Assess for Obesity-Related Complications

As noted in the Kickstart section, obesity is associated with a wide range of chronic conditions that can affect morbidity and mortality. The risk for these conditions increases with the degree of obesity (Apovian et al., 2025). Obesity can affect multiple systems, including cardiovascular, pulmonary, endocrine, neurological, gastrointestinal, musculoskeletal, and integumentary systems.

Cardiovascular disease, hypertension, dyslipidemia, chronic kidney disease, certain cancers, metabolic dysfunction–associated steatotic liver disease (MASLD)/metabolic dysfunction–associated steatohepatitis (MASH), obstructive sleep apnea, type 2 diabetes, increased dementia risk, osteoarthritis/low back pain, and gastroesophageal reflux are among the common manifestations of these effects. 

The assessment of a patient with overweight or obesity should include assessments for the presence of such conditions. A baseline laboratory evaluation for patients with obesity should include (Apovian et al., 2025):

Fasting plasma glucose
Fasting lipid panel (total cholesterol, LDL, HDL, triglycerides)
TSH and free thyroxine (fT4)
Complete metabolic panel (for ALT, AST, creatinine, BUN, and electrolytes)
A1C and fasting insulin
Complete blood count

Additional assessments for other comorbidities as well as for endocrine or genetic causes of obesity may be appropriate based on the overall clinical assessment. The assessment should also consider whether common combinations of interrelated comorbid conditions such as metabolic syndrome and cardiovascular-kidney-metabolic (CKM) syndrome are present. 

Metabolic syndrome describes a constellation of atherosclerotic cardiovascular risk factors that are associated with abdominal obesity. Although definitions vary among organizations, a widely accepted definition is that patients with metabolic syndrome have three or more of the following risk factors (OMA, 2025):

Abdominal obesity (men ≥40 in; women ≥35 in)
Triglycerides ≥150 mg/dL
HDL cholesterol <40 mg/dL for men or <50 mg/dL for women
Blood pressure ≥130/85 mm Hg
Fasting glucose ≥100 mg/dL

Practice Pearl | Obesity as a Chronic Disease

Kathryn N. Porter Starr, PhD, RDN, Associate Professor of Medicine – Geriatrics, Duke University School of Medicine, Research Health Scientist, Durham VA Health System

As a result of biomedical advances and research, we have been able to understand and be able to stand firm that obesity is a chronic disease... it is complex. It is relapsing, it is remitting. It also affects over 180 comorbid conditions.

CKM syndrome is defined as interactions between cardiovascular, renal, and metabolic problems that result in multiorgan dysfunction and increased risk for poor cardiovascular outcomes. CKM is staged as (OMA, 2025):

Neurovascular risk management.

Stage 0: No risk factors
Stage 1: Overweight/obesity or abdominal adiposity
Stage 2: Any metabolic syndrome criteria or chronic kidney disease (CKD)
Stage 3: Subclinical atherosclerosis, elevated cardiac biomarkers, stage 4 or 5 CKD, or high 10-year predicted cardiovascular disease risk in individuals with excess/dysfunctional adiposity, other risk factors, or CKD
Stage 4: Coronary heart disease, heart failure, stroke, peripheral arterial disease, or atrial fibrillation in individuals with excess/dysfunctional adiposity, other metabolic risk factors, or CKD

The approach to patients with obesity should include management of all identified comorbidities.

Assess | Approaches to Implement