A comprehensive diagnostic approach to detect underlying causes of obesity in adults

Abstract

SummaryObesity is a worldwide growing problem. When confronted with obesity, many health care providers focus on direct treatment of the consequences of adiposity. We plead for adequate diagnostics first, followed by an individualized treatment. We provide experience‐based and evidence‐based practical recommendations (illustrated by clinical examples), to detect potential underlying diseases and contributing factors. Adult patients consulting a doctor for weight gain or obesity should first be clinically assessed for underlying diseases, such as monogenetic or syndromic obesity, hypothyroidism, (cyclic) Cushing syndrome, polycystic ovarian syndrome (PCOS), hypogonadism, growth hormone deficiency, and hypothalamic obesity. The most important alarm symptoms for genetic obesity are early onset obesity, dysmorphic features/congenital malformations with or without intellectual deficit, behavioral problems, hyperphagia, and/or striking family history. Importantly, also common contributing factors to weight gain should be investigated, including medication (mainly psychiatric drugs, (local) corticosteroids, insulin, and specific β‐adrenergic receptor blockers), sleeping habits and quality, crash diets and yoyo‐effect, smoking cessation, and alcoholism. Other associated conditions include mental factors such as chronic stress or binge‐eating disorder and depression.Identifying and optimizing the underlying diseases, contributing factors, and other associated conditions may not only result in more effective and personalized treatment but could also reduce the social stigma for patients with obesity.

Identifying underlying medical causes of pediatric obesity: Results of a systematic diagnostic approach in a pediatric obesity center

“…Medication-induced obesity was diagnosed in the presence of start or intensification of known weight-inducing medication (i.e., corticosteroids, anti-epileptic, anti-depressant and anti-psychotic drugs) [34][35][36][37][38] coinciding with a sudden progression of obesity (seen as a clear visual slope discontinuity in the growth curve) and the absence of other plausible explanations for the sudden weight gain.…”

“…[10] Establishing a main underlying cause of obesity can improve personalized treatment. [34] In all our 54 patients with an underlying medical cause, counseling about the diagnosis was given. This included advice pertaining to bariatric surgery, which has unclear long-term success rates for patients with underlying medical causes.…”

The Impact of Obesity and Lifestyle on the Immune System and Susceptibility to Infections Such as COVID-19

“…Next to societal and lifestyle factors, numerous other factors contribute to weight gain or impair weight loss. For example, medication may promote weight gain, as well as endocrine or hypothalamic disease, genetic syndromes or psychiatric conditions (37). It is counterproductive to blame people for their obesity or for severe progression of COVID-19.…”

The Bariatric-Metabolic Physician’s Role in Managing Clinically Severe Obesity

“…The patient’s current diet and eating behaviour, including sources of excess calories, adequacy of macro and micronutrient intake, meal patterns and the need for modification, are ascertained in conjunction with the dieticians. The physician should also enquire about physical activity and sleep patterns as these may contribute to excessive weight gain [ 20 ]. Furthermore, the patient’s motivation for change and their expectations for weight loss and health improvement should be explored.…”