMI

> 30 kg/m2) doubled,> > morbid obesity (BMI > 40 kg/m2)

quadrupled, and super obesity (BMI > 50> > kg/m2) increased fivefold

in US adults.> >> >> >

http://www.drmartin-duce.com/html_en/obesity_frame.html> >>

> Classification of obesity according to BMI and severity of risk factors:> >> > Categories BMI Values> > A: Normal weight

<25> B: Overweight 25-27> > C: Overweight + 27-30> >

D: Obese> > (Class 1) 30-35> > E: Obese> >

(Class 2) 35-40> > F: Morbid Obesity 40-50> > G: Super

Obesity 50-60> > H: Super-Super Obesity > 60> > Advisory

Committee: American Society for Bariatric Surgery.> > Obes. Surg. 7:523,

1997.> >> > ===========================> >> > Here is an interesting related story.> >> >

http://news.yahoo.com/s/afp/healthchinausoffbeat;_ylt=AuE.fKD4K1xxqEI_v1UHi1wDW7oF> >> >> > To shed pounds, three Americans head to

China> >> > by nne Barriaux nne Barriaux –

Tue Dec 2, 3:14 pm ET> > Play Video AFP – Americans losing weight

the Chinese way> >> > Slideshow: Americans try living in

China to lose weight> >> > AFP/File – R-L: Three

American men - Alonzo Bland and brothers Walt > > and

- walk in the Chinese …> >> > TIANJIN, China

(AFP) – Three American men have taken the unusual step of> >

moving to China in an extreme attempt to shed huge amounts of weight at a>

> fat reduction clinic -- and have become surprise local celebrities.>

>> > Alonzo Bland, 33, and brothers Walt and , 56 and

50, have> > lived in the northern Chinese city of Tianjin since the

middle of this year> > as part of an effort to break away from their

unhealthy lifestyles back> > home.> >> >

Together, they have lost a combined 192 kilogrammes (427 pounds) and are>

> aiming to shed over 100 more.> >> > snip/snip>

>> > Locke, MD> >> >> >

________________________________> >> From:

> >

[mailto: ] On Behalf Of Skaggs>

> Sent: Tuesday, December 02, 2008 7:38 PM> > To:

practiceimprovement1> > Subject: language

question> >> > I am finding myself without a good

descriptive term to use in my exams. How> > do you guys describe

obesity that is " beyond morbid " ? For body habitus, I> >

usually choose from lean, muscular, well developed and well nourished,>

> overweight (applied to BMI 26-30), obese (BMI 31-33) and morbidly obese (BMI> >> 33)> >> > Problem is, I have more and more

patients with BMIs that are A LOT more than> > 33....like 46 to 56...and

I haven't been able to think of a term that sounds> > nonjudgmental and

still conveys the reality.> >> > Any suggestions?>

>> > --> > Annie Skaggs> > Lexington, KY> >> >> > > > -->

Graham Chiu> http://www.synapsedirect.com> Synapse - the use from

anywhere EMR.> > ------------------------------------>

>

December 3, 2008

There is also a new ICD-9 code for BMI > 40. As well as

BMI codes for pediatric patients that are overweight or underweight.

Kathy Saradarian, MD

Branchville, NJ

www.qualityfamilypractice.com

Solo 4/03, Practicing since 9/90

Practice Partner 5/03

Low staffing

From:

[mailto: ] On Behalf Of Locke

Sent: Wednesday, December 03, 2008 1:02 AM

To:

Subject: Super Obese --> RE: language question

I agree with megan.

Once they are Morbidly Obese -- you could differentiate w/

Mild, Moderate, and Severe Morbid Obesity.

Although the argument could be made -- Are there varying

degrees of Morbidly?

Or is that like -- Mild, Moderate, and Severe Death?

There really is not gradation for some problems.

If nothing else, as long as the phrasing makes sense to you,

it probably doesn't matter whether it is " correct " or not -- it just

reminds you of the patient's situation.

Did stumble on this...

Technically, I guess there is a classification for the BMI

> 50 - super obese.

Some sites suggested that those w/ BMI >60 are -- super

super obese.

http://www.asbs.org/Newsite07/media/fact-sheet4_morbid-obesity.pdf

Weight classifications for adults:

o Super obese: A person with a BMI

of 50 or more

50,000 adults are super obese in the U.S.

o Morbidly obese: A person with a

BMI of 40 or more, or a BMI of 35 or more with an obesity-related

disease, such as type 2 diabetes, heart disease or sleep apnea

15 million adults are morbidly obese in the U.S.

o Obese: A person with a BMI of 30

– 39.9

64 million adults are obese in the U.S.

o Overweight: A person with a BMI of

25 – 29.9

134 million adults are overweight or obese in the U.S.

http://www.asbs.org/html/pdf/2004_ASBS_Consensus_Conference_Statement.pdf

Between 1986 and 2000, prevalence of obesity (BMI > 30 kg/m2)

doubled, morbid obesity (BMI > 40 kg/m2) quadrupled, and super obesity

(BMI > 50 kg/m2) increased fivefold in US adults.

http://www.drmartin-duce.com/html_en/obesity_frame.html

Classification

of obesity according to BMI and severity of risk factors:

Categories

BMI

Values

A: Normal weight

<

25

B: Overweight

25-27

C: Overweight +

27-30

D: Obese

(Class 1)

30-35

E: Obese

(Class 2)

35-40

F: Morbid

Obesity

40-50

G: Super Obesity

50-60

H: Super-Super

Obesity

>

60

Advisory Committee: American Society for Bariatric

Surgery.

Obes. Surg. 7:523, 1997.

===========================

Here is an interesting related story.

http://news.yahoo.com/s/afp/healthchinausoffbeat;_ylt=AuE.fKD4K1xxqEI_v1UHi1wDW7oF

To shed pounds, three Americans head to

China

by nne Barriaux nne

Barriaux – Tue Dec 2,

3:14 pm ET

Play

Video AFP – Americans losing weight

the Chinese way

Slideshow:

Americans try living in China to lose weight

AFP/File – R-L: Three American men -

Alonzo Bland and brothers Walt and - walk in the

Chinese …

TIANJIN, China (AFP) – Three American men have taken the unusual step

of moving to China in an extreme attempt to shed

huge amounts of weight at a fat reduction clinic -- and have become surprise

local celebrities.

Alonzo Bland, 33, and brothers Walt and ,

56 and 50, have lived in the northern Chinese city of Tianjin

since the middle of this year as part of an effort to break away from their unhealthy lifestyles back home.

Together, they have lost a combined 192 kilogrammes (427 pounds) and are

aiming to shed over 100 more.

snip/snip

Locke, MD

From:

[mailto: ] On Behalf Of Skaggs

Sent: Tuesday, December 02, 2008 7:38 PM

To: practiceimprovement1

Subject: language question

I am finding myself without a good descriptive term to use in my

exams. How do you guys describe obesity that is " beyond

morbid " ? For body habitus, I usually choose from lean, muscular, well

developed and well nourished, overweight (applied to BMI 26-30), obese (BMI

31-33) and morbidly obese (BMI > 33)

Problem is, I have more and more patients with BMIs that are A LOT more than

33....like 46 to 56...and I haven't been able to think of a term that sounds

nonjudgmental and still conveys the reality.

Any suggestions?

--

Annie Skaggs

Lexington, KY

December 3, 2008

Tim, on the one hand I agree, but on the other hand, words are all we have in the note to describe a patient.

When a patient is being referred or a patient we haven't seen very often and doesn't ring a bell, etc, words are what give us a description of the patient.

Saying someone is obese probably doesn't separate out the super super obese patient in our minds or give the consultant a good idea of what they are coming up against.

Granted, the consultant and I will get the whole picture when the patient shows up in the office.

I agree one could spend many hours possibly wasted coming up with subtle variations on how obese someone is.

But I think it is sort of like diabetes -- are they diet controlled, oral med controlled, insulin controlled, brittle, etc.

Diabetes or Obese doesn't always give the full flavor of the diagnosis.

Sometimes a descriptor is helpful.

Just my thoughts.

Locke, MD

From: [mailto: ] On Behalf Of Malia, MDSent: Wednesday, December 03, 2008 5:45 AMTo: compkarori@...; practiceimprovement1 Subject: Re: Super Obese --> RE: language question

Considering time management, I gotta be truthful, this discussion isn't good use of our time. Semantics won't change a thing for how the patient is cared for. We have the height and weight noted, we say "morbidly obese" (there is no high end of that description) and we perhaps add other points like "abdominal exam limited by obesity." The point is made clear. Then we get to the real clear issue at hand, making a plan for the patient's conditions/health.Don't waste time even thinking of other "better" words, it's a useless effort and no one benefits.IMHOTim

..

December 3, 2008

Tim, on the one hand I agree, but on the other hand, words are all we have in the note to describe a patient.

When a patient is being referred or a patient we haven't seen very often and doesn't ring a bell, etc, words are what give us a description of the patient.

Saying someone is obese probably doesn't separate out the super super obese patient in our minds or give the consultant a good idea of what they are coming up against.

Granted, the consultant and I will get the whole picture when the patient shows up in the office.

I agree one could spend many hours possibly wasted coming up with subtle variations on how obese someone is.

But I think it is sort of like diabetes -- are they diet controlled, oral med controlled, insulin controlled, brittle, etc.

Diabetes or Obese doesn't always give the full flavor of the diagnosis.

Sometimes a descriptor is helpful.

Just my thoughts.

Locke, MD

From: [mailto: ] On Behalf Of Malia, MDSent: Wednesday, December 03, 2008 5:45 AMTo: compkarori@...; practiceimprovement1 Subject: Re: Super Obese --> RE: language question

Considering time management, I gotta be truthful, this discussion isn't good use of our time. Semantics won't change a thing for how the patient is cared for. We have the height and weight noted, we say "morbidly obese" (there is no high end of that description) and we perhaps add other points like "abdominal exam limited by obesity." The point is made clear. Then we get to the real clear issue at hand, making a plan for the patient's conditions/health.Don't waste time even thinking of other "better" words, it's a useless effort and no one benefits.IMHOTim

..

December 3, 2008

Yeah, but honestly, I think the best place to emphasize the massive size of someone

is in the A/P since that is the place most specialists or other docs will look

first. In the exam, we'll have the weight, height, BMI, or perhaps a note that

" pt too obese for office scale " which is a give away. I don't need

anything else too special in the exam note besides " morbidly obese " .

Anything more can be in A/P and related to why I am advising something specific.I would not call someone with a BMI over 40 as just " obese. "

Definitely " morbidly obese " is a better phrase.But I would contend

that anything beyond that for special wording isn't too important, or could be

explained in the A/P.TimOn

Wed, December 3, 2008 11:07 am EST, Locke wrote:

Tim, on the one hand I agree, but on the other hand, words

are all we have in the note to describe a patient.

When a patient is being referred or a patient we haven't

seen very often and doesn't ring a bell, etc, words are what give us a

description of the patient.

Saying someone is obese probably doesn't separate out the

super super obese patient in our minds or give the consultant a good idea of

what they are coming up against.

Granted, the consultant and I will get the whole picture

when the patient shows up in the office.

I agree one could spend many hours possibly wasted coming

up with subtle variations on how obese someone is.

But I think it is sort of like diabetes -- are they diet

controlled, oral med controlled, insulin controlled, brittle, etc.

Diabetes or Obese doesn't always give the full flavor of

the diagnosis.

Sometimes a descriptor is helpful.

Just my thoughts.

Locke, MD

From:

[mailto: ] On Behalf Of

Malia, MDSent: Wednesday, December 03,

2008 5:45 AMTo: compkarori@...;

practiceimprovement1 Subject: Re: Super

Obese --> RE: language question

Considering time management, I gotta be truthful, this discussion isn't good use of our time. Semantics won't change a thing for how the patient is cared for. We have the height and weight noted, we say " morbidly obese "

(there is no high end of that description) and we perhaps add other points

like " abdominal exam limited by obesity. " The point is made clear.

Then we get to the real clear issue at hand, making a plan for the patient's

conditions/health.Don't waste time even thinking of other

" better " words, it's a useless effort and no one benefits.IMHOTim

..

---------------------------------------- Malia, MDMalia Family Medicine & Skin Sense Laser6720 Pittsford-Palmyra Rd.Perinton Square MallFairport, NY 14450 (phone /

fax)www.relayhealth.com/doc/DrMaliawww.SkinSenseLaser.com--

Confidentiality Notice --This email message, including all the attachments, is

for the sole use of the intended recipient(s) and contains confidential information.

Unauthorized use or disclosure is prohibited. If you are not the intended recipient,

you may not use, disclose, copy or disseminate this information. If you are not the

intended recipient, please contact the sender immediately by reply email and destroy

all copies of the original message, including attachments.----------------------------------------

December 3, 2008

Good points, Tim.

I still think there probably is a level above morbidly obese -- I guess that is where the super obese tag comes in.

But you are correct, the A/P is a good place for further description of a disease, especially if referring.

Locke, MD

From: Malia, MD Sent: Wednesday, December 03, 2008 11:47 AMTo: lockecolorado@...; practiceimprovement1 Subject: RE: Super Obese --> RE: language question

Yeah, but honestly, I think the best place to emphasize the massive size of someone is in the A/P since that is the place most specialists or other docs will look first. In the exam, we'll have the weight, height, BMI, or perhaps a note that "pt too obese for office scale" which is a give away. I don't need anything else too special in the exam note besides "morbidly obese". Anything more can be in A/P and related to why I am advising something specific.I would not call someone with a BMI over 40 as just "obese." Definitely "morbidly obese" is a better phrase.But I would contend that anything beyond that for special wording isn't too important, or could be explained in the A/P.Tim

Tim, on the one hand I agree, but on the other hand, words are all we have in the note to describe a patient.

When a patient is being referred or a patient we haven't seen very often and doesn't ring a bell, etc, words are what give us a description of the patient.

Saying someone is obese probably doesn't separate out the super super obese patient in our minds or give the consultant a good idea of what they are coming up against.

Granted, the consultant and I will get the whole picture when the patient shows up in the office.

I agree one could spend many hours possibly wasted coming up with subtle variations on how obese someone is.

But I think it is sort of like diabetes -- are they diet controlled, oral med controlled, insulin controlled, brittle, etc.

Diabetes or Obese doesn't always give the full flavor of the diagnosis.

Sometimes a descriptor is helpful.

Just my thoughts.

Locke, MD

From: [mailto: ] On Behalf Of Malia, MDSent: Wednesday, December 03, 2008 5:45 AMTo: compkarori@...; practiceimprovement1 Subject: Re: Super Obese --> RE: language question

Considering time management, I gotta be truthful, this discussion isn't good use of our time. Semantics won't change a thing for how the patient is cared for. We have the height and weight noted, we say "morbidly obese" (there is no high end of that description) and we perhaps add other points like "abdominal exam limited by obesity." The point is made clear. Then we get to the real clear issue at hand, making a plan for the patient's conditions/health.Don't waste time even thinking of other "better" words, it's a useless effort and no one benefits.IMHOTim

.. ---------------------------------------- Malia, MDMalia Family Medicine & Skin Sense Laser6720 Pittsford-Palmyra Rd.Perinton Square MallFairport, NY 14450 (phone / fax)www.relayhealth.com/doc/DrMaliawww.SkinSenseLaser.com-- Confidentiality Notice --This email message, including all the attachments, is for the sole use of the intended recipient(s) and contains confidential information. Unauthorized use or disclosure is prohibited. If you are not the intended recipient, you may not use, disclose, copy or disseminate this information. If you are not the intended recipient, please contact the sender immediately by reply email and destroy all copies of the original message, including attachments.----------------------------------------

December 5, 2008

Tim's right...drop it

To: compkarori@...; practiceimprovement1 Sent: Wednesday, December 3, 2008 7:45:21 AMSubject: Re: Super Obese --> RE: language question

Considering time management, I gotta be truthful, this discussion isn't good use of our time. Semantics won't change a thing for how the patient is cared for. We have the height and weight noted, we say "morbidly obese" (there is no high end of that description) and we perhaps add other points like "abdominal exam limited by obesity." The point is made clear. Then we get to the real clear issue at hand, making a plan for the patient's conditions/health.Don't waste time even thinking of other "better" words, it's a useless effort and no one benefits.IMHOTim> > > > I like the term> > Jolly obese ...> > > > I agree with megan.> > Once they are Morbidly Obese -- you could differentiate w/ Mild, Moderate,> > and Severe Morbid

Obesity.> >> > Although the argument could be made -- Are there varying degrees of> > Morbidly?> >> > Or is that like -- Mild, Moderate, and Severe Death?> > There really is not gradation for some problems.> >> > If nothing else, as long as the phrasing makes sense to you, it probably> > doesn't matter whether it is "correct" or not -- it just reminds you of the> > patient's situation.> >> > Did stumble on this...> >> > Technically, I guess there is a classification for the BMI > 50 - super> > obese.> >> > Some sites suggested that those w/ BMI >60 are -- super super obese.> >> > http://www.asbs. org/Newsite07/ media/fact- sheet4_morbid- obesity.pdf> >> >> > Weight classifications for adults:> >> > o Super

obese: A person with a BMI of 50 or more> >> > 50,000 adults are super obese in the U.S.> >> > o Morbidly obese: A person with a BMI of 40 or more, or a BMI of 35 or more> > with an obesity-related disease, such as type 2 diabetes, heart disease or> > sleep apnea> >> > 15 million adults are morbidly obese in the U.S.> >> > o Obese: A person with a BMI of 30 – 39.9> >> > 64 million adults are obese in the U.S.> >> > o Overweight: A person with a BMI of 25 – 29.9> >> > 134 million adults are overweight or obese in the U.S.> >> >> > http://www.asbs. org/html/ pdf/2004_ ASBS_Consensus_ Conference_ Statement. pdf> >> >> > Between 1986 and 2000, prevalence of obesity (BMI > 30 kg/m2) doubled,> > morbid obesity (BMI > 40

kg/m2) quadrupled, and super obesity (BMI > 50> > kg/m2) increased fivefold in US adults.> >> >> > http://www.drmartin -duce.com/ html_en/obesity_ frame.html> >> > Classification of obesity according to BMI and severity of risk factors:> >> > Categories BMI Values> > A: Normal weight <25> B: Overweight 25-27> > C: Overweight + 27-30> > D: Obese> > (Class 1) 30-35> > E: Obese> > (Class 2) 35-40> > F: Morbid Obesity 40-50> > G: Super Obesity 50-60> > H: Super-Super Obesity > 60> > Advisory Committee: American Society for Bariatric Surgery.> > Obes. Surg. 7:523, 1997.> >> > ============ ========= ======> >> > Here is an interesting related story.> >> > http://news. yahoo.com/ s/afp/healthchin ausoffbeat; _ylt=AuE. fKD4K1xxqEI_ v1UHi1wDW7oF> >> >> > To shed pounds, three Americans head to China> >> > by nne Barriaux nne Barriaux – Tue Dec 2, 3:14 pm ET> > Play Video AFP – Americans losing weight the Chinese way> >> > Slideshow: Americans try living in China to lose weight> >> > AFP/File – R-L: Three American men - Alonzo Bland and brothers Walt > > and - walk in the Chinese …> >> > TIANJIN, China (AFP) – Three American men have taken the unusual step of> > moving to China in an extreme attempt to shed huge amounts of weight at a> > fat reduction clinic -- and have become surprise local celebrities.> >> > Alonzo Bland, 33, and brothers Walt and , 56 and 50, have> >

lived in the northern Chinese city of Tianjin since the middle of this year> > as part of an effort to break away from their unhealthy lifestyles back> > home.> >> > Together, they have lost a combined 192 kilogrammes (427 pounds) and are> > aiming to shed over 100 more.> >> > snip/snip> >> > Locke, MD> >> >> > ____________ _________ _________ __> >> From: Practiceimprovement 1yahoogroups (DOT) com> > [mailto:Practiceimp rovement1@ yahoogroups. com] On Behalf Of Skaggs> > Sent: Tuesday, December 02, 2008 7:38 PM> > To: practiceimprovement 1> > Subject: [Practiceimprovemen t1] language question> >> > I am finding myself without a good descriptive term to use in my exams. How> > do you guys describe obesity that is "beyond morbid"? For body

habitus, I> > usually choose from lean, muscular, well developed and well nourished,> > overweight (applied to BMI 26-30), obese (BMI 31-33) and morbidly obese (BMI> >> 33)> >> > Problem is, I have more and more patients with BMIs that are A LOT more than> > 33....like 46 to 56...and I haven't been able to think of a term that sounds> > nonjudgmental and still conveys the reality.> >> > Any suggestions?> >> > --> > Annie Skaggs> > Lexington, KY> >> >> > > > --> Graham Chiu> http://www.synapsed irect.com> Synapse - the use from anywhere EMR.> > ------------ --------- --------- ------> >

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