eMedicine Specialties > Endocrinology > Metabolic Disorders

Obesity: Differential Diagnoses & Workup

Author: 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
Coauthor(s): Elif Arioglu, MD, Assistant Professor of Medicine, Division of Endocrinology and Metabolism, University of Michigan
Contributor Information and Disclosures

Updated: May 21, 2009

Differential Diagnoses

Acromegaly
Hiatal Hernia
Apnea, Sleep
Hirsutism
Bulimia
Hypercholesterolemia, Polygenic
Cardiac Cirrhosis
Hypertension
Cardiomyopathy, Dilated
Hypothyroidism
Cardiomyopathy, Hypertrophic
Insulinoma
Cholecystitis
Kallmann Syndrome and Idiopathic Hypogonadotropic Hypogonadism
Cholelithiasis
Lipodystrophy, Acquired Partial
Cirrhosis
Lipodystrophy, Generalized
Cushing Syndrome
Nephrotic Syndrome
Depression
Polycystic Ovarian Disease (Stein-Leventhal Syndrome)
Diabetes Mellitus, Type 1
Pseudo-Cushing Syndrome
Diabetes Mellitus, Type 2
Fatty Liver
Growth Hormone Deficiency

Other Problems to Be Considered

Adiposa dolorosa (Dercum disease)
Partial lipodystrophies associated with localized lipohypertrophy
Mesomorphic body states, as seen in body builders and people in related occupations (eg, professional wrestling) may be associated with elevated BMIs because of increased muscle mass rather than excess adiposity.
Various causes of anasarca may be mistaken as obesity if not carefully evaluated clinically.

Workup

Laboratory Studies

  • Full lipid panel, at minimum, test of fasting cholesterol, triglycerides, and high-density lipoprotein cholesterol (HDL-C) levels
    • These levels may be normal, or the typical dyslipidemia associated with metabolic syndrome X may be found.
    • This is characterized by reduced HDL-C, increased low-density lipoprotein cholesterol (LDL-C), normal-to-marginally increased total cholesterol, and elevated fasting triglyceride concentrations.
  • Hepatic panel: This test is expected to yield normal results, but findings may be abnormal (eg, elevated transaminase levels in the setting of NASH or fatty infiltration of the liver).
  • Thyroid function tests
    • The results are typically normal, but checking them to detect primary hypothyroidism (characterized by increased serum thyrotropin and normal or reduced levothyroxine and/or triiodothyronine levels) is worthwhile.
    • Screening with a serum thyrotropin level is usually sufficient. Of importance, hypothyroidism itself rarely causes more than mild obesity.
  • For screening purposes, 24-hour urinary free cortisol test
    • This test is needed only when Cushing syndrome or other hypercortisolemic states are clinically suspected.
    • Approximately 4% of patients with Cushing syndrome have normal urinary free cortisol values.
  • Fasting glucose and insulin test
    • Obesity is associated with insulin resistance, though these levels are normal in many subjects who are obese.
    • In other people, insulin levels may be elevated.
    • In those with impaired glucose tolerance, the fasting serum glucose level is elevated to higher than 100 mg/dL.

Procedures

  • Among the various procedures relevant to the treatment of patients who are obese are procedures to estimate the degree of visceral and subcutaneous fat.
  • These procedures include the standard anthropometric measurements and caliper-derived estimates of skin thickness.

Histologic Findings

Hypertrophic obesity characterized by enlarged fat cells is typical of android abdominal obesity. Hypercellular obesity is more variable than hypertrophic obesity. Hypercellular obesity is typical of obesity with an onset in childhood or adolescence, but it is also invariably found in subjects with severe obesity.

More on Obesity

Overview: Obesity
Differential Diagnoses & Workup: Obesity
Treatment & Medication: Obesity
Follow-up: Obesity
Multimedia: Obesity
References
Further Reading
[ CLOSE WINDOW ]

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Further Reading

Clinical guidelines:
Adult weight management evidence-based nutrition practice guideline. American Dietetic Association - Professional Association. 2006 May. Various pagings. NGC:006622

American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery medical guidelines for clinical practice for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient. American Association of Clinical Endocrinologists - Medical Specialty Society
American Society for Metabolic and Bariatric Surgery - Professional Association
The Obesity Society - Disease Specific Society. 2008 Jul-Aug. 83 pages. NGC:006716

Pediatric weight management evidence-based nutrition practice guideline. American Dietetic Association - Professional Association. 2007 Jun. Various pagings. NGC:006623

Prevention and treatment of pediatric obesity: an Endocrine Society clinical practice guideline. The Endocrine Society - Disease Specific Society. 2008 Dec. 38 pages. NGC:006944

SAGES guideline for clinical application of laparoscopic bariatric surgery. Society of American Gastrointestinal and Endoscopic Surgeons - Medical Specialty Society. 2003 Jul (revised 2008 Oct). 20 pages. NGC:006413

Screening for obesity in adults: recommendations and rationale. United States Preventive Services Task Force - Independent Expert Panel. 1996 (revised 2003 Dec 2). 13 pages. NGC:003163

Clinical trials:
Evaluating the Transferability of a Successful, Hospital-Based, Childhood Obesity Clinic to Primary Care: a Pilot Study

Investigating the Use of Quercetin on Glucose Absorption in Obesity, and Obesity With Type 2 Diabetes

Mitochondrial Function in Pediatric Obesity

Observational Study of Early Metabolic and Vascular Changes in Obesity (STYJOBS)

Medscape Resource Center:
Obesity Resource Center

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Keywords

obesity, weight loss, diet, BMI, overweight, type 2 diabetes, obese, gastric bypass, body mass index, weight loss surgery, weight control, childhood obesity, bariatric surgery, insulin resistance, leptin, over weight, overeating, child obesity, gastric bypass surgery, hypertension, obesity children, obesity in children, obesity America, obesity surgery, adipose tissue, causes of obesity, obesity treatment, adipocyte, adiponectin, increased BMI, excess body fat, excess adiposity, increased body mass index, Quetelet index, POMC, MC4, satiety, weight loss, weight gain, severe obesity, morbid obesity, super obese, body weight, percentage body fat, fat distribution, android obesity, gynecoid obesity, waist circumference, Atkinsdiet, South Beach diet

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Contributor Information and Disclosures

Author

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.

Coauthor(s)

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

Medical Editor

Harris C Taylor, MD, Clinical Professor of Medicine, Division of Clinical and Molecular Endocrinology, Case Western Reserve University School of Medicine
Harris C Taylor, MD is a member of the following medical societies: American Association of Clinical Endocrinologists, American College of Physicians, American Thyroid Association, and Endocrine Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Romesh Khardori, MD, Chief, Division of Endocrinology, Metabolism and Molecular Medicine, Professor, Department of Internal Medicine, Southern Illinois University School of Medicine
Romesh Khardori, MD is a member of the following medical societies: American Association of Clinical Endocrinologists, American College of Physicians, American Diabetes Association, American Federation for Medical Research, American Medical Association, American Society of Andrology, Endocrine Society, and Illinois State Medical Society
Disclosure: Nothing to disclose.

CME Editor

Mark Cooper, MBBS, PhD, FRACP, Head, Diabetes & Metabolism Division, Baker Heart Research Institute, Professor of Medicine, Monash University
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.

 
 
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