Obesity history, physical exam, laboratory, body composition, and energy expenditure: An Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) 2022

Abstract

Background: This Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) on History, Physical Exam, Body Composition and Energy Expenditure is intended to provide clinicians an overview of the clinical and diagnostic evaluation of patients with pre-obesity/obesity.

Methods: The scientific information for this CPS is based upon published scientific citations, clinical perspectives of OMA authors, and peer review by the Obesity Medicine Association leadership.

Results: This CPS outlines important components of medical, dietary, and physical activity history as well as physical exams, with a focus on specific aspects unique to managing patients with pre-obesity or obesity. Patients with pre-obesity/obesity benefit from the same preventive care and general laboratory testing as those without an increase in body fat. In addition, patients with pre-obesity/obesity may benefit from adiposity-specific diagnostic testing - both generally and individually - according to patient presentation and clinical judgment. Body composition testing, such as dual energy x-ray absorptiometry, bioelectrical impedance, and other measures, each have their own advantages and disadvantages. Some patients in clinical research, and perhaps even clinical practice, may benefit from an assessment of energy expenditure. This can be achieved by several methods including direct calorimetry, indirect calorimetry, doubly labeled water, or estimated by equations. Finally, a unifying theme regarding the etiology of pre-obesity/obesity and effectiveness of treatments of obesity centers on the role of biologic and behavior efficiencies and inefficiencies, with efficiencies more often associated with increases in fat mass and inefficiencies more often associated with decreases in fat mass.

Conclusion: The Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) on History, Physical Exam, Body Composition and Energy Expenditure is one of a series of OMA CPSs designed to assist clinicians in the care of patients with the disease of pre-obesity/obesity.

Keywords: Android fat; Body composition; Clinical practice statement; Energy expenditure; Percent body fat; Visceral fat.

Fig. 1

Dual Energy X-Ray Absorptiometry (DXA): Derivable Information. DXA can provide information about patients including percent body fat, android fat, visceral fat, lean body mass, and bone mineral density [54]. Not all DXA scans measure and/or report android and visceral fat.

Fig. 2

Body Weight Homeostasis. The variance in resting metabolic rate (RMR) is dependent upon genetic influences on body mass-dependent energy expenditure (i.e., individuals of male sex, increased height, increased muscle, younger age, and with obesity typically have higher RMRs). An increase in fat free mass may not only increase RMR, but may also increase hunger, which influences the nutritional aspect of energy balance. Beyond RMR, other common contributors to variances in energy expenditure include non-exercise activity thermogenesis (NEAT), physical exercise activity, and diet-induced thermogenesis (DIT). Finally, RMR can be affected by climate. Hotter environments increase RMR to cool the body; colder environments increase RMR through non-shivering thermogenesis to warm the body [[111], [112], [113], [114],116].

Fig. 3

Energy Expenditure: Obesity Medicine Association Physical Activity Goals. The OMA Physical Activity Goals include steps, which may be augmented by moderate intensity or vigorous intensity aerobic activity minutes per week, and resistance training sessions [106,117,118].