8
Evaluation
TOP 10 TAKEAWAY MESSAGES:
Obesity Evaluation
1. Patients with obesity often do not receive standard preventive
medical care.
2. Useful nutrition monitoring approaches include recording food
and beverage intake using a diary.
3. Body systems to be evaluated before prescribing a physical
activity program include cardiac, pulmonary, and neuro-
musculoskeletal systems, as well as metabolic processes
(diabetes mellitus, hypertension).
4. Routine laboratory assessment may include measures of
glycemia (fasting glucose levels, hemoglobin A1c [HbA1c]), lipid
levels, liver enzymes, electrolytes, creatinine and blood urea
nitrogen, thyroid stimulating hormone (TSH), complete blood
count (CBC), urine for albumin, and possibly vitamin D.
5. Individual testing may include evaluation for insulin resistance,
insulinoma or nesidioblastosis, hypercortisolism, oligomenorrhea/
amenorrhea, hyperandrogenemia and polycystic ovary syndrome
in women, and hypogonadism in men.
6. Other diagnostic tests in patients with overweight or obesity
might include magnetic-resonance imaging or computed
tomography (CT) of the pituitary, resting electrocardiogram
(EKG), cardiac stress testing, echocardiogram, coronary calcium
scores, ankle-brachial index, sleep studies, and imaging studies
of the liver.
7. Methods to measure body composition include dual-energy x-ray
absorptiometry (DXA), bioelectrical impedance, whole-body air
displacement plethysmography (BOD POD), measuring tape, or
skinfold calipers.
8. Prader-Willi is the most common non-inherited, non-polygenic
genetic syndrome that may promote obesity.
9. MC4R deficiency (autosomal dominant or recessive) is the
most common inherited, non-polygenetic syndrome that may
promote obesity.
10. Medical conditions that may promote fat mass gain include
hypothalamic damage, immobility, insulinoma, hypercortisolism,
sleep disorders, untreated hypothyroidism, and adverse effects
of concurrent medications.
