Obesity seems to be underdiagnosed in primary care. When evaluating and treating a patient, the vital signs include blood pressure, heart rate, respiration rate, body temperature, oxygen, and pain. If one of these is abnormal, we evaluate and intervene early to prevent long-term complications. To prevent long-term complications of obesity, should BMI be included as one of the vital signs?  Kristine Yearwood, DNP, FNP, El Paso, Tex. 

This is an excellent recommendation. In some practices, weight and BMI are trended in the electronic health record and other patient tracking systems. Unfortunately, recent evidence indicates that only 26% of primary-care providers regularly note elevated BMI and then provide counseling and track weight-loss goals as part of routine practice.1

More importantly, along with including this “vital sign,” clinicians would need to recognize the elevated BMI, rule out other causes for the weight gain (e.g., thyroid disease and high suspicion for Cushing syndrome), and provide patient interventions that would facilitate weight loss for health.

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The 2013 obesity guidelines from the American College of Cardiology and the American Heart Association provide a useful treatment algorithm of clinician recommendations for weight management that include measurement of waist circumference and screening for diabetes, dyslipidemia and hypertension.2— Katherine Pereira, DNP, RN, FNP-BC, ADM-BC, FAANP coordinator, FNP specialty, Duke University School of Nursing, Durham, N.C.


  1. Klabunde CN et al. Am J Health Promot. 2014;28(3):e67-e80.
  2. Jensen MD et al. Circulation. 2013; doi: 10.1161/​01.cir.0000437739.71477.ee.

These are letters from practitioners around the country who want to share their clinical problems and successes, observations and pearls with their colleagues. We invite you to participate. If you have a clinical question, submit it here.