THE NOTION OF THE STANDARD 70-KG PATIENT IS OUT-dated; in the United States, the mean weight of men is now 88.3 kg and the mean weight of women is 74.7 kg.1 The most recent national data show that 35% of adults are obese,2 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.
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