History and exam

Key diagnostic factors

common

height

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

weight

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

waist circumference

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 cutoffs are used depending on ancestry.[93]

comorbid conditions

Obesity is often associated with comorbid conditions such as type 2 diabetes, cardiovascular disease, hypertension, hyperlipidemia, GERD, hiatal hernia, asthma, obstructive sleep apnea, stroke, gout, pseudotumor cerebri, arthritis, nonalcoholic steatohepatitis, cancer, urinary incontinence, gallbladder disease, and depression.

Risk factors

strong

hypothyroidism

Secondary obesity is uncommon, but hypothyroidism can be associated with abnormal weight gain.[44]

hypercortisolism

Secondary obesity is uncommon, but hypercortisolism can be associated with excess weight.[44]

corticosteroid therapy

Weight gain is associated with long-term corticosteroid use.

weak

age ≥40 years

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.[32][52][53]

peri- and postmenopause

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.[54][55]​ Hormone replacement therapy (HRT) is not associated with further weight gain.[55] HRT actually may prevent weight gain and abdominal fat redistribution, but may have untoward effects on other endpoints.[56]

prior pregnancy

There may be a weak association with obesity and parity.[57][58] This association is confounded by contributing cultural, environmental, and socioeconomic factors.

marital status

Some investigators have noted that the prevalence of obesity is higher in married people than in single people.[32][59][60] While there are a number of theories to explain this, this association is not well understood.

sleep deprivation

Sleep deprivation, whether voluntary or induced (e.g., shift working), has been associated with weight gain and obesity.[61][62][63]

tobacco

Obesity and smoking are commonly observed in association, but it is unclear whether smoking might be a risk factor for obesity.[32][64] Some studies suggest smoking cessation may also be a risk factor for weight gain.[65]

education level

In large epidemiologic studies, the prevalence of obesity has been noted to be increased in groups with less formal education.[32][53][66]

poor in utero nutrition

Long-term epidemiologic studies have noted a correlation between poor maternal nutrition during pregnancy (mostly manifested by low birth weight) and obesity in adulthood.[3][41][42]

socioeconomic status

In most large epidemiologic studies in the US and Europe, the prevalence of obesity is higher in groups with low socioeconomic status.[32][39][67]

sedentary lifestyle

Because the relationship between obesity and a sedentary lifestyle remains a loose association, a sedentary lifestyle is characterized as a weak risk factor for obesity.[23][24][68]

television watching or video gaming

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.[23][62][69]

diet high in sugar, cholesterol, fat, and fast food

Dietary composition, or the choice of which types of foods to eat, has been implicated as a risk factor for obesity.[70][71][72] 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 intake

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.[73][74][75]

binge-eating disorder

An obesogenic behavior loosely associated with obesity.[76][77]

night eating syndrome

An obesogenic behavior loosely associated with obesity.[78][79]

leptin deficiency

A rare cause of inherited obesity.[17][18][19]

antidepressant therapy

Some reports correlate weight gain with antidepressant use.[80]

antipsychotic therapy

Obesity is associated with some antipsychotic medications.[29][80][81]

beta-blocker therapy

Some correlation has been described between beta-blocker use and weight gain.[82]

adjuvant breast cancer therapy

Adverse effects of adjuvant therapies for breast cancer can include weight gain.[83]

psychiatric diagnosis

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.[29][84][85]

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