When studying for the ABOM examination, medications, genetics, comorbidities, and hormones often take the spotlight. However, one area that may be neglected is correctly obtaining accurate measurements. Proper measurements of blood pressure or adipose deposition are essential to review.

Blood pressure monitoring is vital to ensure accurate results and avoid overdiagnosing and overtreating hypertension. Systolic blood pressure may appear artificially elevated if patient positioning is ignored. For example, if the patient’s legs are crossed and they are talking while their blood pressure is being checked, it is possible to diagnose hypertension inaccurately. Accurate patient position and proper cuff size are essential in blood pressure monitoring and diagnosing a condition that can require medication.

Proper techniques for obtaining blood pressure are described below:

  • Patients should be seated comfortably. The back should be supported, and the legs should be uncrossed.
  • The blood pressure cuff should be on bare skin.
  • The patient’s arm should be supported at the level of the heart.
  • The cuff bladder should encircle 80% of the arm circumference.
  • There should be no talking while obtaining the measurement.

The term ‘large adult’ for a blood pressure cuff is a misnomer. The proper size should be based on the arm circumference, not a subjective ‘adult-size’. For example, an adolescent with an arm circumference of 36 centimeters requires a ‘large adult’ blood pressure cuff despite their age. Be familiar with this principle and able to recognize obesity stigmas. A patient with obesity should feel comfortable in the setting in which they are being seen. Patients can feel isolated and embarrassed when the correct size blood pressure cuff is not readily available for them. Making sure there are a variety of cuff sizes can help promote patient comfort.

For the ABOM board examination, you should also be familiar with obtaining an accurate waist circumference and how these findings correlate to eventual outcomes. For the most accurate results, abdominal waist circumference should be obtained at the level of the iliac crest (the highest point). The measuring tape should be snug but not compress the skin, and should be kept parallel to the floor. The measurement taken at the end of normal expiration is the most precise.

Abdominal obesity indicates excess adiposity and infers an increased risk of cardiometabolic risks such as diabetes, metabolic syndrome, hypertension, etc. Cut-off values for abdominal obesity in the U.S. and Canada are as follows:

  • Men: >102 cm (>40 in)
  • Women: >88 cm (>35 in)

Importantly, waist circumference cut-offs of ≥80 cm for women and ≥90 cm for men are consistent with abdominal obesity in South Asian, Southeast Asian, and East Asian populations per the World Health Organization. These ethnic populations have similar cardiovascular and diabetes risks at these lower values compared to Caucasians at higher thresholds.

The abdominal circumference is recommended to provide additional information on cardiovascular risk. In fact, a large study (>15,000 participants) of patients with coronary artery disease were evaluated to see which group had the highest mortality rate. Interestingly, they found that patients with increased waist circumference had higher associated 5-year mortality rates across all BMI ranges. Even more interestingly, patients with a normal BMI but increased waist circumference had the highest 5-year mortality risk. This highlighted the significance of visceral fat in relation to adiposopathy.

Although BMI is generally the first step in determining the degree of excess weight to estimate adiposity, remember that this does not always accurately determine cardiovascular risks, as this may be better predicted by waist circumference, waist-to-hip ratio, or body-mass composition in certain populations.

There you have it! These topics are likely to show up on examination day, and now will hopefully not take you by surprise.

Sample Question

A 14-year-old adolescent male presents to his family physician for his annual physical examination. He is in the 105th percentile for weight and the 65th percentile for height. His upper arm circumference is 36 cm. Which of the following would likely cause an inaccurately elevated systolic blood pressure?

A. Using a large adult-sized cuff (16×36 cm)

B. Sitting in a chair with back support

C. Having the patient rest his arm by his side

D. Telling the patient not to talk during inflation

E. Deflating the cuff at 5-10 mmHg per second

Next Week: Monthly Knowledge Check (Subscribe!). This is a review checklist of must-know items for ABOM exams based on the previous four blog topics (Contrave®, SADI-S, childhood growth charts, and BP & waist circumference measurements). In addition, this will include a brief explanation of the correct answers to previous sample questions.

Upcoming: Homeostatic vs. Hedonic Eating, Supplements, MC4r Deficiency, and OSA

For more practice questions, check out the following:

  • Obesity Medicine Board Review Questions (2026): Q’s 58, 80, 104, and 107.
  • Obesity Medicine Practice Tests (2026): Qs 16, 125, 249, and 283.

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