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University of Vermont UVM ScholarWorks Family Medicine Clerkship Student Projects Family Medicine Community 2021 Waist Circumference as a Vital Sign Brad R. Fiske Follow this and additional works at: https://scholarworks.uvm.edu/fmclerk Part of the Medical Education Commons, and the Primary Care Commons Recommended Citation Fiske, Brad R., "Waist Circumference as a Vital Sign" (2021). Family Medicine Clerkship Student Projects. 662. https://scholarworks.uvm.edu/fmclerk/662 This Book is brought to you for free and open access by the Family Medicine Community at UVM ScholarWorks. It has been accepted for inclusion in Family Medicine Clerkship Student Projects by an authorized administrator of UVM ScholarWorks. For more information, please contact donna.omalley@uvm.edu.
Implementation of
Waist
Circumference
Measurements at
Norwalk
Community Health
Clinic
Presentation by Brad Fiske MS III
Mentors/PI’s: Cristina Smina MD & Giselle Volney MD
My role in this project: • This project (and the research writeup from which this presentation is derived) was developed by Drs. Cristina Smina MD & Giselle Volney MD PGY-3 of the Norwalk Hospital Internal Medicine Residency Program. • My role as a medical student was/is to help convert the original research protocol into an implementable quality improvement project at the Norwalk Community Health Center. • Moving forward, I will be helping with in-person measurements at the clinic and any other tasks the PI’s listed above need help with. • For this FM clerkship project, my deliverable is the QI writeup from the original proposal. • This PowerPoint is an abbreviated version of the QI writeup. QI writeup itself will be emailed to clerkship staff as a deliverable.
Why use waist
circumference as a
vital sign?
Obesity is associated with increased risk of cardiovascular disease (CVD) & type 2
diabetes mellitus (DM II); the prevalence of obesity has increased worldwide
throughout the last three decades 1.
•
High levels of visceral adipose tissue (VAT) are associated with chronic
inflammation and conditions such as metabolic syndrome, insulin resistance,
and CVD as well as breast, colorectal, & prostate cancers 2.
•
BMI as a measurement does not account for variations in lean mass vs. adipose
tissue, nor does BMI distinguish between subcutaneous & visceral fat stores.
Thus, the amount of VAT present may differ radically within a narrow range of
BMI values.
•
Waist circumference (WC) measurements have been demonstrated to provide
additive information for predicting all-cause mortality & CVD-related mortality
in obese patients; it is also a more accurate measurement of VAT stores than is
BMI1,3.
Elevated waist circumference: 40” (102 cm) + in men; 35” (88 cm) + in women (6)Cost of comorbidities
associated with VAT
• According to CDC: obesity-related
medical costs in 2008 dollar value:
$147 billion
• Associated costs in productivity
loss = $3.38 billion $6.38 billion
(CDC)
• Costs are projected to increase to
be upwards of $65 billion/year in
the US by 2030 (5)“I think it’s a good idea---I wouldn’t
be opposed to having it done at
annual physicals or other routine
appointments”- CJB; office staff at
local Dr.’s office
Community
perspective “I would be open to having it (WC
measurement) done when I go to
the doctor’s (office). A lot of the life-
insurance paperwork we need to fill
for patients already requires this
kind of measurement.” –NC; nurse at
local Dr.’s office• Methods:
- Male & female patients with a BMI between 25-34.9 who have upcoming visits will
be included in the study.
•
- During the patient’s first visit after enrollment, medical assistants (MA) will perform
the WC measurement (inches). The MA will also instruct the patient on how to take
their own WC. A hand-out with graphic (Fig.1) will be used to assist with instruction
and will be given to patient prior to their leaving the office. The patient will also be
provided a log where they can keep track of their measurements.
•
- WC obtained by the MA on initial visit will be entered into the EMR as a vital sign
with the BMR.
•
- Patients will be asked to measure their WC every month and to keep a log of these
measurements on the provided document.
•
- A follow-up telephone or in-person visit with a resident will occur every three
months throughout a 12-month period. The patient will be assigned the same
Methodology:
resident provider (or a provider from the same group) to ensure continuity of care.
•
o In-person visits at the 3- & 9-month marks will be “non-billable”
•
o Telephone follow-ups conducted at the other three-month intervals will be
“non-billable” as well.
•
o These visits will pertain strictly to management of BMI & WC; no other
medical concerns will be addressed during these visits.
•
o At each visit, patients will be educated on the “Weight Loss & Waist Loss” to
further solidify their understanding and to encourage them in adopting the
necessary lifestyle changes.
Resident providers will spend time educating patients on
recommended diet & physical activity per current
recommendations.
Patients will be offered a nutrition consult.
•
o No weight loss drugs will be used.Waist Circumference Protocol (Fig. 1) :
(1) Identify the top of iliac crest on both sides:
this is where the measuring tape will be
placed.
(2) Stand straight with feet within shoulder
distance apart & weight evenly distributed.
(3) Hold the tape snug across the abdomen at
the end of a normal breath; repeat this
measurement twice (i.e. repeat step 3 to get
two measurements)
(4) If measurements are more than 0.4”
(approx. 3/8”) apart, repeat step 3 until
measurements fall within 3/8” of each
other.
(5) Once measurements are taken, calculate the
average and record the average calculated
as the WC measurement (in inches).- Measurements of WC, BMI, and weight
will be exported into an excel spread
sheet. A graph showing the trends of
their measurements over the 12-month
period will be created and provided to
Proposed results the patient.
collection: - The delta of patients’ weight and waist
measurements will be analyzed using
Statistical Package for the Social Sciences
(SPSS)- A survey at the end of the 12-month
period will be administered to every
patient who completed the program. This
survey will provide metrics on:
o Percentage of patients who found
Evaluation of the campaign helpful in encouraging
lifestyle changes as it relates to diet
effectiveness &
and exercise.
o Percentage of patients who found
limitations campaign helpful in achieving
weight-loss and waist-loss goals.
o Percentage of clinic staff who found
measuring of WC to be tedious and
not helpful.Future interventions
could include the
IMO, this is a great start development of an app
as a screening patients that can link the
prior to their developing patient’s at-home-
sequelae from excessive measurements and
Recommendations
visceral adiposity. update their WC
measurements to the
EMR in live time.
for future Other improvements
interventions
could be development
of app-alerts through There could also be an
the patient portal “opt-in” social network
system to allow for daily for participants in the
motivation and program to foster better
reminders according to adherence and support.
current weight-loss &
exercise guidelines.• 1. Ross R, Neeland IJ, Yamashita S, et al. Waist
circumference as a vital sign in clinical practice: a Consensus
Statement from the IAS and ICCR Working Group on Visceral
Obesity. Nat Rev Endocrinol. 2020;16(3):177-189.
doi:10.1038/s41574-019-0310-7
• 2. Wang YC, McPherson K, Marsh T, Gortmaker SL,
Brown M. Health and economic burden of the projected obesity
trends in the USA and the UK. The Lancet. 2011;378(9793):815-
825. doi:10.1016/S0140-6736(11)60814-3
• 3. Shuster A, Patlas M, Pinthus JH, Mourtzakis M.
The clinical importance of visceral adiposity: a critical review of
methods for visceral adipose tissue analysis. Br J Radiol.
References 2012;85(1009):1-10. doi:10.1259/bjr/38447238
• 4. Brown P. Waist circumference in primary care.
Prim Care Diabetes. 2009;3(4):259-261.
doi:10.1016/j.pcd.2009.09.006
• 5. Jensen MD, Ryan DH, Apovian CM, et al. 2013
AHA/ACC/TOS Guideline for the Management of Overweight
and Obesity in Adults. Circulation. 2014;129(25 Suppl 2):S102-
S138. doi:10.1161/01.cir.0000437739.71477.ee
• 6. Arnett DK, Blumenthal RS, Albert MA, et al. 2019
ACC/AHA Guideline on the Primary Prevention of
Cardiovascular Disease. Circulation. 2019;140(11):e596-e646.
doi:10.1161/CIR.0000000000000678Interview Consent Forms • Sent to clerkship staff via email to preserve anonymity.
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