Obesity

Description Defined as an increase in total body fat, or at least a 20% increase in on...

Description

Defined as an increase in total body fat, or at least a 20% increase in one's ideal body weight. Obesity has increased in frequency in the last 20 years. One calculation of obesity is the body mass index or BMI. To calculate the BMI, people take their weight in pounds and multiplies it by 705, then divides this number by their height in inches, then divides this number again by their height in inches. A normal BMI = 18.5-24.9; overweight = 25.0-29.9; obese = 30 or greater; and morbidly obese = 40 or greater. Obesity is the second leading cause of preventable death (after smoking), and is associated with type 2 diabetes, elevated cholesterol, heart disease, arthritis, gallstones, obstructive sleep apnea, and cancer. There are many causes of obesity from genetic to environmental factors, and certain conditions including Cushing's syndrome, hypothyroidism and medications, such as steroids, can cause obesity. In the great majority of cases no secondary cause is determined.

Symptoms

Most of the symptoms of obesity come from the diseases obesity causes such as arthritis, heart disease, gallstones, sleep apnea, and poor self-esteem. These symptoms include: back pain, hip pain, knee pain, ankle pain, neck pain, chest pain, breathing problems, sadness, depression, snoring, rashes in the folds of the skin, and excessive sweating.

Tests

Common tests used for diagnosis and treatment

Workup:
A history and physical exam will be done. Other tests may be performed to determine the cause of the excess body fat. A BMI will be calculated.

Tests:
Thyroid function tests

Other Specific Tests: Fasting glucose, cholesterol, triglycerides

Specialists:
Internal Medicine, Pediatrics, Family Practice, Diabetes, Endocrinology and Metabolism, Bariatric Medicine, Bariatric Surgery

Treatment

Treatment is aimed at decreasing the intake of calories while still maintaining a healthy diet, and increasing exercise. Successful programs for weight loss should be started and followed under the care of a physician and/or a nutritionist. Behavioral modification therapy and social support can help achieve positive results. Medications can be used and include orlistat, bupropion, lorcaserin, phentermine and diethylpropion. Bariatric surgery such as gastric bypass and lap band procedures have been found to be effective. They are usually reserved for those patients with BMIs greater than 40, or for those with a BMI between 35-40 and with a co-existing obesity related medical problem such as diabetes.