# Situation: The public health nurse visits adults with noncommunicable diseases (NCDs) in their homes and runs lifestyle counseling sessions at the Barangay Health Station (BHS). A 41-year-old woman who is 159 cm tall chose her own diet and activity changes 3 months ago. The nurse reviews her record: Start: weight 68 kg, waist 88 cm, brisk walking 30 minutes a week Now: weight 67 kg, waist 82 cm, brisk walking 160 minutes a week Using the Asia-Pacific cut-offs adopted locally, which evaluation of her progress is BEST supported? Round off body mass index (BMI) to one decimal place.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=627219  
> language: ko  
> subject: Nursing Practice I — Community Health Nursing

## 문제

Situation: The public health nurse visits adults with noncommunicable diseases (NCDs) in their homes and runs lifestyle counseling sessions at the Barangay Health Station (BHS).

A 41-year-old woman who is 159 cm tall chose her own diet and activity changes 3 months ago. The nurse reviews her record:
Start: weight 68 kg, waist 88 cm, brisk walking 30 minutes a week
Now: weight 67 kg, waist 82 cm, brisk walking 160 minutes a week
Using the Asia-Pacific cut-offs adopted locally, which evaluation of her progress is BEST supported? Round off body mass index (BMI) to one decimal place.

## 보기

1. Her waist is now normal, so her follow-up can be spaced out
2. She is improving, but BMI and waist remain above cut-offs **✔ 정답**
3. Her BMI has dropped from the obese to the overweight range
4. The plan is not working, since she lost only 1 kg of weight

**정답: 2**

## 해설

Her BMI fell from 68 ÷ 1.59² = 26.9 to 67 ÷ 1.59² = 26.5 kg/m², which is still obese under the Asia-Pacific cut-off of 25 kg/m² or more. Her waist fell by 6 cm to 82 cm, still at or above the 80 cm cut-off for abdominal obesity in women, and she now exceeds the 150-minute weekly activity target. The plan is working with gradual change and should continue with follow-up, but she has not yet reached either cut-off.

## 심화 해설

Evaluation of Progress Using Asia-Pacific Cut-offs

The woman’s current BMI is calculated as 67 ÷ (1.59 × 1.59) = 26.5 kg/m², down from 26.9 kg/m² three months ago. Under the Asia-Pacific classification, a BMI of 25 kg/m² or greater is already considered obese, not merely overweight. Therefore, although her BMI has decreased slightly, she remains in the obese range by this regional standard .

Her waist circumference improved from 88 cm to 82 cm, a reduction of 6 cm. However, the cut-off for abdominal obesity in women is 80 cm, so her current waist measurement is still at or above the threshold [2]. This distinction matters because abdominal obesity is an independent risk factor for noncommunicable diseases and is not fully captured by BMI alone [2]. A person can have a normal BMI but still carry excess visceral fat, which is why waist circumference is measured separately in NCD risk assessment.

Her physical activity increased from 30 minutes to 160 minutes of brisk walking per week. This now exceeds the commonly recommended minimum of 150 minutes of moderate-intensity activity per week. The change in activity level is substantial and indicates that the behavioral intervention is being adopted.

Key point! The plan is working, but success is defined by reaching the cut-offs, not by the speed of weight loss. A loss of only 1 kg over three months may seem small, yet it is accompanied by a meaningful reduction in waist circumference and a large increase in physical activity. Gradual change is often more sustainable than rapid weight loss.

Watch out! Do not interpret a BMI of 26.5 kg/m² as “overweight” using Western cut-offs. In the Asia-Pacific region, the threshold for obesity is lower (25 kg/m²) because metabolic complications appear at lower BMI levels in Asian populations . The same principle applies to waist circumference: the cut-off for women is 80 cm, not the higher values used in some other guidelines [2].

The most accurate evaluation is that she is improving but has not yet reached either the BMI or waist circumference target. Follow-up should continue, and the current plan should be reinforced rather than changed or discontinued.References (research sources)

- [2]Abdominal Obesity, Adipokines and Non-communicable Diseases.Research articleDhawan D, Sharma S (2020) · DOI: 10.1016/j.jsbmb.2020.105737

## 임상 시나리오

Asia-Pacific NCD Progress EvaluationBMI, waist, and activity tracking in home-based counseling
Under the Asia-Pacific cut-offs, a BMI of 25 kg/m2 or more is already classified as obese, not overweight. This woman’s BMI decreased from 26.9 to 26.5, so she remains in the obese range.

Her waist circumference improved from 88 cm to 82 cm, but the cut-off for abdominal obesity in women is 80 cm. She is still at or above the threshold, so central obesity risk persists.

Physical activity rose from 30 to 160 minutes of brisk walking per week, now exceeding the 150-minute weekly target. This indicates the behavioral plan is being adopted.

CautionSuccess is defined by reaching the cut-offs, not by speed of weight loss. Continue follow-up and reinforce gradual change because both BMI and waist remain above risk thresholds.

## 핵심 개념

- **Asia-Pacific BMI cut-off** — BMI 25 kg/m2 or more is classified as obese, unlike the WHO cut-off of 30.
- **Abdominal obesity cut-off for women** — Waist circumference of 80 cm or more indicates central obesity in Asian women.
- **Moderate-intensity physical activity target** — At least 150 minutes per week is recommended for NCD risk reduction.

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