Obesity

Obesity: Excerpt from Field Guide to Bedside Diagnosis

Differential Overview

❑ 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.

Clinical Findings

Caloric excess  Weight gain is commonly caused by an imbalance between energy intake and use, either voluntary or via an altered hypothalamic “set point.” A familial form occurs in childhood or with onset of puberty and is characterized by peripheral as well as central obesity.

Depression  Diagnostic clues include depressed mood, anhedonia, and an altered sleep pattern, especially with early morning awakening.

Drugs  Glucocorticoids, oral contraceptives, phenothiazines, cyproheptadine, and tricyclic antidepressants all cause weight gain.

Hypothyroidism  Cold intolerance (obese individuals are usually heat intolerant), dry waxy skin, constipation, delayed deep-tendon relaxation phase, and goiter are helpful clues.

Hypogonadism  This is a common cause of modest weight gain in the perimenopausal period.

Cushing syndrome  Truncal obesity with thin limbs is typical. Purple striae,
a plethoric moon face, and a dorsocervical buffalo hump are usually found to some degree. This syndrome usually occurs as a result of therapeutic steroid use.

Polycystic ovary syndrome  Obesity associated with hirsutism, acne, irregular menses/oligomenorrhea, and infertility suggests PCOS.

Hypothalamic  This is characterized by marked and uncontrollable hyperphagia. Other manifestations of hypothalamic and pituitary dysfunction are usually present. Causes may include craniopharyngioma, sarcoidosis, hypothalamic cyst, or tuberculous encephalitis.

Insulinoma  Modest weight gain occurs with a history of episodic hyperepinepherinemic and hypoglycemic symptoms.

Pictures

Book Source Details

• Book Title: Field Guide to Bedside Diagnosis
• Author(s): David S. Smith
• Year of Publication: 2007
• Copyright Details: Field Guide to Bedside Diagnosis, Copyright © 2007 Lippincott Williams & Wilkins.

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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.

More About This Book: Title: Field Guide to Bedside Diagnosis Authors: David S. Smith Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 0-78178-165-5

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