Weight gain

Question 1

Probability diagnosis

Answer 1

Exogenous obesity

Alcohol excess

Fluid/oedema

Drugs

Genetic polymorphisms

Question 2

Serious disorders not to be missed

Answer 2

Cardiovascular:

• cardiac failure

Hypothalamic disorders (hyperphagia):

• craniopharyngiomas
• optic gliomas

Insulinoma

Liver failure

Nephrotic syndrome

Question 3

Pitfalls (often missed)

Answer 3

Pregnancy (early)

Postmenopause

Endocrine disorders:

• hypothyroidism
• Cushing syndrome
• insulinoma
• acromegaly
• hypogonadism
• hyperprolactinaemia
• polycystic ovarian disease

Idiopathic oedema syndrome

Klinefelter syndrome

Congenital disorders:

• Prader–Willi syndrome
• Laurence–Moon–Biedl syndrome

Question 4

Masquerades checklist

Answer 4

Depression

Drugs e.g.

• OCP
• steroids
• pizotifen
• sulphonylureas
• insulin

Thyroid disorder (hypothyroidism) and other endocrine

Question 5

Is the patient trying to tell me something?

Answer 5

Yes: the reasons for obesity should be explored.

Question 6

Key history

Answer 6

Ascertain food and beverage intake including typical daily meals.

Exercise

drug

psychological

family history

Question 7

Key examination

Answer 7

Measure body weight and height and calculate BMI

• waist circumference
• waist–hip circumference
• upper arm circumference

Assess the degree and distribution of body fat and the overall nutritional status

Search for evidence of ;

• diabetes
• atherosclerosis
• hypothyroidism
• Cushing syndrome
• signs of alcohol abuse

Question 8

Key investigations

Answer 8

These are more appropriate if patient unwell:

anthropometric measurements, esp BMI and waist circumference

• FBE
• blood lipids
• glucose (fasting)
• LFTs
• U&E

Consider TFTs, serum cortisol, ECG and CXR.

Question 9

Diagnostic tips

Answer 9

The onset of obesity can occur at any age.

Abd obesity gives a higher cardiovascular risk at any rate.

Ask pt what they believe is the cause of their weight gain/obesity.