Selection of Tools for Comprehensive Assessment of Patients with Obesity for Patient-oriented Treatment in Primary Care

Abstract

In the modern world, obesity has become a large problem and now is one of the most complex medical and social problems. That is why the assessment of the health status of an obese patient is of the great importance for maintaining health, eliminating risk factors, patient-oriented treatment and improving the quality of their life. The article analyzes literature data regarding tools for complex assessment of obese patients at the level of primary health care (PHC) for the implementation of patient-oriented treatment. The bibliosemantic method and the system analysis method were used for the analysis. A systematic review of literature sources identified the most practical tools for assessing obesity at PHC level. It is noted that for clinical and instrumental assessment of the patient’s condition, anthropometric, instrumental indicators should be used: height, body weight, waist circumference, hip circumference, blood pressure; calculated indexes: Quetelet index (BMI), body surface area (BSA), waist/hip ratio (WHR), Conicity Index (ConI), A body shape index (ABSI), Abdominal Volume Index (AVI). These indicators better describe abdominal obesity and make possible to assess the risks of non-communicable diseases. Laboratory indicators include determination of fasting glucose, insulin, HOMA index, lipidogram (with determination of total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein, very low-density lipoprotein, atherogenicity index). The best tools for assessing psychosocial status and sleep were: the Dutch Eating Behavior Questionnaire (DEBQ), the Hospital Anxiety and Depression Scale (HADS), the Beck Depression Scale, the Hamilton Anxiety Scale (HAM-A), the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS). The SF-36 (36-Item Short Form Health Survey), IPAQ, FINDRISK scale should be used to assess the quality of life and risks. For a complex assessment of obese patients at the primary care level, in addition to generally accepted clinical and laboratory examinations, it is necessary to study eating behavior, anxiety and depression levels, sleep quality, quality of life, physical activity level, and the risk of diabetes in patients. This allows family doctors to improve their patient-centered approach. Due to their compactness, availability and high sensitivity, they can be widely used by general practitioners.