Obesity Clinical Presentation

  • Author: Osama Hamdy, MD, PhD, FACE; Chief Editor: George T Griffing, MD   more...
 
Updated: May 17, 2012
 

History

In most patients, the presentation of obesity is straightforward, with the patient indicating problems with weight or repeated failure in achieving sustained weight loss. In other cases, however, the subject may present with complications and/or associations of obesity.

A full history must include a dietary inventory and an analysis of the subject's activity level. Screening questions to exclude depression are vital because depression may be a consequence or a cause of excessive dietary intake and reduced activity.

Because almost 30% of patients who are obese have eating disorders, screen for these in the history. The possibility of binging, purging, lack of satiety, food-seeking behavior, night eating syndrome, and other abnormal feeding habits must be identified because management of these habits is crucial to the success of any weight-management program.

When asking a patient about his or her history, investigate whether the rest of the patient's family has weight problems, inquire about the patient's expectations, and estimate the patient's level of motivation. Also, determine if any of the comorbidities related to obesity, including the following have occurred[3] :

  • Respiratory - Obstructive sleep apnea,[43] greater predisposition to respiratory infections, increased incidence of bronchial asthma, and Pickwickian syndrome (obesity hypoventilation syndrome)
  • Malignant - Association with endometrial, prostate, colon, breast, gall bladder, and, possibly, lung cancer[34]
  • Psychologic - Social stigmatization and depression
  • Cardiovascular - Coronary artery disease,[44] essential hypertension, left ventricular hypertrophy, cor pulmonale, obesity-associated cardiomyopathy, accelerated atherosclerosis, and pulmonary hypertension of obesity
  • Central nervous system (CNS) - Stroke, idiopathic intracranial hypertension, and meralgia paresthetica
  • Obstetric and perinatal - Pregnancy-related hypertension, fetal macrosomia, and pelvic dystocia[45]
  • Surgical - Increased surgical risk and postoperative complications, including wound infection, postoperative pneumonia, deep venous thrombosis, and pulmonary embolism
  • Pelvic - Stress incontinence
  • Gastrointestinal (GI) - Gall bladder disease (cholecystitis, cholelithiasis), nonalcoholic steatohepatitis (NASH), fatty liver infiltration, and reflux esophagitis
  • Orthopedic - Osteoarthritis, coxa vera, slipped capital femoral epiphyses, Blount disease and Legg-Calvé-Perthes disease, and chronic lumbago
  • Metabolic -Type 2 diabetes mellitus (see the image below), insulin resistance, hyperinsulinemia, and dyslipidemia (characterized by high total cholesterol, high triglycerides, low high-density lipoprotein, normal or elevated low-density lipoprotein) Simplified scheme for the pathophysiology of type Simplified scheme for the pathophysiology of type 2 diabetes mellitus.
  • Reproductive - Anovulation, early puberty, infertility, hyperandrogenism and polycystic ovaries (in women), and hypogonadotropic hypogonadism (in men)
  • Cutaneous - Intertrigo (bacterial and/or fungal), acanthosis nigricans, hirsutism, and increased risk for cellulitis and carbuncles
  • Extremity - Venous varicosities, lower extremity venous and/or lymphatic edema
  • Miscellaneous - Reduced mobility and difficulty maintaining personal hygiene

Include questions to exclude the possible and rare secondary causes of obesity. (See the chart below.)

Secondary causes of obesity. Secondary causes of obesity.
Next

Physical Examination

In the clinical examination, measure anthropometric parameters and perform the standard, detailed examination required in evaluating people with any chronic, multisystemic disorder, such as obesity.

Waist and hip circumference are useful surrogates in estimating visceral fat; serial tracking of these measurements helps in estimating the clinical risk over time.

Neck circumference is predictive of a risk of sleep apnea, and its serial measurement in the individual patient is clinically useful for risk stratification.[43]

For the skin examination, include a search for hirsutism in women; intertriginous rashes; acanthosis nigricans and skin tags, which are common with insulin resistance secondary to obesity; and possible contact dermatoses.

A detailed cardiac and respiratory evaluation is crucial to exclude cardiomegaly and respiratory insufficiency.

In the abdominal examination, attempt to exclude tender hepatomegaly, which may suggest hepatic fatty infiltration or nonalcoholic steatohepatitis (NASH), and distinguish the striae distensae from the pink and broad striae that suggest cortisol excess

When examining the extremities, search for joint deformities (eg, coxa vara), evidence of osteoarthritis, and any pressure ulcerations.

Localized and lipodystrophic fat distribution should also be indentified for being commonly associated with insulin resistance.

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Contributor Information and Disclosures
Author

Osama Hamdy, MD, PhD, FACE  Medical Director, Obesity Clinical Program, Director of Inpatient Diabetes Management, Joslin Diabetes Center; Assistant Professor of Medicine, Harvard Medical School

Osama Hamdy, MD, PhD, FACE is a member of the following medical societies: American Association of Clinical Endocrinologists and American Diabetes Association

Disclosure: Merck Inc Honoraria Speaking and teaching

Coauthor(s)

Elena Citkowitz, MD, PhD, FACP  Clinical Professor of Medicine, Yale University School of Medicine; Director, Cholesterol Management Center, Director, Cardiac Rehabilitation, Department of Medicine, Hospital of St Raphael

Elena Citkowitz, MD, PhD, FACP is a member of the following medical societies: American College of Physicians, American Heart Association, National Lipid Association, and Sigma Xi

Disclosure: Nothing to disclose.

Gabriel I Uwaifo, MBBS  Clinical and Research Attending, Assistant Professor of Medicine and Endocrinology, MedStar Clinical Research Center, MedStar Research Institute and Washington Hospital Center

Gabriel I Uwaifo, MBBS is a member of the following medical societies: American Association of Clinical Endocrinologists, American College of Physicians-American Society of Internal Medicine, American Diabetes Association, American Medical Association, American Society of Hypertension, and Endocrine Society

Disclosure: Nothing to disclose.

Elif Arioglu, MD  Assistant Professor of Medicine, Division of Endocrinology and Metabolism, University of Michigan Medical School

Elif Arioglu, MD is a member of the following medical societies: American College of Physicians-American Society of Internal Medicine, American Diabetes Association, American Medical Association, and Endocrine Society

Disclosure: Nothing to disclose.

Chief Editor

George T Griffing, MD  Professor of Medicine, St Louis University School of Medicine

George T Griffing, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Medical Practice Executives, American College of Physician Executives, American College of Physicians, American Diabetes Association, American Federation for Medical Research, American Heart Association, Central Society for Clinical Research, Endocrine Society, International Society for Clinical Densitometry, and Southern Society for Clinical Investigation

Disclosure: Nothing to disclose.

Additional Contributors

Romesh Khardori, MD, PhD, FACP Former Professor, Department of Medicine, Former Chief, Division of Endocrinology, Metabolism, and Molecular Medicine, Southern Illinois University School of Medicine

Romesh Khardori, MD, PhD, FACP is a member of the following medical societies: American Association of Clinical Endocrinologists, American College of Physicians, American Diabetes Association, and Endocrine Society

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Additional Contributors

Romesh Khardori, MD, PhD, FACP Former Professor, Department of Medicine, Former Chief, Division of Endocrinology, Metabolism, and Molecular Medicine, Southern Illinois University School of Medicine

Romesh Khardori, MD, PhD, FACP is a member of the following medical societies: American Association of Clinical Endocrinologists, American College of Physicians, American Diabetes Association, and Endocrine Society

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

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Central nervous system neurocircuitry for satiety and feeding cycles.
Comorbidities of obesity.
Energy balance equation.
Secondary causes of obesity.
Simplified scheme for the pathophysiology of type 2 diabetes mellitus.
Gastric electrical-stimulation device.
 
 
 
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