Risk assessment of the overweight and obese patient.

Risk assessment of the overweight and obese patient is an important and necessary first step in the treatment process. Risk classification begins with determination of body mass index (BMI), waist circumference for those with a BMI of 35 or less, and presence of comorbid conditions. With the exception of measuring a fasting blood glucose and lipid panel on all patients, other diagnostic laboratory tests are selected based on the patient's risk factor status. Understanding the reasons leading to and sustaining the patient's overweight and obesity is the next major step and is paramount to designing individualized and targeted treatment. This information is ascertained by having the patient graph his or her weight pattern with associated life events and by assessing detailed dietary and physical activity histories. Calculating estimated energy balance has both benefits and limitations in clinical practice. Pediatric and geriatric patients represent special populations that require additional focus. Improvement in the assessment process will likely be achieved by using a team approach along with future developments in practical measurement of body composition and energy expenditure.