Assessment Models and Tools

This section provides a range of models and tools relevant to the clinical assessment of adults living
with obesity. These resources are designed to support physiotherapy learners in applying evidence-informed, structured approaches to assessment in practice.

Body Mass Index Calculator (link to NHS website)

This tool calculates Body Mass Index (BMI) using a person's weight (kg) divided by height (m²).

Formula: BMI = weight (kg) / [height (m)]²

Clinical interpretation: The following are BMI cut-offs for obesity as per the WHO (Caucasian, Europid and North American ethnicity):

Class I: 30.0-34.9kg/m²
Class II: 35.0-39.9kg/m²
Class III: 40- 49.9kg/m²
Class IV: 50–59.9kg/m²
Class V: ≥ 60kg/m²

It is important to note that while BMI is a useful initial screening tool in the diagnosis of obesity, it does not account for fat distribution or individual health risk.

Waist to Height Ratio Calculator (link to NHS website)

This calculator determines waist-to-height ratio (WHtR), which assesses fat distribution and central obesity risk.

Formula: WHtR = waist circumference (cm) / height (cm)

Clinical interpretation: A WHtR ≥0.5 suggests increased health risk due to central adiposity.

This measure is particularly relevant to the EASO Framework, which emphasises waist circumference and body composition in diagnosing and staging obesity.

Waist to Hip Ratio Calculator (link to WHR Calculator)

This tool calculates Waist-to-Hip Ratio (WHR) by dividing waist circumference by hip circumference.

Formula: WHR = waist (cm) / hips (cm)

Clinical interpretation: a WHR >0.85 for women and a WHR >0.90 for men indicate higher cardiometabolic risk associated with abdominal obesity.

4Ms Framework of Obesity

4Ms Framework graphic

Adapted by the PROMINENCE team: Original
Developer: Sharma AM. M, M, M & M: a mnemonic for assessing obesity. Obesity reviews. 2010 Nov;11(11):808-9. https://doi.org/10.1111/j.1467-789X.2010.00766.x

Adapted by the PROMINENCE team, the 4Ms Framework (Sharma, 2010) provides a holistic structure
for assessing underlying causes and impacts of obesity. It considers:

Mental: Psychological well-being, mood, eating behaviours
Mechanical: Physical function, mobility, musculoskeletal issues
Metabolic: Cardiometabolic health (e.g., diabetes, hypertension)
Monetary: Social determinants of health, including economic barriers

This model encourages clinicians to take a whole-person approach, helping identify factors influencing both obesity and treatment outcomes.

The 4Ms Framework can be used in practice to provide you with a practical structure to help guide your clinical assessment of adults living with obesity. It can support you in identifying the key drivers, complications, and barriers influencing a person’s health and weight. The framework can be used
to structure a more holistic and efficient assessment, including elements of the history, physical examination, and any relevant investigations.

5As Framework for Obesity Management

Developer: Appendix to: Wharton S, Lau DCW, Vallis M, et al. Obesity in adults: a clinical practice guideline

CMAJ 2020. doi:10.1503/cmaj.191707.

Download 5As Framework for Obesity Management in Adults

This infographic, used in the 2020 Canadian Clinical Practice Guidelines, provides a visual presentation
of the 5As Framework (Wharton et al., 2020). This framework provides a structured, evidence-based approach to clinical conversations about obesity. The five steps are:

Ask – for permission to discuss weight
Assess – obesity-related risks, root causes, and readiness to change
Advise – on treatment options using evidence-based recommendations
Agree – on goals and expectations collaboratively
Assist – in identifying barriers, resources, and follow-up plans

This framework supports respectful, patient-centred communication and guides clinical assessment and goal setting.

Sample Clinical Assessment Proforma

This downloadable proforma, developed by the PROMINENCE team, offers a structured guide
for conducting a physiotherapy assessment with an adult living with obesity. It integrates key elements of obesity-specific history, physical assessment domains and relevant outcome measures.

This can be used as a learning tool or clinical guide during clinical practice or simulated scenarios.

Download the Proforma Clinical Assessment Sample

Acknowledgement: Special thanks to the Physiotherapy Team at the Center for Obesity Management
at St Columcille's Hospital, Loughlinstown, Dublin, Ireland for sharing resources which supported
the development of this sample proforma.

Diagnostic Blood Tests

Diagnostic blood tests description graphic

Adapted by the PROMINENCE team: Original

This resource names and briefly describes the purpose of some of the relevant diagnostic blood tests that may be performed by other members of the multidisciplinary team. Understanding the outcomes
of these tests can support your clinical decision-making and contribute to a more holistic approach
to care.

It is important to note that other tests may also be relevant i.e., urinalysis for micro-proteinuria (screens for early kidney damage, especially in the presence of diabetes or hypertension).

The list of tests outlined in this resource was adapted by the PROMINENCE team from the Association
for the Study of Obesity on the island of Ireland (ASOI) Adult Obesity Clinical Practice Guideline adaptation (2022) chapter on ‘Clinical Assessment of People Living with Obesity’.