Weight gain, excessive
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 the elderly, weight gain commonly reflects a sustained food intake in the presence of the normal, progressive fall in basal metabolic rate. Among women, a progressive weight gain occurs with pregnancy, whereas a periodic weight gain usually occurs with menstruation.
Weight gain, a primary sign of many endocrine disorders, also occurs with 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, pages 644 and 645.) Note fat distribution and the presence of localized or generalized edema and overall nutritional status. Inspect 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
Acromegaly 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, and heat intolerance. Occasionally, hirsutism may occur.
Diabetes mellitus
The increased appetite associated with diabetes mellitus may lead to weight gain, although weight loss sometimes occurs instead. Other findings include fatigue, polydipsia, polyuria, nocturia, weakness, polyphagia, and somnolence.
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.
Hyperinsulinism
Hyperinsulinism increases appetite, leading to weight gain. Emotional lability, indigestion, weakness, diaphoresis, tachycardia, visual disturbances, and syncope also occur.
Hypogonadism
Weight gain is common in hypogonadism. 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 with subsequent weight gain, along with altered body temperature and sleep rhythms.
Hypothyroidism
With hypothyroidism, 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.
Nephrotic syndrome
With nephrotic syndrome, weight gain results from edema. In severe cases, anasarca develops — increasing body weight up to 50%. Related effects include abdominal distention, orthostatic hypotension, and lethargy.
Pancreatic islet cell tumor
Pancreatic islet cell 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
With preeclampsia, rapid weight gain (exceeding the normal weight gain of pregnancy) may accompany nausea and vomiting, epigastric pain, elevated blood pressure, and visual blurring or double vision.
Sheehan’s syndrome
Most common in women who experience severe obstetric hemorrhage, Sheeehan’s syndrome may cause weight gain.
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 necessary for patients with weight gain, particularly when it results from emotional problems or when uneven weight distribution alters body image. If the patient is obese or has a cardiopulmonary disorder, any exercises should be monitored closely. Further study to rule out possible secondary causes should include serum thyroid-stimulating hormone determination and dexamethasone suppression testing. Laboratory test results of all patients ideally include cardiac risk factors: serum cholesterol, triglyceride, and glucose levels.
Pediatric pointers
Weight gain in children can result from an endocrine disorder, such as hypercortisolism. Other causes include inactivity caused by Prader-Willi syndrome, Down syndrome, Werdnig-Hoffmann disease, late stages of muscular dystrophy, and severe cerebral palsy.
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. The incidence of obesity is increasing among children.
Geriatric pointers
Desired weights (associated with lowest mortality rates) increase with age.
Pictures
Book Source Details
- Book Title: Handbook of Signs & Symptoms (Third Edition)
- Author(s): Springhouse
- Year of Publication: 2006
- Copyright Details: Handbook of Signs & Symptoms (Third Edition), Copyright © 2006 Lippincott Williams & Wilkins.
Other Book Chapters Related to Undereating
Read excerpts from these other book chapters related to Undereating:
Medical Books Excerpts
- ANOREXIA
- "Algorithmic Diagnosis of Symptoms and Signs" (2003)
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- "In A Page: Pediatric Signs and Symptoms" (2007)
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- ANOREXIA
- "Differential Diagnosis in Primary Care" (2007)
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- Anorexia
- "Handbook of Signs & Symptoms (Third Edition)" (2006)
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- Anorexia
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
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- Anorexia
- "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
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- Weight Loss
- "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
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- Anorexia
- "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
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- Anorexia
- "Nursing: Interpreting Signs and Symptoms" (2007)
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- ANOREXIA
- "Differential Diagnosis in Primary Care" (2007)
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Copyright Details: Handbook of Signs & Symptoms (Third Edition), Copyright © 2008 Williams & Wilkins.
More About Causes of Undereating
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Low birth weight (Handbook of Signs & Symptoms (Third Edition))
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