Kushner Robert F, Blatner Dawn Jackson
Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
J Am Diet Assoc. 2005 May;105(5 Suppl 1):S53-62. doi: 10.1016/j.jada.2005.02.014.
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.
超重和肥胖患者的风险评估是治疗过程中重要且必要的首要步骤。风险分类首先要确定体重指数（BMI）、BMI为35或更低者的腰围以及合并症的存在情况。除了对所有患者进行空腹血糖和血脂检测外，其他诊断性实验室检查则根据患者的风险因素状况来选择。了解导致并维持患者超重和肥胖的原因是接下来的主要步骤，对于设计个性化和有针对性的治疗至关重要。通过让患者绘制其体重模式与相关生活事件的图表，并评估详细的饮食和身体活动史来确定这些信息。在临床实践中，计算估计能量平衡既有好处也有局限性。儿科和老年患者是需要额外关注的特殊人群。采用团队方法以及未来在身体成分和能量消耗实际测量方面的发展，可能会实现评估过程的改进。
