IN THE CONSULTATION: HOW IS OBESITY EVALUATED?
In evaluating a patient with a ponderal overload (overweight or obese) various factors have to be taken into account, understanding that not everyone has the same evaluation or the same risk of associated diseases or mortality. The medical evaluation will distinguish:
1) the type and grade of obesity or being overweight
2) identification of correctable causes of the obesity
3) evaluation of the risk of suffering other illnesses and the associated risk of mortality.
Medical Inquest
- Evaluation of obesity and being overweight: initial weight, minimum and maximum weight, triggering factors.
- Food register: general (number of meals, time, place, snacking habits, preferences...) and a dietary inquest (in the form of a food registry of the last 24 hours or even more complete, a weekly registry).
- Level of daily physical activity or exercise program. Type of work (sedentary, light, moderate, heavy).
- Previous attempts at losing weight: number, personal situation, type of diet (standard or "miracle"), use of regulated products and "not permitted" (amphetamines, hormones, etc) the results of previous attempts, the appearance of a 'yo-yo' effect, the cause of relapse.
- Emotional evaluation: estimate of the grade of motivation and the cause for the desire to lose weight, the grade of emotional affectation in daily and social life (social shyness, lack of self-esteem, the presence of complexes, etc.) and a basic study to discount associated food behaviour disorders (bulimia, compulsive overeating). If there are doubts a complementary psychiatric study should be done.
- The presence of associated illnesses: Diabetes Mellitus, arterial hypertension, elevation of lipids (dyslipemia), ischemic cardiopathy and cerebrovascular accidents, osteoarticular alterations, venous or arterial insufficiency in lower limbs, hyperuricemia and gout, digestive problems, sleep apnea, respiratory insufficiency, coetaneous conditions, tumours.
Physical Exam
- Weight measured on a scale of intervals of a 100 g minimum. Height in measurements of intervals of 1mm, without shoes. Calculation of the BMI and classification according to the result.
- Measurement of the perimeter of the waist (at the middle point between the iliac spine and the lower margin of the ribs) and hips (greatest circumference at the level of the trochanters) Waist-to-Hip formula.
- Measure of blood pressure, with a special sleeve for obese patients, if necessary.
- Other measurements like a study of the coetaneous folds, impedanciometry measurement to estimate or a measurement of the total fat mass can assist in diagnosis, but are not essential.
- Basic, general exploration: auscultation, evaluation of skin, arteries, etc.
Complementary Studies
- General Analytics: glucose, haemogram, lipid profile, renal, hepatic and uric acid, reactive C protein, insulinemia if insulin resistance is suspected or an oral tolerance test for glucose if diabetes is a possibility, TSH if it is necessary to discount thyroid alterations, ovarian or suprarenal study if endocrine pathologies are suspected.
- Electrocardiogram.
- Abdominal ecography if hepatic steatosis (fatty liver) or biliary lithiasis is suspected.
- Respiratory function tests if respiratory pathology is suspected and a sleep study (polysomnography) to rule out sleep apnea syndrome.
- Other more precise techniques to measure body fat like the DEXA, MRI, etc., but are only used if there is a motive for the study.