Reexamining the Physical Examination for Obese Patients

The notion of the standard 70-kg patient is outdated; in the US, the mean weight of men is now 88.3 kg and the mean weight of women is 74.7 kg. The most recent national data show that 35% of adults are obese, 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.