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Obesity Management Guidelines, National Institutes of Health / NHLBI TreeCalc

 
The EBMcalc module Obesity Management Guidelines, National Institutes of Health / NHLBI TreeCalc is available in EBMcalc Complete Edition.
 

 
This Decision TreeCalc evaluates the following decision points:

• BMI ≥25 OR waist circumference >35 in. (F), >40 in. (M)
• Assess risk factors: Cigarette smoking, Hypertension, LDL ≥160 or 130-159 plus 2 risk factors, HDL <35, IFG 110-125, Family history of premature CAD, Age ≥45 (M), ≥55 (F). BMI ≥30 OR BMI >25-29.9 with ≥2 risk factors OR waist circumference >35 in. (F) OR >40 in. (M) and ≥2 risk factors
• Clinician and patient devise treatment strategy. Recommend to lose 10 % of baseline weight at a rate of 1 - 2 lb/wk in 6 months.
• Diet: 500 - 1000 kcal/day reduction from usual intake. Physical Activity: 30- 45 min of moderate levels of physical activity ( 150 cal expenditure per day ) , 3-5 days per week. Behavior therapy: consider attitudes, beliefs, and histories. Build and cultivate a partnership with the patient. Set achievable goals. Help the patient to modify behaviors. Progress being made?
• Diet: 500 - 1000 kcal/day reduction from usual intake. Physical Activity: 30- 45 min of moderate levels of physical activity ( 150 cal expenditure per day ) , 3-5 days per week. Behavior therapy: consider attitudes, beliefs, and histories. Build and cultivate a partnership with the patient. Set achievable goals. Help the patient to modify behaviors. Pharmacotherapy: consider as an adjunct to lifestyle changes. Progress being made?
• Diet: 500 - 1000 kcal/day reduction from usual intake. Physical Activity: 30- 45 min of moderate levels of physical activity ( 150 cal expenditure per day ) , 3-5 days per week. Behavior therapy: consider attitudes, beliefs, and histories. Build and cultivate a partnership with the patient. Set achievable goals. Help the patient to modify behaviors. Pharmacotherapy: consider as an adjunct to lifestyle changes. Weight loss surgery: consider if other attempts at weight loss have failed. Progress being made?
• Does the patient want to lose weight?
• Hx BMI ≥25

 
Decision Tree end points include:

• Maintenance counseling. Periodic weight, BMI, and waist circumference check.
• Assess reasons for failure
• Advise to maintain weight loss/ address other risk factors. Periodic weight, BMI and waist circumference check.
• Brief reinforcement/ educate on weight management.