Obesity

Published on 06/06/2015 by admin

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Last modified 06/06/2015

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Chapter 37 Obesity

INTRODUCTION

Description: Obesity is a state of increased fat and lean body mass (>20% higher ideal weight, body mass index [BMI] >28) associated with increased health risks. Obesity affects more women than men and is of special concern to adolescents and older women. Weight gained during pregnancy (in excess of that related to the pregnancy) is often not lost.
Prevalence: Varies with age: 30% to 40% of women.
Predominant Age: Any.
Genetics: Of the variance in body mass, 20% to 30% may be genetically determined. Rare genetic syndromes have been described.

ETIOLOGY AND PATHOGENESIS

Causes: Calorie consumption in excess of expenditure, insulinoma, hypothalamic disorders, Cushing’ syndrome, corticosteroid drugs.
Risk Factors: Parental obesity, pregnancy, sedentary lifestyle, high-fat diet (higher calorie density), low socioeconomic status.

CLINICAL CHARACTERISTICS

Signs and Symptoms

• Increased body mass and fat (male pattern obesity [abdominal] is associated with the greatest health risk)

DIAGNOSTIC APPROACH

Differential Diagnosis

• Pathologic process other than excess dietary consumption

Associated Conditions: Increased morbidity and mortality (see Complications), cholelithiasis. Recent studies indicate an increase in the risks of ovarian and breast cancers.

Workup and Evaluation

Laboratory: No evaluation indicated. Consider thyroid testing in selected patients. Determine serum cholesterol, triglycerides, or glucose levels to assess risk factors for complications.
Imaging: No imaging indicated.
Special Tests: Body mass index = weight (kg)/height (m2), waist to hip circumference ratio (normal female gynecoid pattern is greater than 0.85).
Diagnostic Procedures: Physical examination, body mass index.

Pathologic Findings

Hypertrophy and/or hyperplasia of adipocytes. Cardiomegaly or hepatomegaly is common.

MANAGEMENT AND THERAPY

Nonpharmacologic

General Measures: Risk assessment, diet and exercise counseling. Assistance with diet planning or selection of a commercial program.
Specific Measures: Behavior modification and hypnosis have been applied with variable success. In select patients (body mass index >40) surgical intervention (stapling or bypass) may be indicated. Surgery is the most effective long-term therapy for morbid obesity.
Diet: Restriction to 500 kcal below maintenance generally provides the best sustainable loss (1 lb/week). Verylow-calorie diets are associated with increased risk and occasional deaths.
Activity:

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