History and exam

Your Organisational Guidance

ebpracticenet urges you to prioritise the following organisational guidance:

Multimodale aanpak van obesitas bij volwassenen in de eerstelijnszorgPublished by: WORELLast published: 2024Guide de pratique clinique sur la prise en charge multimodale de l’obésité chez l’adultePublished by: WORELLast published: 2024Overgewicht en obesitas bij volwassenen in de huisartsenpraktijkPublished by: Domus Medica | SSMGLast published: 2006Surcharge pondérale et obésité chez l'adultePublished by: Domus Medica | SSMGLast published: 2006

Key diagnostic factors

common

For manual determination of the body mass index (BMI), the height needs to be in metres. Many online BMI calculators exist. [ Body Mass Index (Quetelet's index) Opens in new window ]

For determination of the BMI, weight must be in kg. Many online BMI calculators exist. [ Body Mass Index (Quetelet's index) Opens in new window ]

Other diagnostic factors

common

Measured just above the iliac crests at a normal minimal inspiration.[1]

Waist circumference may be a more sensitive indicator of insulin resistance than BMI. Varying cut-offs are used depending on ancestry.[94]

Obesity is often associated with comorbid conditions such as type 2 diabetes, cardiovascular disease, hypertension, hyperlipidaemia, GORD, hiatal hernia, asthma, obstructive sleep apnoea, stroke, gout, pseudotumor cerebri, arthritis, non-alcoholic steatohepatitis, cancer, urinary incontinence, gallbladder disease, and depression.

Risk factors

strong

Secondary obesity is uncommon, but hypothyroidism can be associated with abnormal weight gain.[45]

Secondary obesity is uncommon, but hypercortisolism can be associated with excess weight.[45]

Weight gain is associated with long-term corticosteroid use.

weak

The prevalence of obesity is not equal across age groups; there appears to be a peak in the prevalence in the fifth decade, followed by a plateau in the sixth through eighth decades, with a subsequent tapering in the prevalence after the eighth decade.[33][53][54]

Weight gain and abdominal redistribution of fat after menopause has been well described, but is not universal and has a complex relationship with environmental factors.[55][56]​ Hormone replacement therapy (HRT) is not associated with further weight gain.[56] HRT actually may prevent weight gain and abdominal fat redistribution, but may have untoward effects on other endpoints.[57]

There may be a weak association with obesity and parity.[58][59] This association is confounded by contributing cultural, environmental and socioeconomic factors.

Some investigators have noted that the prevalence of obesity is higher in married people than in single people.[33][60][61] While there are a number of theories to explain this, the association is not well understood.

Sleep deprivation, whether voluntary or induced (e.g., shift working), has been associated with weight gain and obesity.[62][63][64]

Obesity and smoking are commonly observed in association, but it is unclear whether smoking might be a risk factor for obesity.[33][65] Some studies suggest smoking cessation may also be a risk factor for weight gain.[66]

In large epidemiological studies, the prevalence of obesity has been noted to be increased in groups with less formal education.[33][54][67]

Long-term epidemiological studies have noted a correlation between poor maternal nutrition during pregnancy (mostly manifested by low birth weight) and obesity in adulthood.[3][42][43]

In most large epidemiological studies in the US and Europe, the prevalence of obesity is higher in groups with low socioeconomic status.[33][40][68]

Because the relationship between obesity and a sedentary lifestyle remains a loose association, a sedentary lifestyle is characterised as a weak risk factor for obesity.[24][25][69]

Excessive television watching and video game playing generally are viewed as markers of a sedentary lifestyle and, not surprisingly, people (particularly children) who watch or play an excessive amount of television or video games (generally more than 2-3 hours daily) have a higher incidence of obesity than people who are more active.[24][63][70]

Dietary composition, or the choice of which types of foods to eat, has been implicated as a risk factor for obesity.[71][72][73] Not all people whose diet is dominated by these choices become obese; the precise contribution of dietary choice to the development of obesity is difficult to quantify.

Heavy alcohol consumption (>2 drinks per day) has been associated with obesity, although moderate alcohol consumption (i.e., 1-2 drinks per day) has been described as having a modest protective effect against obesity.[74][75][76]

An obesogenic behaviour loosely associated with obesity.[77][78]

An obesogenic behaviour loosely associated with obesity.[79][80]

A rare cause of inherited obesity.[18][19][20]

Some reports correlate weight gain with anti-depressant use.[81]

Obesity is associated with some antipsychotic medicine.[30][81][82]

Some correlation has been described between beta-blocker use and weight gain.[83]

Adverse effects of adjuvant therapies for breast cancer can include weight gain.[84]

While there may be an association between obesity and psychiatric diagnosis, the importance of this latter risk factor is not clear because many, if not most, patients with a diagnosis such as schizophrenia or depression are on medication, which is associated with obesity.[30][85][86]

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