Reexamining the Physical Examination for Obese Patients

Silk, Ann W.; McTigue, Kathleen M.

doi:10.1001/jama.2010.1950

Cited by 48 publications

(34 citation statements)

References 9 publications

(7 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…61 Unique aspects of the physical examination for patients with obesity have recently been reviewed. 62 No single laboratory test or diagnostic evaluation is indicated for all patients with obesity, although a fasting glucose and lipid profile is consistent with current guidelines. 63,64 The specific evaluation performed should be based on the presentation of symptoms, risk factors, index of suspicion, and screening guidelines appropriate for the patient.…”

Section: Identifying the High-risk Obese Patientmentioning

confidence: 89%

Clinical Assessment and Management of Adult Obesity

Kushner

2012

Circulation

View full text Add to dashboard Cite

Section: Identifying the High-risk Obese Patientmentioning

confidence: 89%

Clinical Assessment and Management of Adult Obesity

Kushner

2012

Circulation

View full text Add to dashboard Cite

“…Obesity in the United States (and elsewhere) is well understood to limit the diagnostic evaluation of patients both through physical examination and radiologic imaging, and diagnostic strategies need to accommodate this. [52][53][54] Obesity is an independent risk factor for kidney stone formation, with 59% of our subjects stratified as having high BMI. 17,55 Our study suggests that a high-BMI protocol is a feasible way to include all patients while still achieving substantial dose reduction.…”

Section: Discussionmentioning

confidence: 99%

Accuracy of Reduced-Dose Computed Tomography for Ureteral Stones in Emergency Department Patients

Moore

Daniels

Ghita

et al. 2015

Annals of Emergency Medicine

View full text Add to dashboard Cite

Study objective-Reduced-dose computed tomography (CT) scans have been recommended for diagnosis of kidney stone but are rarely used in the emergency department (ED) setting. Test characteristics are incompletely characterized, particularly in obese patients. Our primary outcome is to determine the sensitivity and specificity of a reduced-dose CT protocol for symptomatic ureteral stones, particularly those large enough to require intervention, using a protocol stratified by patient size.Methods-This was a prospective, blinded observational study of 201 patients at an academic medical center. Consenting subjects underwent both regular-and reduced-dose CT, stratified into a high and low body mass index (BMI) protocol based on effective abdominal diameter. Reduceddose CT scans were interpreted by radiologists blinded to regular-dose interpretations. Follow-up for outcome and intervention was performed at 90 days.Results-CT scans with both regular and reduced doses were conducted for 201 patients, with 63% receiving the high BMI reduced-dose protocol. Ureteral stone was identified in 102 patients (50.7%) of those receiving regular-dose CT, with a ureteral stone greater than 5 mm identified in 26 subjects (12.9%). Sensitivity of the reduced-dose CT for any ureteral stone was 90.2% (95% confidence interval [CI] 82.3% to 95.0%), with a specificity of 99.0% (95% CI 93.7% to 100.0%). For stones greater than 5 mm, sensitivity was 100% (95% CI 85.0% to 100.0%). Reduced-dose CT identified 96% of patients who required intervention for ureteral stone within 90 days. Mean * Corresponding Author. Chris.Moore@yale.edu, Twitter: Chris.Moore@Yale_EUS. Author contributions: CLM, MG, and GPG conceived the study and designed the trial. CLM, DS, and CPG obtained research funding.CLM and SL supervised the conduct of the trial and data collection. SL participated in recruitment of patients. GG performed overreadings of the CT scans in the trial. CLM, SL, and AM managed the data, including quality control. AM and CPG provided statistical advice. BD, GG, AM, DS, and CPG provided advisement on study design and methodology. CLM, SL, AM, and CPG analyzed the data. CLM drafted the article, and all authors contributed substantially to its revision. CLM takes responsibility for the paper as a whole.Presented as an abstract at the Society for Academic Emergency Medicine annual meeting, May 2013, Atlanta, GA.The content of this article is solely the responsibility of the authors and does not necessarily represent the official views of the AHRQ. HHS Public Access Author Manuscript Author ManuscriptAuthor ManuscriptAuthor Manuscript reduction in size-specific dose estimate was 18.6 milligray (mGy), from 21.7 mGy (SD 9.7) to 3.4 mGy (SD 0.9). Conclusion-CT

show abstract

“…Many NCDs have common etiologies, whereby a shift from a vertical to a horizontal approach will ultimately pave the path to more effective prevention and management strategies. In order to warrant adequate patient care and progress during the life course, special emphasis should be applied in teaching practicing doctors and residents, as well as other health care workers, about how to deal with the NCD epidemic, how to adequately diagnose and treat patients with obesity, and how to avoid the negative impact of body weight bias and stigmatization [33, 18]. Moreover, pre-, post-graduate, and continuous education of health care workers should offer a much more prominent place to obesity but also lifestyle medicine into the curriculum, given its prevalence and relevance to reduce the global impact on health care systems, economies, and societies.…”

Section: Strategy and Perspectivesmentioning

confidence: 99%

The ABCD of Obesity: An EASO Position Statement on a Diagnostic Term with Clinical and Scientific Implications

et al. 2019

View full text Add to dashboard Cite

Obesity is a frequent, serious, complex, relapsing, and chronic disease process that represents a major public health problem. The coining of obesity as an adiposity-based chronic disease (ABCD) is of particular relevance being in line with EASO’s proposal to improve the International Classification of Diseases ICD-11 diagnostic criteria for obesity based on three dimensions, namely etiology, degree of adiposity, and health risks. The body mass index as a unique measurement of obesity does not reflect the whole complexity of the disease. Obesity complications are mainly determined by 2 pathological processes, i.e., physical forces (fat mass disease) as well as endocrine and immune responses (sick fat disease), which are embedded in a cultural and physical context leading to a specific ABCD stage.

show abstract

Reexamining the Physical Examination for Obese Patients

Cited by 48 publications

References 9 publications

Clinical Assessment and Management of Adult Obesity

Clinical Assessment and Management of Adult Obesity

Accuracy of Reduced-Dose Computed Tomography for Ureteral Stones in Emergency Department Patients

The ABCD of Obesity: An EASO Position Statement on a Diagnostic Term with Clinical and Scientific Implications

Contact Info

Product

Resources

About