Clinical Assessment of Obese Patients
ROLAND L. WEINSIER
ROBERT F. KUSHNER
The clinical assessment of patients presenting with obesity is critical for understanding the etiology of the disorder in individual cases and for establishing a reference point for response to therapy. Not all clinical assessments have to be conducted by a physician, although one has to be qualified to rule out neuroendocrine causes of obesity, to assess the presence and extent of comorbidities, to recommend further medical and laboratory evaluation, and to recognize individuals at high risk for complications of obesity and/or its treatment. The clinical assessment consists of a focused medical history, a careful physical examination, and, as appropriate, laboratory studies. In addition, evaluation of readiness, motivation for weight loss, and potential barriers to change need to be appraised.
The focused medical history should identify the following: (1) potential factors contributing to the individual’s obesity (e.g., familial, behavioral, or endocrinological), (2) current medical complications (see Chapter 84), (3) past treatment responses, and (4) factors that should preclude weight reduction intervention. Table 92.1 outlines the factors generally to be considered under each of these categories. Weight cycling (i.e., a history of repeated bouts of weight loss and gain) is common among obesity-prone persons. However, most studies indicate that weight cycling does not cause persistent metabolic abnormalities, such as depressed resting metabolic rate, and should not be a deterrent to subsequent attempts. Although endocrinological abnormalities associated with obesity are listed, it is important to be aware that identifiable endocrine disorders causing obesity are quite uncommon, occurring in less than 1% of cases. When present, the endocrine disorders most likely to cause weight gain (i.e., Cushing’s syndrome, hypothyroidism, polycystic ovary syndrome) rarely cause severe degrees of obesity.
When searching for medical complications of the patient’s obesity, it is important to