European Society of Endocrinology Clinical Practice Guideline: Endocrine work-up in obesity

Abstract

Obesity is an emerging condition, with a prevalence of ~20%. Although the simple measurement of BMI is likely a simplistic approach to obesity, BMI is easily calculated, and there are currently no data showing that more sophisticated methods are more useful to guide the endocrine work-up in obesity. An increased BMI leads to a number of hormonal changes. Additionally, concomitant hormonal diseases can be present in obesity and have to be properly diagnosed – which in turn might be more difficult due to alterations caused by body fatness itself. The present European Society of Endocrinology Clinical Guideline on the Endocrine Work-up in Obesity acknowledges the increased prevalence of many endocrine conditions in obesity. It is recommended to test all patients with obesity for thyroid function, given the high prevalence of hypothyroidism in obesity. For hypercortisolism, male hypogonadism and female gonadal dysfunction, hormonal testing is only recommended if case of clinical suspicion of an underlying endocrine disorder. The guideline underlines that weight loss in obesity should be emphasized as key to restoration of hormonal imbalances and that treatment and that the effect of treating endocrine disorders on weight loss is only modest.

Effectiveness of a Very Low Calorie Ketogenic Diet on Testicular Function in Overweight/Obese Men

“…A very interesting aspect to consider is the relationship between VLCKD and vitamin D. It is known that vitamin D levels are lower in obese people than in normal-weight subjects, possibly given volumetric dilution effects, but also due to other obesity-related factors, such as poor dietary intake, lack of exposure to sunlight, and lower skin synthesis [ 1 , 15 ]. Although the 2020 European Society of Endocrinology (ESE) guidelines about the work-up in obesity do not suggest the routine measurement of vitamin D levels in obese patients, its evaluation in patients undergoing VLCKD is of great interest since suboptimal levels seem to be associated with impaired glucose homeostasis, insulin resistance, and DM2 [ 15 ].…”

“…Obesity and low vitamin D levels (and other comorbidities that are obesity-related, such as metabolic syndrome and DM2) are also associated with a functional “dysmetabolic” hypogonadism [ 1 , 15 , 21 ]. In men with obesity, the prevalence of hypogonadism ranges between 22.9% and 78.8% [ 6 ].…”

“…In men with obesity, the prevalence of hypogonadism ranges between 22.9% and 78.8% [ 6 ]. However, according to the ESE guidelines, gonadotropin, TT, and sexual hormone binding globulin (SHBG) for the determination of bioavailable testosterone must be assessed only in the presence of known signs/symptoms of hypogonadism [ 1 ]. Obesity was suggested to be associated with low or inappropriately normal levels of LH, indicating the occurrence of a dominant suppression at the hypothalamic–pituitary level [ 22 ].…”

“…In the last two decades, obesity has become an increasingly worrisome reality, with evidence of a dramatic increase in its prevalence, estimated to be around 20% [ 1 ]. According to the World Health Organization (WHO), about 1.6 billion adults worldwide were overweight in 2005 and around 400 million were obese [ 2 ].…”

In memoriam: Renato Pasquali (1946–2019)

“…He published more than 300 articles in international scientific journals. He actively participated in the expert Conference that was organized in Even after the end of his academic career, he participated in the writing of guidelines for the European Society of Endocrinology on the 'Endocrine Work-up in Obesity', which was published in this journal (1). Two years ago, he received the prestigious Clinical Endocrinology Trust prize awarded by the European Society of Endocrinology, in recognition of noteworthy scientific activity in the field of endocrinology.…”