Obesity

Question 1

54yo M 120kg, BMI 34. Nil past medical history. Seen before in-clinic for an ankle sprain some years ago. No allergies, no medications.

Impression/Goals/PDx

Answer 1

Impression
Given stem, key issue in this patients presentation is her obesity, and concomitant cardiovascular risk.

Goals:
Would want to assess for any underlying causes of weight-gain, and attempt appropriate management to reduce cardiovascular risk factors

PDx
Obesity in setting of western diet and sedentary lifestyle

DDx - other organic causes
Maternal factors, epigenetics of family profile

Exogenous:
Endocrine: Cushings disease/syndrome, Hypothyroidism, PCOS,
Medications: Corticosteroids, antipsychotics, diabetes meds - gliclazide, insulin

Endogenous
Psychiatric: depression, anxiety, eating disorder
Genetic: leptin deficiency
Intracranial tumors

Question 2

Obesity - History

Answer 2

Hx:
PC/HxPC: history of weight change, fluctuations?
Sx of alternative disease: endocrine problems (hypothyroidism, psychiatric/ associated features,
Mental screen?
Cardiovascular risk factors/complications of obesity
Meds, fam hx
SNAP; including eating behaviours
Surgical hx- bariatric surgery (and if failed)

Question 3

Obesity - Examination

Answer 3

Exam:
Want to get baseline measures for future comparison and monitoring, also need to assess for any evidence of systemic complications of obesity:
- BMI + waist circumference
- CVD: cardio exam, 
- Neuro 
- ?Ankle exam

Question 4

Obesity - Investigations

Answer 4

Investigations
Bedside: absolute CVD risk
Blood: (if concerned about underlying endocrine cause): TSH, lipid panel, BSL, HbA1c, FBC
Imaging: nil relevant

Question 5

Obesity - Management

Answer 5

Non-pharm:

• Lifestyle modifications
• Diet
• Exercise
• Psychiatric factors (psychology services, other allied health)
• Patient education
• Reduction of other CVD risk factors (smoking, drinking, etc)

Pharmacotherapy

• Appetite suppressants eg. GLP1 analogues, phentermine,
• Absorption inhibitors eg. Orlistat
• management of other medical comorbidities (diabetes, HTN, etc)

Surgical
- Bariatric surgery

Safety-net/referral/follow-up

• Allied health services (psychology,
• To be regularly reviewed initially to establish management plan