Etiology

 The result of an imbalance between daily energy intake and energy expenditure resulting in
excessive weight gain.
 Multifactorial disease, caused by a myriad of genetic, cultural, and societal factors.
 Obesity is extremely heritable, with numerous genes identified with adiposity and weight gain.
 Reduced physical activity
 Insomnia
 Endocrine disorders
 Medications
 The accessibility and consumption of excess carbohydrates and high-sugar foods
 Decreased energy metabolism

Most common syndromes associated with obesity:

 Prader Willi syndrome

 MC4R syndrome

Least common syndromes:

 Fragile X
 Bardet-Beidl syndrome
 Wilson Turner congenital leptin deficiency
 Alstrom syndrome

Clinical Manifestations

 Acne
 Hirsutism
 Skin tags
 Acanthosis nigricans
 Striae
 Mallampati scoring
 Buffalo hump
 Fat pad distribution
 Irregular rhythms
 Gynecomastia
 Abdominal pannus
 Hepatosplenomegaly
 Hernia
 Hypoventilation
 Pedal edema
 Varicoceles
 Stasis dermatitis
 Gait abnormalities

Managements
  Dietary modification – Low calorie diet (either carbohydrate/fat restricted)
 Behavior Interventions - Includes motivational interviewing, cognitive behavior therapy,
dialectical behavior therapy, and interpersonal psychotherapy.
 Medications - Antiobesity medications can be used for BMI greater than or equal to 30 or BMI
greater than or equal to 27 with comorbidities. Medications can be combined with diet,
exercise, and behavior interventions. Antiobesity medications include phentermine, orlistat,
lorcaserin, liraglutide, diethylpropion, phentermine/topiramate,naltrexone/bupropion,
phendimetrazine.
 Surgery: Indications for surgery are a BMI greater or equal to 40 or a BMI of 35 or greater with
severe comorbid conditions. The patient should be compliant with post-surgery lifestyle
changes, office visits, and exercise programs. Commonly performed bariatric surgeries include
adjustable gastric banding, Rou-en-Y gastric bypass, and sleeve gastrectomy. Rapid weight loss
can be achieved with a gastric bypass, and it is the most commonly performed procedure.

Prognosis

Obesity has enormous morbidity and mortality rates. Obese patients have a high risk of adverse cardiac
events and stroke. In addition, the quality of life is poor. Factors that worsen morbidity include:

 Age of onset of obesity

 Amount of central adiposity
 Severity of obesity
 Gender
 Associated comorbidity
 Race

Reference

RK;, P. K. K. N. M. K. (n.d.). Obesity. National Center for Biotechnology Information.

Retrieved October 5, 2022, from https://pubmed.ncbi.nlm.nih.gov/29083734/