The A & W Of Obesity Assessment

One of the common problems in clinical practice is initiating a non-judgemental conversation about body weight.

Research shows that many practitioners are surprisingly uncomfortable addressing the issue – most do not know how to bring up the topic, which is why they’d rather ignore it.

For clinicians, who simply do not know how to bring up the issue of weight, here is a simple tip: ask about appetite.

Indeed, we have all learnt that appetite is an important vital sign and should really be part of any clinical assessment (as should questions about mood or sleep). Often, a loss or increase in appetite can be a sign of other underlying health issues. As a corollary to this, as long as there is no change in appetite, things are probably not too serious.

No patient I know of has ever objected to being asked about their appetite.

But here is the catch – to really understand the relevance of the reported change in appetite, given that appetite is rather subjective – any question about appetite always needs to be followed by a question about body weight.

If appetite is reportedly bad – you would expect to see weight loss.

If appetite is reportedly increased – you would expect to see weight gain.

If appetite is unchanged – you would expect weight to be stable.

Thus, a question about appetite quite naturally opens the door to further questions about body weight.

Obviously, you would have to use your clinical judgement to decide whether or not the patient may have concerns about their weight and respond appropriately.

Incidentally, changes in body weight without subjective changes in appetite, should also prompt further investigation.

But remember, you can always get to discussing weight via questions about appetite (just remember A&W).

@DrSharma
Edmonton, AB