Obesity

Question 1

Obesity definition

Answer 1

Obesity occurs when the weight exceeds 120%

of the median weight for height.

Question 2

Ddx of Obesity

Answer 2

1. Simple Obesity (Intake > output, assoc with psychological stress
2. Familial Obesity
3. Syndromes (PWS, Lawrence-Moon-Biedl Syn, Frolich Syndrome- Female, adipo-genital dystrophy, DI, growth failure, hypogonads)
4. Endocrine causes: Cushings, Pseudohypoparathyroidism, Hypothyroidism

Question 3

Steps in clinical examination in Obesity

Answer 3

1. Impression of Obesity - confirm weight and skin fold thickness (use caliper)
2. Note Height - Tall for simple obesity and Short for Endocrine / Syndromal causes
3. Assess mentality - retardation in Syndromes
4. Note facial features - Dysmorphism (Syndromes), Moon face / Plethora/ acnes (Cushings), Coarse face and Goitre (Cretin)
5. Examine Neck for buffalo hump
6. Examine Limbs for Polydactyly, Short 4th MCP, Small hand, Hypotonia and Thin limbs (relative to truncal obesity)
7. Examine Abdo for Striae and Hypogonadism
8. Offer to look at Fundi (Retinitis Pigmentosa) and do BP and urinalysis for protein and sugar, casts

Question 4

Investigations in Obesity

Answer 4

1. Parental growth parameters
2. Bone age
3. Endocrine Screening - TFTs and Cortisol