Public - Obesity - Diagnosis

Obesity

Author: George A. Bray, MD
Editorial changes - 2009-11-18
Author information and module status



		Prevention
		Screening
		Diagnosis
		Consultation for Diagnosis
		Hospitalization
		Non-drug Therapy
		Drug Therapy
		Patient Education
		Consultation for Management
		Follow-up

	Tables
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	Glossary
	What's New
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	Quality Measures

Diagnosis
Use history to obtain information about risk factors for obesity. Use physical examination to establish the presence of obesity, central adiposity, and associated comorbid conditions. Use laboratory testing to confirm clinical evaluation and to assess for presence of comorbidities. Consider the broad range of conditions associated with unhealthy weight.
History and Physical Examination Elements for Obesity (table)
Laboratory and Other Studies for Obesity (table)
Differential Diagnosis of Obesity (table)


Use history to obtain information about risk factors for obesity.
Take a thorough history to determine: If parents are or were overweight The occurrence of any life events such as stopping smoking, pregnancy, surgery with disability, or recent injury Family income and educational level Membership in a minority population with high prevalence of obesity, such as African American, Latino, or Polynesian Level of physical activity Medication history See table History and Physical Examination Elements for Obesity. See table Drugs That Produce Weight Gain and Alternatives. See figure Obesity Risk in Ethnic Groups.
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Use physical examination to establish the presence of obesity, central adiposity, and associated comorbid conditions.
Measure BMI and waist circumference. Look for physical findings associated with obesity conditions, including: Hypertension Endocrinopathies such as hypothyroidism and Cushing's syndrome Reproductive disorders such as polycystic ovary disorders Phenotypic abnormalities suggesting rare genetic disorders in children See table History and Physical Examination Elements for Obesity . See table Clinical Features of the Metabolic Syndrome.
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Use laboratory testing to confirm clinical evaluation and to assess for presence of comorbidities.
In all patients with a BMI >25 kg/m² or associated comorbid conditions, obtain: Blood for glucose, creatinine levels Lipid profile including HDL cholesterol, triglycerides, LDL cholesterol levels Sleep test to confirm sleep apnea in patients with somnolence, plethora, or history of snoring Ultrasound to screen for gallstones and hepatic fat Assess patients for the presence of metabolic syndrome. See table Laboratory and Other Studies for Obesity. See table Clinical Features of the Metabolic Syndrome
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Consider the broad range of conditions associated with unhealthy weight.
Use clinical and laboratory evaluation to look for: Sleep apnea and alveolar hypoventilation Diabetes mellitus The metabolic syndrome Hypothyroidism Gallbladder disease and gallstones Nonalcoholic fatty liver disease Cushing's disease Polycystic ovary syndrome Prader-Willi syndrome and other genetic disorders Pituitary or hypothalamic lesions Rare disorders such as melanocortin receptor defect, PPAR-γ defects, leptin and leptin receptor deficiency See table History and Physical Examination Elements for Obesity. See table Differential Diagnosis of Obesity. See table Some Genetic Syndromes of Obesity with Hypogonadism and Mental Retardation. See table Genotyping for Rare Syndromic and Nonsyndromic Forms of Obesity.
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FAQs

George A. Bray, MD, is a speaker for Eli Lilly, Amylin Corp., and Merck & Co., received grants from Merck & Co., and Takeda Pharmaceuticals; and has consulted for Sanofi-Aventis, Merck, and Amylin.
Steven E. Weinberger, MD, FACP, Acting Editor, PIER, has stock holdings in Glaxosmithkline and Abbott.

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