Weight gain, excessive
Weight gain, excessive: Excerpt from Professional Guide to Signs & Symptoms (Fifth Edition)
Weight gain occurs when ingested calories exceed body requirements for energy, causing increased adipose tissue storage. It can also occur when fluid retention causes edema. When weight gain results from overeating, emotional factors—most commonly anxiety, guilt, and depression—and social factors may be the primary causes.
Among elderly people, weight gain commonly reflects a sustained food intake in the presence of the normal, progressive fall in basal metabolic rate. Among women, progressive weight gain occurs in pregnancy, whereas periodic weight gain usually occurs with menstruation.
Weight gain, a primary sign of many endocrine disorders, also occurs in conditions that limit activity, especially cardiovascular and pulmonary disorders. It can also result from drug therapy that increases appetite or causes fluid retention or from cardiovascular, hepatic, and renal disorders that cause edema.
History and physical examination
Determine your patient’s previous patterns of weight gain and loss. Does he have a family history of obesity, thyroid disease, or diabetes mellitus? Assess his eating and activity patterns. Has his appetite increased? Does he exercise regularly or at all? Next, ask about associated symptoms. Has he experienced visual disturbances, hoarseness, paresthesia, or increased urination and thirst? Has he become impotent? If the patient is female, has she had menstrual irregularities or experienced weight gain during menstruation?
Form an impression of the patient’s mental status. Is he anxious or depressed? Does he respond slowly? Is his memory poor? What medications is he using?
During your physical examination, measure skin-fold thickness to estimate fat reserves. (See Evaluating nutritional status.) Note fat distribution, the presence of localized or generalized edema, and overall nutritional status. Examine the patient for other abnormalities, such as abnormal body hair distribution or hair loss and dry skin. Take and record the patient’s vital signs.
Medical causes
Acromegaly
This disorder causes moderate weight gain. Other findings include coarsened facial features, prognathism, enlarged hands and feet, increased sweating, oily skin, deep voice, back and joint pain, lethargy, sleepiness, heat intolerance and, occasionally, hirsutism.
Cushing’s syndrome (hypercortisolism)
Excessive weight gain, usually over the trunk and the back of the neck (buffalo hump), characteristically occurs in this disorder. Other cushingoid features include slender extremities, moon face, weakness, purple striae, emotional lability, and increased susceptibility to infection. Gynecomastia may occur in men; hirsutism, acne, and menstrual irregularities may occur in women.
Diabetes mellitus
The increased appetite associated with this disorder may lead to weight gain, although weight loss sometimes occurs instead. Other findings include fatigue, polydipsia, polyuria, nocturia, weakness, polyphagia, and somnolence.
Heart failure
Despite anorexia, weight gain may result from edema. Other typical findings include paroxysmal nocturnal dyspnea, orthopnea, and fatigue.
Hyperinsulinism
This disorder increases appetite, leading to weight gain. Emotional lability, indigestion, weakness, diaphoresis, tachycardia, visual disturbances, and syncope also occur.
Hypogonadism
Weight gain is common in this disorder. Prepubertal hypogonadism causes eunuchoid body proportions with relatively sparse facial and body hair and a high-pitched voice. Postpubertal hypogonadism causes loss of libido, impotence, and infertility.
Hypothalamic dysfunction
Conditions such as Laurence-Moon-Biedl syndrome cause a voracious appetite and subsequent weight gain along with altered body temperature and sleep rhythms.
Hypothyroidism
In this disorder, weight gain occurs despite anorexia. Related signs and symptoms include fatigue; cold intolerance; constipation; menorrhagia; slowed intellectual and motor activity; dry, pale, cool skin; dry, sparse hair; and thick, brittle nails. Myalgia, hoarseness, hypoactive deep tendon reflexes, bradycardia, and abdominal distention may occur. Eventually, the face assumes a dull expression with periorbital edema.
Metabolic syndrome
This syndrome, previously called syndrome X, consists of a group of disorders that affect metabolism, including excessive weight gain (usually in the central abdomen), hypertension (blood pressure greater than 135/85 mm Hg), abnormal cholesterol levels (high low-density lipoprotein and triglyceride levels, low high-density lipoprotein level), and high insulin levels. Inefficient use of insulin in the body is thought to be a major contributor to metabolic syndrome, as are physical inactivity, poor diet, and genetic factors. Individuals with metabolic syndrome are at a significantly increased risk for heart disease, stroke, and diabetes. Treatment typically involves exercising, following a heart-healthy diet, and refraining from smoking; medical therapy may be prescribed to treat the individual disorders.
Nephrotic syndrome
In this syndrome, weight gain results from edema. Severe edema (anasarca) can increase body weight by up to 50%. Related effects include abdominal distention, orthostatic hypotension, and lethargy.
Pancreatic islet cell tumor
This type of tumor causes excessive hunger, which leads to weight gain. Other findings include emotional lability, weakness, malaise, fatigue, restlessness, diaphoresis, palpitations, tachycardia, visual disturbances, and syncope.
Preeclampsia
In this disorder, rapid weight gain (exceeding the normal weight gain of pregnancy) may accompany nausea and vomiting, epigastric pain, elevated blood pressure, and blurred or double vision.
Sheehan’s syndrome
Most common in women who experience severe obstetric hemorrhage, this syndrome may cause weight gain caused by impaired pituitary gland function.
Other causes
Drugs
Corticosteroids, phenothiazines, and tricyclic antidepressants cause weight gain from fluid retention and increased appetite. Other drugs that can lead to weight gain include hormonal contraceptives, which cause fluid retention; cyproheptadine, which increases appetite; and lithium, which can induce hypothyroidism.
Special considerations
Psychological counseling may be needed for patients with excessive weight gain, particularly when it’s caused by emotional problems or alters body image. If the patient is obese or has a cardiopulmonary disorder, any exercise should be monitored closely. Further study to rule out possible secondary causes should include thyroid-stimulating hormone determination and dexamethasone suppression testing. Laboratory test results of all patients ideally include cardiac risk factors: cholesterol, triglyceride, and glucose levels.
Pediatric pointers
Weight gain in children can result from an endocrine disorder such as Cushing’s syndrome or from disorders that cause inactivity, such as Prader-Willi syndrome, Down syndrome, Werdnig-Hoffmann disease, late stages of muscular dystrophy, and severe cerebral palsy.
The incidence of obesity is increasing among children. Nonpathologic causes include poor eating habits, sedentary recreation, and emotional problems, especially among adolescents. Regardless of the cause, discourage fad diets and provide a balanced weight loss program.
Geriatric pointers
Desired weights (associated with lowest mortality rates) increase with age.
Patient counseling
Educating the patient about weight control is extremely important. Stress the benefits of behavior modification and dietary compliance. Help the patient plan an appropriate exercise routine.
Pictures
Book Source Details
- Book Title: Professional Guide to Signs & Symptoms (Fifth Edition)
- Author(s): Springhouse
- Year of Publication: 2006
- Copyright Details: Professional Guide to Signs & Symptoms (Fifth Edition), Copyright © 2006 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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