Diseases » Overweight » Diagnosis

Diagnosis of Overweight

Diagnostic Test list for Overweight:

The list of medical tests mentioned in various sources as used in the diagnosis of Overweight includes:

• Body Mass Index (BMI) - BMC 25..<30 is overweight; BMI >= 30 is obesity
• Weight-for-height charts
• Skinfold thickness measurement
• Bioelectrical impedance analysis (BIA)

Overweight Diagnosis: Book Excerpts

• Ask the Following Questions - OBESITY, PATHOLOGIC
• Differential Diagnosis - Obesity
• Approach to the Diagnosis - OBESITY
• History and physical examination - Abdominal distention
• Diagnosis - Obesity
• History and physical examination - Abdominal distention
• Differential Overview - Obesity
• History - Abdominal distention
• Clinical Features and Diagnosis - Obesity
• History and physical examination - Abdominal distention
• Approach to the Diagnosis - OBESITY

Tests and diagnosis discussion for Overweight:

Am I at Risk for Type 2 Diabetes: NIDDK (Excerpt)

Body mass index (BMI) is a measure of body weight relative to height. You can use BMI to see whether you are underweight, normal weight, overweight, or obese. Use the body mass index table below to find your BMI.

• Find your height in the left-hand column.
• Move across in the same row to the number closest to your weight.
• The number at the top of that column is your BMI. Check the word above your BMI to see whether you are normal weight, overweight, or obese.

For a printer-friendly version of this table, use the pdf.*

	Normal						Overweight					Obese
BMI	19	20	21	22	23	24	25	26	27	28	29	30	31	32	33	34	35	36
Height (inches)	Body Weight (pounds)
58	91	96	100	105	110	115	119	124	129	134	138	143	148	153	158	162	167	172
59	94	99	104	109	114	119	124	128	133	138	143	148	153	158	163	168	173	178
60	97	102	107	112	118	123	128	133	138	143	148	153	158	163	168	174	179	184
61	100	106	111	116	122	127	132	137	143	148	153	158	164	169	174	180	185	190
62	104	109	115	120	126	131	136	142	147	153	158	164	169	175	180	186	191	196
63	107	113	118	124	130	135	141	146	152	158	163	169	175	180	186	191	197	203
64	110	116	122	128	134	140	145	151	157	163	169	174	180	186	192	197	204	209
65	114	120	126	132	138	144	150	156	162	168	174	180	186	192	198	204	210	216
66	118	124	130	136	142	148	155	161	167	173	179	186	192	198	204	210	216	223
67	121	127	134	140	146	153	159	166	172	178	185	191	198	204	211	217	223	230
68	125	131	138	144	151	158	164	171	177	184	190	197	203	210	216	223	230	236
69	128	135	142	149	155	162	169	176	182	189	196	203	209	216	223	230	236	243
70	132	139	146	153	160	167	174	181	188	195	202	209	216	222	229	236	243	250
71	136	143	150	157	165	172	179	186	193	200	208	215	222	229	236	243	250	257
72	140	147	154	162	169	177	184	191	199	206	213	221	228	235	242	250	258	265
73	144	151	159	166	174	182	189	197	204	212	219	227	235	242	250	257	265	272
74	148	155	163	171	179	186	194	202	210	218	225	233	241	249	256	264	272	280
75	152	160	168	176	184	192	200	208	216	224	232	240	248	256	264	272	279	287
76	156	164	172	180	189	197	205	213	221	230	238	246	254	263	271	279	287	295

	Obese			Extreme Obesity
BMI	37	38	39	40	41	42	43	44	45	46	47	48	49	50	51	52	53	54
Height (inches)	Body Weight (pounds)
58	177	181	186	191	196	201	205	210	215	220	224	229	234	239	244	248	253	258
59	183	188	193	198	203	208	212	217	222	227	232	237	242	247	252	257	262	267
60	189	194	199	204	209	215	220	225	230	235	240	245	250	255	261	266	271	276
61	195	201	206	211	217	222	227	232	238	243	248	254	259	264	269	275	280	285
62	202	207	213	218	224	229	235	240	246	251	256	262	267	273	278	284	289	295
63	208	214	220	225	231	237	242	248	254	259	265	270	278	282	287	293	299	304
64	215	221	227	232	238	244	250	256	262	267	273	279	285	291	296	302	308	314
65	222	228	234	240	246	252	258	264	270	276	282	288	294	300	306	312	318	324
66	229	235	241	247	253	260	266	272	278	284	291	297	303	309	315	322	328	334
67	236	242	249	255	261	268	274	280	287	293	299	306	312	319	325	331	338	344
68	243	249	256	262	269	276	282	289	295	302	308	315	322	328	335	341	348	354
69	250	257	263	270	277	284	291	297	304	311	318	324	331	338	345	351	358	365
70	257	264	271	278	285	292	299	306	313	320	327	334	341	348	355	362	369	376
71	265	272	279	286	293	301	308	315	322	329	338	343	351	358	365	372	379	386
72	272	279	287	294	302	309	316	324	331	338	346	353	361	368	375	383	390	397
73	280	288	295	302	310	318	325	333	340	348	355	363	371	378	386	393	401	408
74	287	295	303	311	319	326	334	342	350	358	365	373	381	389	396	404	412	420
75	295	303	311	319	327	335	343	351	359	367	375	383	391	399	407	415	423	431
76	304	312	320	328	336	344	353	361	369	377	385	394	402	410	418	426	435	443

Source: Adapted from Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults: The Evidence Report. (Source: excerpt from Am I at Risk for Type 2 Diabetes: NIDDK)

Helping Your Overweight Child: NIDDK (Excerpt)

If you think that your child is overweight, it is important to talk with your child's doctor. A doctor is the best person to determine whether your child has a weight problem. Physicians will measure your child's weight and height to determine if your child's weight is within a healthy range. A physician will also consider your child's age and growth patterns to determine whether your child is overweight. Assessing overweight in children is difficult because children grow in unpredictable spurts.

For example, it is normal for boys to have a growth spurt in weight and catch up in height later.  It is best to let your child's doctor determine whether your child will "grow into" a normal weight. If your doctor finds that your child is overweight, he or she may ask you to make some changes in your family's eating and activity habits. (Source: excerpt from Helping Your Overweight Child: NIDDK)

NIDDK _ Statistics Related to Overweight and Obesity: NIDDK (Excerpt)

A number of methods are used to determine if an individual is overweight or obese. Some of them are based on mathematical calculations of the relation between height and weight--others are based on measurements of body fat. These methods are described below.

Body Mass Index

Body Mass Index (BMI) can be used to measure both overweight and obesity in adults. It is the measurement of choice for many obesity researchers and other health professionals. BMI is a direct calculation based on height and weight, and it is not gender-specific. Most health organizations and published information on overweight and its associated risk factors use BMI to measure and define overweight and obesity. BMI does not directly measure percent of body fat, but it provides a more accurate measure of overweight and obesity than relying on weight alone.

BMI is found by dividing a person's weight in kilograms by height in meters squared. The mathematical formula is:

weight (kg)/height squared (m²).

To determine BMI using pounds and inches, multiply your weight in pounds by 704.5,* then divide the result by your height in inches, and divide that result by your height in inches a second time (Source: excerpt from NIDDK _ Statistics Related to Overweight and Obesity: NIDDK)

NIDDK _ Statistics Related to Overweight and Obesity: NIDDK (Excerpt)

The National Institutes of Health (NIH) identify overweight as a BMI of 25-29.9 kg/m², and obesity as a BMI of 30 kg/m² or greater. However, overweight and obesity are not mutually exclusive, since obese persons are also overweight.¹ Defining overweight as a BMI of 25 or greater is consistent with the recommendations of the World Health Organization ² and most other countries. (Source: excerpt from NIDDK _ Statistics Related to Overweight and Obesity: NIDDK)

NIDDK _ Statistics Related to Overweight and Obesity: NIDDK (Excerpt)

Weight-for-height charts are another measure used to determine if a person is overweight (although they do not measure body fat). These charts, which have been used by doctors and other health care workers for decades, usually give a range of acceptable weights for a person of a given height. Many versions of weight-for-height charts exist, some showing different acceptable weight ranges for men and women. Health care workers often disagree over which is the best chart to use. The 2000 Dietary Guidelines for Americans, published jointly by the U.S. Departments of Agriculture and Health and Human Services, provide the most up-to-date weight-for-height chart. The healthy weight range in this chart corresponds to a BMI between 18.5 and 25. (Source: excerpt from NIDDK _ Statistics Related to Overweight and Obesity: NIDDK)

NIDDK _ Statistics Related to Overweight and Obesity: NIDDK (Excerpt)

Measurements of Body Fat

There are a number of ways to measure body fat. Historically, the standard method is to weigh a person underwater; this procedure is limited to laboratories with specialized equipment.

Other simpler methods for measuring body fat include skinfold thickness measurements and bioelectrical impedance analysis (BIA). Skinfold thicknesses are measures of the subcutaneous (lying just beneath the skin) fat at specific sites of a person's body, such as the triceps (the back of the upper arm). Accurate measurements of skinfold thickness depend on the skill of the examiner and may vary widely when measured by different examiners.

To measure body fat using BIA, a harmless amount of an electrical current is sent through the body. The body's ability to conduct an electrical current reflects the total amount of water in the body. Generally, a higher percent body water indicates a larger amount of muscle and lean tissue. Mathematical equations are used to translate the percent body water measure into an indirect estimate of body fat and lean body mass. A standard method should be used to measure bioelectrical impedance because dehydration, recent exercise, skin and room temperature, and placement of electrodes all can affect test results. To obtain the most precise reading, the person being tested should fast for at least 4 hours and lie down for at least several minutes prior to testing. BIA may not be accurate in severely obese individuals, and it is not useful for tracking short-term changes in body fat brought about by diet or exercise.

In addition to body weight and height measurements, health professionals may also rely on a person's waist measurement to determine the location of excess body fat and the corresponding health risks. Analogous to BMI, health risks increase as waist circumference increases. A woman whose waist measures more than 35 inches and a man whose waist measures more than 40 inches may be at particular risk for developing health problems. Studies indicate that increased abdominal or upper body fat is related to the risk of developing heart disease, diabetes, high blood pressure, gallbladder disease, stroke, and certain cancers, and is associated with overall mortality (likelihood of death). Body fat concentrated in the lower body (around the hips, for example) may be less harmful in terms of mortality and morbidity (likelihood of disease), with the exception of varicose veins and orthopedic problems (Source: excerpt from NIDDK _ Statistics Related to Overweight and Obesity: NIDDK)

NIDDK _ Statistics Related to Overweight and Obesity: NIDDK (Excerpt)

The definitions or measurement characteristics for overweight and obesity have varied over time, from study to study, and from one part of the world to another. The varied definitions affect the prevalence statistics of studies and make it difficult to compare data from different studies and from different countries. (Source: excerpt from NIDDK _ Statistics Related to Overweight and Obesity: NIDDK)

Diet: NWHIC (Excerpt)

The words obesity and overweight are generally used interchangeably. However, according to the Institute of Medicine report, their technical meanings are not identical. Overweight refers to an excess of body weight that includes all tissues, such as fat, bone and muscle. Obesity refers specifically to an excess of body fat. It is possible to be overweight without being obese, as in the case of a body builder who has a substantial amount of muscle mass. It is possible to be obese without being overweight, as in the case of a very sedentary person who is within the desirable weight range but who nevertheless has an excess of body fat. However, most overweight people are also obese and vice versa. Men with more than 25 percent and women with more than 30 percent body fat are considered obese. The USFDA has released a chart detailing recommended weights relative to height; women should be in the lower end of their appropriate weight range, according to the chart. (Source: excerpt from Diet: NWHIC)

Diagnosis of Overweight: medical news summaries:

The following medical news items are relevant to diagnosis and misdiagnosis issues for Overweight:

• About metabolic syndrome
• Bone problems for obese kids
• Children suffering adult disease
• Different types of sleep disorders plague many millions of Americans
• Overweight men risk having their prostate cancer misdiagnosed
• WHO concerned with increase incidence in stroke and heart disease
• More news »

Diagnostic Tests for Overweight: Online Medical Books

16 MEDICAL BOOKS ONLINE! Review excerpts from medical books online, free, without registration, for more information about diagnostis of Overweight.

OBESITY, PATHOLOGIC: Ask the Following Questions:
(Algorithmic Diagnosis of Symptoms and Signs)

1. Is there associated hyperphagia? If the patient recognizes that he or she has a ravenous appetite or eats more than is necessary, the possibility of an insulinoma or Fröhlich's syndrome should be considered.
2. Is the obesity centripetal? The presence of centripetal obesity, especially with moon facies, should suggest Cushing's syndrome.
3. Is the obesity mainly of the lower extremities? This finding would suggest lipodystrophy.
4. Is there mental retardation? The presence of mental retardation should suggest Laurence-Moon-Bardet-Biedl syndrome.
5. What is the sex of the patient? In male patients one should consider Klinefelter's syndrome, and in female patients one should consider polycystic ovary.

DIAGNOSTIC WORKUP

Routine laboratory tests include a CBC, urinalysis, chemistry panel, 2-hr postprandial blood sugar, and thyroid profile. If an insulinoma is strongly suspected, a 24- to 36-hr fast, a 5-hr glucose tolerance test, and tolbutamide tolerance test may be done. If Cushing's syndrome is suspected, a serum cortisol and cortisol suppression test should be done. Pelvic ultrasound will help diagnose polycystic ovaries. Chromosomal analysis will help diagnose Klinefelter's syndrome. Perhaps a psychiatrist should be consulted.

 

» READ BOOK EXCERPT ONLINE »

Source: Algorithmic Diagnosis of Symptoms and Signs, 2003

Obesity: Differential Diagnosis
(In A Page: Pediatric Signs and Symptoms)

• Exogenous obesity (most common)
  –No demonstrable disease as the cause
  –Excessive weight gain from imbalance between caloric intake and energy expenditure
  –Linear growth is robust and frequently accelerated

• Hormonal causes
  –Associated with poor linear growth
  –Hypercortisolism: Cushing syndrome is any type of glucocorticoid excess (endogenous or exogenous); Cushing disease describes pituitary ACTH overproduction
  –Hypothyroidism
  –Growth hormone deficiency

• Insulinoma
• Hypothalamic obesity
  –Tumors (e.g., craniopharyngiomas)
  –Following neurosurgery or irradiation
  –Head trauma
  –Infiltrative/inflammatory
• Genetic syndromes
  –Prader-Willi syndrome
  –Laurence-Moon-Bardet-Biedl syndrome
  –Alström syndrome
  –Cohen syndrome
  –Down syndrome
  –Carpenter syndrome
  –Grebe syndrome
  –Beckwith-Wiedemann syndrome
• Defects in metabolic/eating regulatory pathways is an area of intense investigation; multiple mutations are theoretically possible, but only a few have actually been discovered in humans
  –Congenital leptin deficiency (extremely rare)
  –Leptin resistance (more common than deficiency)
• Drugs
  –Chronic glucocorticoids
  –Neuropsychotropic medications
• Adiposogenital dystrophy syndrome

Workup and Diagnosis

• History: Age and course of onset; linear growth progression; birth and neonatal history (tone, failure to thrive); polydipsia, polyuria, polyphagia; dietary intake, physical activity; cold intolerance, constipation, dry skin, headaches; abdominal pain, onset of puberty if pubertal; developmental delay (genetic syndromes); family history of obesity and genetic disorders
• Physical exam: Vital signs (blood pressure); growth parameters (height, weight, BMI); distribution of fat, moon or coarse facies, pallor, buffalo hump, striae (Cushingoid appearance); acanthosis nigricans (dark velvety areas in skin folds; cutaneous marker of insulin resistance); abdominal masses, micropenis, hypogonadism; depressed deep tendon reflexes; in infants skin “puddling,” midline defects
• Diagnostic workup
  –24-hour urine free cortisol/creatinine ratio (best screen for Cushing syndrome)
  –MRI (hypothalamic/pituitary mass)
  –Adrenal ultrasound (if suspect adrenal mass)
  –Thyroid function tests (T4, TSH)
  –IGF-I and IGFBP-3; possibly provocative growth hormone testing (if suspect GH deficiency)
  –Genetic (FISH) testing for genetic syndromes
  –Serum leptin
• Labs: Urinalysis for glucose, serum glucose, fasting serum insulin, hemoglobin A1c
  –Fasting lipid profile, urine microalbumin

» READ BOOK EXCERPT ONLINE »

Source: In A Page: Pediatric Signs and Symptoms, 2007

OBESITY: Approach to the Diagnosis
(Differential Diagnosis in Primary Care)

It would be ridiculous to do a complete endocrine workup on every case of obesity, but thyroid function studies may be worthwhile. Patients who fail to lose weight on a strict diet may require hospitalization with observation. If they still fail to lose weight, a complete endocrine workup would seem to be indicated.

» READ BOOK EXCERPT ONLINE »

Source: Differential Diagnosis in Primary Care, 2007

Abdominal distention: History and physical examination
(Handbook of Signs & Symptoms (Third Edition))

If the patient’s abdominal distention isn’t acute, ask about its onset and duration and associated signs. A patient with localized distention may report a sensation of pressure, fullness, or tenderness in the affected area. A patient with generalized distention may report a bloated feeling, a pounding heart, and difficulty breathing deeply or when lying flat. (See Abdominal distention: Common causes and associated findings.)

The patient may also feel unable to bend at his waist. Make sure to ask about abdominal pain, fever, nausea, vomiting, anorexia, altered bowel habits, and weight gain or loss.

Obtain a medical history, noting GI or biliary disorders that may cause peritonitis or ascites, such as cirrhosis, hepatitis, or inflammatory bowel disease. (See Detecting ascites, page 4.) Also, note chronic constipation. Has the patient recently had abdominal surgery, which can lead to abdominal distention? Ask about recent accidents, even minor ones, such as falling off a stepladder.

Perform a complete physical examination. Don’t restrict the examination to the abdomen because you could miss important clues to the cause of abdominal distention. Next, stand at the foot of the bed and observe the recumbent patient for abdominal asymmetry to determine if distention is localized or generalized. Then assess abdominal contour by stooping at his side. Inspect for tense, taut skin and bulging flanks, which may indicate ascites. Observe the umbilicus. An everted umbilicus may indicate ascites or umbilical hernia. An inverted umbilicus may indicate distention from gas; it’s also common in obesity. Inspect the abdomen for signs of inguinal or femoral hernia and for incisions that may point to adhesions. Both may lead to intestinal obstruction. Then auscultate for bowel sounds, abdominal friction rubs (indicating peritoneal inflammation), and bruits (indicating an aneurysm). Listen for succussion splash — a splashing sound normally heard in the stomach when the patient moves or when palpation disturbs the viscera. However, an abnormally loud splash indicates fluid accumulation, suggesting gastric dilation or obstruction.

Next, percuss and palpate the abdomen to determine if distention results from air, fluid, or both. A tympanic note in the left lower quadrant suggests an air-filled descending or sigmoid colon. A tympanic note throughout a generally distended abdomen suggests an air-filled peritoneal cavity. A dull percussion note throughout a generally distended abdomen suggests a fluid-filled peritoneal cavity. Shifting of dullness laterally with the patient in the decubitus position also indicates a fluid-filled abdominal cavity. A pelvic or intra-abdominal mass causes local dullness upon percussion and should be palpable. Obesity causes a large abdomen without shifting dullness, prominent tympany, or palpable bowel or other masses, with generalized rather then localized dullness.

Palpate the abdomen for tenderness, noting whether it’s localized or generalized. Watch for peritoneal signs and symptoms, such as rebound tenderness, guarding, rigidity, McBurney’s point, obturator sign, and psoas sign. Female patients should undergo a pelvic examination; males, a genital examination. All patients who report abdominal pain should undergo a digital rectal examination with fecal occult blood testing. Finally, measure the patient’s abdominal girth for a baseline value. Mark the flanks with a felt-tipped pen as a reference for subsequent measurements.

» READ BOOK EXCERPT ONLINE »

Source: Handbook of Signs & Symptoms (Third Edition), 2006

Obesity: Diagnosis
(Professional Guide to Diseases (Eighth Edition))

Observation and comparison of height and weight to a standard table indicate obesity. Measurement of the thickness of subcutaneous fat folds with calipers provides an approximation of total body fat. Although this measurement is reliable and isn’t subject to daily fluctuations, it has little meaning for the patient in monitoring subsequent weight loss. Obesity may lead to serious complications, such as respiratory difficulties, hypertension, cardiovascular disease, diabetes mellitus, renal disease, gallbladder disease, psychosocial difficulties, and premature death.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Diseases (Eighth Edition), 2005

Abdominal distention: History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))

If the patient’s abdominal distention isn’t acute, ask about its onset and duration and associated signs. A patient with localized distention may report a sensation of pressure, fullness, or tenderness in the affected area. A patient with generalized distention may report a bloated feeling, a pounding heartbeat, and difficulty breathing deeply or breathing when lying flat. The patient may also feel unable to bend at his waist. Be sure to ask about abdominal pain, fever, nausea, vomiting, anorexia, altered bowel habits, and weight gain or loss.

Obtain a medical history, noting GI or biliary disorders that may cause peritonitis or ascites, such as cirrhosis, hepatitis, or inflammatory bowel disease. (See Detecting ascites.) Also note chronic constipation. Has the patient recently had abdominal surgery, which can lead to abdominal distention? Ask about recent accidents, even minor ones, like falling off a stepladder.

Perform a complete physical examination. Don’t restrict the examination to the abdomen because you could miss important clues to the cause of abdominal distention. Next, stand at the foot of the bed and observe the recumbent patient for abdominal asymmetry to determine if distention is localized or generalized. Then assess abdominal contour by stooping at his side. Inspect for tense, glistening skin and bulging flanks, which may indicate ascites. Observe the umbilicus. An everted umbilicus may indicate ascites or an umbilical hernia. An inverted umbilicus may indicate distention from gas; it’s also common in obese individuals. Inspect the abdomen for signs of an inguinal or femoral hernia and for incisions that may point to adhesions; both may lead to intestinal obstruction. Then auscultate for bowel sounds, abdominal friction rubs (indicating peritoneal inflammation), and bruits (indicating an aneurysm). Listen for a succussion splash—a splashing sound normally heard in the stomach when the patient moves or when palpation disturbs the viscera. An abnormally loud splash indicates fluid accumulation, suggesting gastric dilation or obstruction.

Next, percuss and palpate the abdomen to determine if distention results from air, fluid, or both. A tympanic note in the left lower quadrant suggests an air-filled descending or sigmoid colon. A tympanic note throughout a generally distended abdomen suggests an air-filled peritoneal cavity. A dull percussion note throughout a generally distended abdomen suggests a fluid-filled peritoneal cavity. Shifting of dullness laterally when the patient is in the decubitus position also indicates a fluid-filled abdominal cavity. A pelvic or intra-abdominal mass causes local dullness upon percussion and should be palpable. Obesity causes a large abdomen with generalized rather then localized dullness and without shifting dullness, prominent tympany, or palpable bowel or other masses.

Palpate the abdomen for tenderness, noting whether it’s localized or generalized. Watch for peritoneal signs and symptoms, such as rebound tenderness, guarding, rigidity, McBurney’s point, obturator sign, and psoas sign. Female patients should undergo a pelvic examination; males, a genital examination. All patients who report abdominal pain should undergo a digital rectal examination with fecal occult blood testing. Finally, measure abdominal girth for a baseline value. Mark the flanks with a felt-tipped pen as a reference point for subsequent measurements. (See Abdominal distention: Causes and associated findings, pages 6 and 7.)

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006

Obesity: Differential Overview
(Field Guide to Bedside Diagnosis)

❑ Caloric excess

❑ Depression

❑ Drugs

❑ Hypothyroidism

❑ Hypogonadism

❑ Cushing syndrome

❑ Polycystic ovary syndrome

❑ Hypothalamic

❑ Insulinoma

Diagnostic Approach

Body mass index (BMI) 5 mass (kilograms)/height (meters)². Overweight is
a BMI 25 to 30 kg/m² and obesity is a BMI .30 kg/m². A body mass index .30 correlates with increased risk of type 2 diabetes, sleep apnea syndrome, fatty liver, gallstones, gout, degenerative joint disease, and accelerated atherogenesis. Abdominal obesity (waist–hip ratio .0.95 in men and .0.85 in women) with excess visceral (intra-abdominal) fat is associated with elevated trigylceride, insulin and glucose levels, and confers an especially increased incidence of adverse outcomes.

Less than 1% of patients with obesity have an endocrine or other secon-dary cause.

Rapid weight gain is usually due to fluid accumulation, seen with congestive heart failure, renal failure or chronic liver disease. Ascites with the latter can
produce a prominent abdomen, which can be mistaken for obesity by the patient.

» READ BOOK EXCERPT ONLINE »

Source: Field Guide to Bedside Diagnosis, 2007

Abdominal distention: History
(Signs & Symptoms: A 2-in-1 Reference for Nurses)

If the patient’s abdominal distention isn’t acute, ask about its onset and duration and associated signs. A patient with localized distention may report a sensation of pressure, fullness, or tenderness in the affected area. A patient with generalized distention may report a bloated feeling, a pounding heart, and difficulty breathing when lying flat or breathing deeply. The patient may also feel unable to bend at his waist. Be sure to ask about abdominal pain, fever, nausea, vomiting, anorexia, altered bowel habits, and weight gain or loss.

Obtain a medical history, noting GI or biliary disorders that may cause peritonitis or ascites, such as cirrhosis, hepatitis, and inflammatory bowel disease. (See Detecting ascites.) Also note chronic constipation. Has the patient recently had abdominal surgery, which can lead to abdominal distention? Ask about recent accidents, even minor ones, like falling off a stepladder.

» READ BOOK EXCERPT ONLINE »

Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007

Obesity: Clinical Features and Diagnosis
(The Diagnostic Approach to Symptoms and Signs in Pediatrics)

Genetic Influences and Environmental Factors

In >99% ofobese children, the cause is a complex interaction between geneticinfluences and environmental factors leading to caloric intake inexcess of caloric expenditure. In general these children have normalphysical exam with normal intelligence, normal genital development,and normal or above average height for age. No further diagnosticinvestigation is necessary.

Whitaker et al. (1997) showed thatobesity in 1 or both parents can help predict a child'srisk of obesity in adulthood. In the past few years, 5 single-genedisorders resulting in early-onset obesity have been reported (Farooqiand O'Rahilly, 2000).

Endocrine Disorders

Endocrine causes of obesity are unusual exceptfor chronic corticosteroid therapy. Attenuation of growth velocityis characteristic of glucocorticoid excess, hypothyroidism, andgrowth hormone deficiency.

Glucocorticoid Excess

The term "Cushingsyndrome" is used to describe any type of glucocorticoidexcess. Most common cause of glucocorticoid excess in childhoodis chronic corticosteroid therapy. Other causes include adrenalhyperplasia and adrenal tumors (adenoma, carcinoma).

Cushing disease refers to pituitaryoverproduction of ACTH, which occurs with pituitary adenoma. EctopicACTH syndrome is production of excessive amount of ACTH from nonadrenalsource (neuroblastoma, Wilms tumor, thymoma, carcinoid).

Clinical features of glucocorticoidexcess include round facies, buffalo hump, hypertension, increasedweight gain, and decreased linear growth. Normally, serum cortisolconcentration tends to be higher in morning and lower in evening.Loss of this normal diurnal variation is screening test for Cushing syndrome.

Low-dose dexamethasone suppressiontest helps distinguish whether glucocorticoid excess is due to adrenalor pituitary cause. In low-dose test in normal individuals, plasmacortisol is decreased to <5 μg/dL. Individualswith Cushing disease usually fail to suppress cortisol with low-dosetest, but suppress with high-dose test. MRI should be performedwith suspected pituitary disease, although some tumors secretingACTH may be invisible with current techniques.

Failure to suppress cortisol secretionwith high-dose dexamethasone test usually indicates adrenal tumoror ectopic ACTH syndrome. Serum cortisol is high and ACTH is lowwith adrenal hyperplasia and adrenal tumors. ACTH stimulation testwith measurement of serum cortisol may help distinguish adrenaladenoma from adrenal carcinoma. Serum cortisol concentration usuallyincreases with adrenal adenoma, whereas no response occurs withadrenal carcinoma. With suspected adrenal tumor, CT of abdomen shouldbe performed. Both serum cortisol and ACTH concentrations are veryhigh with ectopic ACTH syndrome. Further investigation includingimaging is necessary to determine location and extent of tumor.

Hypothyroidism

Characteristic features of hypothyroidism,which may be congenital or acquired, are slow linear growth, dryhair and skin, constipation, cold intolerance, and sometimes enlargedthyroid gland. Thyroid hormone serum level [thyroxine (T₄)or free T₄] is low, whereas TSHlevel is high.

Growth Hormone Deficiency

Most striking feature of growth hormone deficiencyis severe decrease in postnatal linear growth (see Chap. 23, Growth Deficiency: Weight and Height).

Hypothalamic Dysfunction

Hypothalamiclesions associated with increased weight gain include neoplasm,trauma, and inflammatory disorders, but mechanism remains elusive.

Continuous food intake results in massiveweight gain.

CT and MRI help locate and define extentof lesion.

Polycystic Ovary Syndrome

Usuallyoccurs at puberty and is characterized by obesity, hirsutism, secondaryamenorrhea, and bilateral enlarged polycystic ovaries.

Ovaries may be palpable on exam andcan be demonstrated by pelvic U/S.

Hyperinsulinemia with insulin resistanceand acanthosis nigricans also may occur, especially in overweightindividuals. Measurement of fasting blood glucose and insulin levelsscreen for insulin resistance.

Cause of this disorder remains to bedetermined.

Syndromes

Alstrom Syndrome

This autosomal-recessive disorder, whosegene locus has been mapped to chromosome 2p13, is characterizedby obesity, usually occurring at 2–10 yrs, retinitis pigmentosawith visual loss, sensorineural hearing loss, acanthosis nigricans,chronic renal disease, diabetes mellitus with insulin resistance,and normal intelligence.

Bardet-Biedl Syndrome

Characterized by obesity, polydactyly, hypogonadism,pigmentary retinopathy with progressive decrease in visual acuity,and mental retardation. It has been linked to several genetic loci.

Carpenter Syndrome

Besides increased weight gain, characteristicfindings include flat nasal bridge, low-set ears, high-arched palate,lateral displacement of inner canthi, brachycephaly with craniosynostosis,polydactyly and partial syndactyly of feet, brachydactyly and partialsyndactyly of hands, and mental retardation.

Cohen Syndrome

In thisautosomal-recessive disorder, whose gene locus has been mapped tochromosome 8q22-q23, onset of obesity is in middle of childhood.

Clinical features include typical facieswith high nasal bridge, malar hypoplasia, short philtrum, prominentmaxillary central incisors and lips, and mild down-slanting palpebralfissures; narrow hands and feet with elongated fingers and toes;retinal degeneration with decreased vision; hypotonia; seizures;and mild mental retardation.

Prader-Willi Syndrome

Althoughthis disorder can occur in families, most instances are sporadic.

Clinical criteria for diagnosis havebeen described by Holm et al. (1993). These individuals have narrowface, almond-shaped eyes, small mouth with thin lips; developmentaldelay; mild to moderate mental retardation; and hyperphagia withobsessive food-seeking behavior. Obesity develops before 6 yrs ofage.

Deletions on proximal long arm of chromosome15 account for 70–80% of cases. The remainderare due to chromosome translocations and maternal uniparental disomy15. Fluorescence in situ hybridization (FISH) can detect the deletions.

Diagnostic Approach

If physicalexam and linear growth are normal, combination of genetic influencesand environmental factors is almost always the cause of obesity.

If decreased linear growth occurs,glucocorticoid excess, hypothyroidism, and growth hormone deficiencyshould be considered.

Many unusual syndromes associated withobesity may be distinguished by their clinical findings and moleculargenetic analysis.

>

» READ BOOK EXCERPT ONLINE »

Source: The Diagnostic Approach to Symptoms and Signs in Pediatrics, 2006

Abdominal distention: History and physical examination
(Nursing: Interpreting Signs and Symptoms)

If the patient's abdominal distention isn't acute, ask about its onset and duration and associated signs. A patient with localized distention may report a sensation of pressure, fullness, or tenderness in the affected area. A patient with generalized distention may report a bloated feeling, a pounding heart, and difficulty breathing deeply or when lying flat.

The patient may be unable to bend at the waist. Make sure to ask about abdominal pain, fever, nausea, vomiting, anorexia, altered bowel habits, and weight gain or loss.

Obtain a medical history, noting GI or biliary disorders that may cause peritonitis or ascites, such as cirrhosis, hepatitis, or inflammatory bowel disease. (See Detecting ascites.) When did the patient last have a bowel movement? Note chronic constipation. Has the patient recently had abdominal surgery, which can lead to abdominal distention? Ask about recent accidents, even minor ones such as falling off a stepladder.

Perform a complete physical examination. Don't restrict the examination to the abdomen because you could miss important clues to the cause of abdominal distention. Next, stand at the foot of the bed and observe the recumbent patient for abdominal asymmetry to determine if distention is localized or generalized. Then assess abdominal contour by stooping at his side. Inspect for tense, taut skin and bulging flanks, which may indicate ascites. Observe the umbilicus. An everted umbilicus may indicate ascites or umbilical hernia. An inverted umbilicus may indicate distention from gas; it's also common in obesity and pregnancy. Inspect the abdomen for signs of inguinal or femoral hernia and for healed incisions that may point to adhesions. Both may lead to intestinal obstruction. Auscultate for bowel sounds, abdominal friction rubs (indicating peritoneal inflammation), and bruits (indicating an aneurysm). Listen for succussion splash—a splashing sound normally heard in the stomach when the patient moves or when palpation disturbs the viscera. An abnormally loud splash indicates fluid accumulation, suggesting gastric dilation or obstruction.

Next, percuss and palpate the abdomen to determine if distention results from air, fluid, or both. A tympanic note in the left lower quadrant suggests an air-filled descending or sigmoid colon. A tympanic note throughout a generally distended abdomen suggests an air-filled peritoneal cavity. A dull percussion note throughout a generally distended abdomen suggests a fluid-filled peritoneal cavity. Shifting of dullness laterally with the patient in the decubitus position also indicates a fluid-filled abdominal cavity. A pelvic or intra-abdominal mass causes local dullness upon percussion and should be palpable. Obesity causes a large abdomen without shifting dullness, prominent tympany, or palpable bowel or other masses, with generalized rather then localized dullness.

Palpate the abdomen for tenderness, noting whether it's localized or generalized. Watch for peritoneal signs and symptoms, such as rebound tenderness, guarding, rigidity, McBurney's point, obturator sign, and psoas sign. Female patients should undergo a pelvic examination; males, a genital examination. All patients who report abdominal pain should undergo a digital rectal examination with fecal occult blood testing. Finally, measure the patient's abdominal girth for a baseline value. Mark the flanks with a felt-tipped pen as a reference for subsequent measurements.

» READ BOOK EXCERPT ONLINE »

Source: Nursing: Interpreting Signs and Symptoms, 2007

OBESITY: Approach to the Diagnosis
(Differential Diagnosis in Primary Care)

It would be ridiculous to do a complete endocrine workup on every case of obesity, but thyroid function studies may be worthwhile. Patients who fail to lose weight on a strict diet may require hospitalization with observation. If they still fail to lose weight, a complete endocrine workup would seem to be indicated.

» READ BOOK EXCERPT ONLINE »

Source: Differential Diagnosis in Primary Care, 2007

 » Next page: Signs of Overweight

Rate This Website

What do you think about the features of this website? Take our user survey and have your say:

Website User Survey

Medical Tools & Articles:

Next articles:

• Signs of Overweight
• Complications of Overweight
• Misdiagnosis of Overweight
• Undiagnosed Overweight
• Misdiagnosis of Underlying Causes of Overweight

Tools & Services:

• Bookmark this page
• Take a survey relating to Overweight
• Symptom Search
• Symptom Checker
• Medical Dictionary
• Give your feedback

Medical Articles:

• Disease & Treatments Search
• Misdiagnosis Center
• Full list of interesting articles

Forums & Message Boards

• Ask or answer a question at the Boards:
• I cannot get a diagnosis. Please help.
• Tell us your medical story.
• Share your misdiagnosis story.
• What is the best treatment for my condition?
• See all the Boards.

Enter your search terms Submit search form
Search The Web Search wrongdiagnosis.com

homepage | back to top

Common Health Mistakes

Choose ... Alzheimers & Dementia Asthma Child ADHD ADHD in Adults Allergy Hypertension Bipolar Breast Cancer Celiac Disease Crohns Disease Colon Cancer Contraception Diabetes Cancer Depression Erectile Disorder Cholesterol COPD GERD Heartburn/Reflux Metabolic Syndrome Migraine/Headache Multiple Sclerosis Obesity Osteoporosis Overactive Bladder Psoriasis Sexual Disorder Sleep Disorders Smoking The Pill Ulcerative Colitis All Common Mistakes

Symptom
Checker

Choose... Fever Rash Pain Headache Fatigue Cough Other symptoms

Search Specialists by State and City

Choose... GENERAL PRACTICE CARDIAC HEALTH WOMEN'S HEALTH CANCER CARE RADIOLOGY MENTAL HEALTH PATHOLOGY EAR, NOSE, THROAT MEDICINE GENETICS NEUROLOGY DIALYSIS CARE SURGERY ORTHOPEDICS/SPORTS MEDICINE CHILDREN'S HEALTH OTHER SPECIALTIES