Weight gain

Question 1

Differential diagnoses of Weight Gain

Answer 1

1. Weight gain due to OCP
2. Weight gain due to Olanzapine

Probability diagnosis 
Exogenous obesity 
Alcohol excess
Fluid/oedema
Drugs
Genetic polymorphisms

Serious disorders not to be missed
Cardiovascular:
•cardiac failure

Hypothalamic disorders (hyperphagia):
•craniopharyngiomas
•optic gliomas

Insulinoma
Liver failure
Nephrotic syndrome

Pitfalls (often missed) 
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

Masquerades checklist
Depression
Drugs (e.g. OCP, steroids, pizotifen, sulphonylureas, insulin)
Thyroid disorder (hypothyroidism) and other endocrine (as above)

Is the patient trying to tell me something?
Yes: the reasons for obesity should be explored.

Question 2

Weight Gain - Key History

Answer 2

Key history

Ascertain food and beverage intake including typical daily meals. Exercise, drug, psychological and family history.

Question 3

Weight Gain - Key PE

Answer 3

Key examination

• 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 and signs of alcohol abuse

Question 4

Weight Gain - Key Investigations

Answer 4

Key investigations

These are more appropriate if patient unwell:
•anthropometric measurements as above, especially BMI and waist circumference
•FBE
•blood lipids
•glucose (fasting)
•LFTs
•U&E

Consider TFTs, serum cortisol, ECG and CXR.

Question 5

Weight Gain - Diagnostic Tips

Answer 5

Diagnostic tips
•The onset of obesity can occur at any age.
•Abdominal obesity gives a higher cardiovascular risk at any rate.
•Ask the patient what they believe is the cause of their weight gain/obesity