Clinical skill 3. Measurement of Obesity : Waist circumference and BMI calculation
Obesity is defined as a condition in which there is an excess of body fat. The operational definition of obesity and overweight however are based on body size or body mass index
BMI which is closely related to body fatness. These BMI cut off point are arbitrary along a continuum of increasing risk with increasing
BMI. Cut offs used for the definition of obesity can be based on:
1. Statistical data from reference population 2. or on the excess morbidity and mortality associated with increasing body fat
content.
a. BMI body mass index
Height and weight are the most simple and commonly used measures. A number of weight for height indices have been developed of which the body mass index BMI
define as this following formula:
b. WC waist circumference and WHR waist to hip ratio
To determine the risk associ, we need to measured the distribution of body fat. Abdominal or visceral fat is associated with the cardiovascular rsik of the metabolic
syndrome.
For WC, the subject stands with feet 25-30 cm apart, weight evenly distributed. Measurement is taken midway between the inferior margin of the last rib and the crest of
the ilium in the horizontal plane. The measurer sits by the side of the subject and fits the tape snugly but not compressing soft tissues. Circumference is measured to nearest 0.1
cm
For hip circumference the measure is taken around the pelvis at the point of maximal protrusion of the buttocks.
Ratio of waist to hip ratio WHR is calculate by:
Tabel 1. Classification of Weight by BMI and Waist Circumference in Adult Asians
Classification BMI kgm
2
Risk of co-morbidities
Underweight 18.5
Low but increased risk of other clinical problem
Normal range 18.5 – 22.9
Average Overweight
At risk Obese I
Obese II 23
23 – 24.9 25 – 29.9
30 Increased
Moderate Severe
Waist circumference Normal
Abdominal obesity 90 cm men
80 cm women 90 cm
80 cm WHR
1.0 men 0.85 women
Udayana University Departement of Medicine Education, DME
33
Body weight kg Height m
=
BMI kgm
2
Waist circumference Hip circumference
= WHR
Clinical skill 4. Thyroid gland physical examination
a. Inspect the neck for the thyroid gland
Tip the patient’s head back a bit. Using tangential lighting derected downward from the tip of the patient’s chin, inspect the region below the cricoid cartilage for the gland.
Goiter is a general term for an enlarged thyroid gland. Ask the patient to sip some water and to extend the neck again and swallow. Watch for
upward movement of the thyroid gland, noting its contour and symmetri The thyroid cartilage, the cricoid cartilage, and the thyroid gland all rise with swallowing
and then fall to their resting positions.
b. Palpation
