148 Obesity
Salient features
History
• Family history of obesity (parental obesity more than doubles the risk of adult obesity among both obese and non-obese children under 10 years of age; N Engl J Med 1997;337:869–73)
• History of sleep apnoea, snoring and insomnia
• History of hypertension, diabetes, hyperlipidaemia, cardiovascular disease
• History of gallstones (cholesterol gallstones more prevalent in obesity)
• History of endometrial cancer in women (two to three times more common in obese than in lean women)
• History of breast cancer (risk increases with body mass index in postmenopausal women)
• Cancer of gallbladder and biliary system (obese women have a higher incidence)
• Cancer of colon, rectum, prostate and renal cell cancer (N Engl J Med 2000;343:1305–11) (higher in obese men)
• Medication history: antipsychotics, antidepressants, corticosteroids, oral contraceptives, beta-blockers, oral hypoglycaemic agents, insulin, anticonvulsants, antihistamines, pitzotifen.
Examination
• Measure the height and body weight (to determine body mass index (BMI))
• Check BP (the prevalence of hypertension is approximately three times higher for the obese than the non-obese)
• Examine the joints to exclude osteoarthrosis
• Examine skin for intertrigo in redundant folds of skin (fungal and yeast infections of skin are also common)
• Tell the examiner that you would like to:
