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January 12, 2011

Reexamining the Physical Examination for Obese Patients

Author Affiliations

Author Affiliations: Internal Medicine Residency Program, University of Pittsburgh Medical Center (UPMC), UPMC Montefiore Hospital (Dr Silk), and Center for Research on Health Care, University of Pittsburgh (Dr McTigue), Pittsburgh, Pennsylvania.

JAMA. 2011;305(2):193-194. doi:10.1001/jama.2010.1950

The notion of the standard 70-kg patient is outdated; in the United States, the mean weight of men is now 88.3 kg and the mean weight of women is 74.7 kg.1 The most recent national data show that 35% of adults are obese,2 defined by a body mass index (BMI) of ≥30. These patients, like healthy-weight patients, rely on their primary care physicians for diagnosis of illness, but the physical examination is often particularly challenging. The primary techniques of the physical examination—inspection, palpation, auscultation, and percussion—are ways for physicians to try to confirm normal physiology and detect pathology. However, each of these techniques is undermined when the viscera and vasculature are enveloped in a thick layer of adipose tissue. To ensure good care of obese patients, special emphasis must be made in teaching physicians to overcome these challenges.