Obesity in Adults - Etiology and Natural History

5/14/2016
Obesityinadults:Etiologyandnaturalhistory
OfficialreprintfromUpToDate
www.uptodate.com2016UpToDate
Author
GeorgeABray,MD
SectionEditor
FXavierPiSunyer,MD,MPH
DeputyEditor
KathrynAMartin,MD
Alltopicsareupdatedasnewevidencebecomesavailableandourpeerreviewprocessiscomplete.
Literaturereviewcurrentthrough:Apr2016.|Thistopiclastupdated:Mar09,2015.
INTRODUCTIONObesityisachronicdiseasethatisincreasinginprevalenceinadults,adolescents,and
children,andisnowconsideredtobeaglobalepidemic.Obesityisassociatedwithasignificantincreasein
mortalityandwithriskofmanydisorders,includingdiabetesmellitus,hypertension,dyslipidemia,heart
disease,stroke,sleepapnea,cancer,andothers.Thistopicwillreviewthenaturalhistoryofobesityandthe
etiologicfactorsassociatedwithbeingoverweightandobese(table1).Theetiologyofobesityinchildrenand
adolescentsisreviewedseparately.Thegeneticcausesofobesityaswellastheevaluation,prevalence,and
treatmentofobesityinadultsarealsodiscussedseparately.
(See"Definitionepidemiologyandetiologyofobesityinchildrenandadolescents".)
(See"Pathogenesisofobesity".)
(See"Obesityinadults:Healthhazards".)
(See"Obesityinadults:Prevalence,screening,andevaluation".)
(See"Obesityinadults:Overviewofmanagement".)
CLASSIFICATIONOFBMIThebodymassindex(BMI)isthemostpracticalwaytoevaluatethedegreeof
overweight.Itiscalculatedfromtheheightandweightasfollows:
BMI=bodyweight(inkg)squareofstature(height,inmeters)
TheBMIcanbeestimatedfromatableoracalculator(table2AB)(calculator1).
TherecommendedclassificationsforBMIadoptedbytheNationalHeart,Lung,andBloodInstitute[1]andthe
WorldHealthOrganization(WHO)[2],andaffirmedintheAmericanHeartAssociation(AHA)/American
CollegeofCardiology(ACC)/TheObesitySociety(TOS)Guidelines[3]are:
NormalweightBMI18.5to24.9kg/m2
OverweightBMI25to29.9kg/m2
ObesityBMIof30kg/m2
SevereobesityBMI40kg/m2(or35kg/m2inthepresenceofcomorbidities)
ThesecutoffsapplytoCaucasian,Hispanic,andBlackindividuals.TheyunderestimateriskintheAsianand
SouthAsianpopulation.Thus,intheWHOandNationalInstitutesofHealth(NIH)guidelinesforAsians,
overweightisaBMIbetween23and24.9kg/m2andobesityaBMI>25kg/m2[4].(See"Obesityinadults:
Prevalence,screening,andevaluation",sectionon'Bodymassindex'.)
AGEATWHICHOVERWEIGHTDEVELOPSPeoplecanbecomeoverweightatanyage.However,there
arecertaintimeswhenweightgaintendstooccur,whichvarybetweenmenandwomen.
GestationandearlylifeThereisincreasingevidencethatenvironmentalandnutritionalinfluencesduring
criticalperiodsindevelopmentcanhavepermanenteffectsonanindividual'spredispositiontoobesityand
metabolicdisease[5].Maternalnutritionorendocrineprofileduringgestationisprobablyanimportant
determinantofmetabolicprogramming.Asanexample,amothersbodyweightduringpregnancymay
influencebodysize,shape,andlaterbodycompositionofherinfant[6].Highprepregnancybodymassindex
(BMI)andexcessivegestationalweightgainareriskfactorsforchildhoodobesity.Inaddition,infantsbornto
diabeticmothershaveahigherriskofbeingoverweightaschildrenandadults[7,8],asdochildrenwhose
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motherssmokedduringpregnancy[9].(See"Definitionepidemiologyandetiologyofobesityinchildrenand
adolescents",sectionon'Metabolicprogramming'.)
Althoughbirthweightisapoorpredictoroffutureobesity,infantswhoaresmall,short,orhaveasmallhead
circumferenceareathigherriskofabdominalfatnessandothercomorbiditiesassociatedwithobesitylaterin
life.
Breastfeeding,whencomparedwithformulafeeding,maybeassociatedwithalowerriskofoverweight.This
topicisreviewedseparately.(See"Infantbenefitsofbreastfeeding",sectionon'Obesity'.)
ChildhoodandadolescenceThepredictivevalueofchildhoodobesityvarieswiththeageatonsetof
obesityandthefamilyhistory[10].Asubstantialcomponentofadolescentobesityisestablishedbeforefive
yearsofage.Studieswithlongertermfollowuprevealthatchildhoodobesitytypicallypersistsintoadulthood,
particularlyforchildrenwithanobeseparent.Obesityinadolescenceisassociatedwithsevereobesityin
adults[11].Inaddition,weightstatusinadolescencepredictslateradversehealthevents[12].Thistopicis
reviewedinmoredetailelsewhere.(See"Definitionepidemiologyandetiologyofobesityinchildrenand
adolescents",sectionon'Persistenceintoadulthood'.)
AdultsInspiteoftheimportanceofchildhoodandadolescentweight,mostoverweightpeopledeveloptheir
probleminadultlife[8].
WomenMostoverweightwomengaintheirexcessweightaftertheonsetofpuberty[13].Thisweight
gainmaybeprecipitatedbyanumberofevents,includingpregnancyandmenopause.
PregnancyWeightgainduringpregnancy,andtheeffectofpregnancyonsubsequentweightgain,are
importanteventsintheweightgainhistoryofwomen[14].Womenexperiencemodestincreasesinbody
weightandfatdistributionafterafirstpregnancythesechangesarepersistentandvaryaccordingtorace
andethnicbackground[15,16].However,whencomparedwithnulliparouswomen,theoverallriskof
weightgainassociatedwithchildbearingisquitesmallforAmericanwomen[17].
Fornormalweightwomen(BMI18.5to24.9kg/m2),weightgainof25to35lbs(11.5to16.0kg)is
optimal.Afewwomengainalargeamountofweightduringpregnancy,occasionallyasmuchas50kg.
Excessivegestationalweightgainincreasestheriskofpostpartumweightretention.(See"Weightgain
andlossinpregnancy",sectionon'Recommendationsforweightgainduringpregnancy'.)
OralcontraceptivesManywomenandtheircliniciansbelievethatoralcontraceptivescauseweight
gain.However,availabledatasuggestthatsignificantweightgainisprobablynotacommonsideeffectof
oralcontraceptives.(See"Risksandsideeffectsassociatedwithestrogenprogestincontraceptives",
sectionon'Weight'.)
MenopauseWeightgainandchangesinfatdistributionoftenoccurintheearlypostmenopausalyears
[18].Themagnitudeoftheincreasedependsuponthemethodofmeasurement[16].IntheStudyof
WomensHealthAcrosstheNation(SWAN),waistcircumferenceandfatmassweremeasuredwith
bioelectricalimpedence[19].Overasixyearperiod,therewasanincreaseinweight(cumulativesixyear
change,2.9kg)andwaistcircumference(5.7cm).Therateofincreaseinwaistcircumferenceslowed
oneyearafterthefinalmenstrualperiod,whereasfatmasscontinuedtoincreasewithnochangeinrate.
Thus,bothagingingeneralandovarianagingcontributetotheincreaseinweightandchangesinbody
compositionnotedduringthemenopause.(See"Clinicalmanifestationsanddiagnosisofmenopause",
sectionon'Longtermconsequencesofestrogendeficiency'.)
Estrogentherapydoesnotpreventweightgaininpostmenopausalwomen,althoughitmayminimizefat
redistribution.InathreeyearsubstudyofwomenintheWomensHealthInitiative,womenwhoreceived
estrogenandprogesteronetherapylostsignificantlylessleansofttissuemassthandidthewomenwho
receivedplacebo(0.04versus0.44kg)[20].Inaddition,thewomeninthetreatmentgrouphadless
changeinratiooftrunktolegfatmass.Althoughthisinterventionsignificantlyreducedboththelossof
leansofttissuemassandtheratiooftrunktolegfatmassinpostmenopausalwomen,theeffectwas
smallanditisunclearwhetherthesechangesinbodycompositionleadtosignificanthealthbenefits.
(See"Menopausalhormonetherapy:Benefitsandrisks".)
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MenThetransitionfromanactivelifestyleduringtheteensandtwentiestoamoresedentarylifestyle
thereafterisassociatedwithweightgaininmanymen.Ariseinbodyweightcontinuesuntilthesixthdecade.
Afterages55to64years,relativeweightremainsstable,andthenbeginstodecline.Thereisevidencefrom
theFraminghamStudyandstudiesofmeninthearmedservicesthatmenhavebecomeprogressivelyheavier
forheightovertime[8].
LongtermrisksThelongtermriskofbecomingoverweight(BMI25kg/m2)orobese(BMI30kg/m2)
duringadulthoodappearstobeveryhigh.Thiswasillustratedinaprospectivecohortstudyof4117menand
women(mostlyCaucasian,ages30to59years)wherethefollowingresultswereseen[21]:
Withinfouryears,14to19percentofwomenand26to30percentofmenwhowerenormalweightat
baselinebecameoverweight5to9percentofmenandwomenwhowereeithernormalweightor
overweightatbaselinebecameobese.
Within30years,morethan50percentofindividualsbecameoverweight,whileapproximately30and25
percentofwomenandmen,respectively,becameobese.
LIFESTYLE
PhysicalactivityAsedentarylifestylelowersenergyexpenditureandpromotesweightgain.
Severalobservationsillustratetheimportanceofdecreasedenergyexpenditureinthepathogenesisofweight
gain.
InonestudyexaminingtrendsinoccupationalphysicalactivityintheUnitedStatesduringthepast50
years,energysparingdevicesintheworkplaceandathomereduceenergyexpenditureandmayenhance
thetendencytogainweight[22].
InananalysisofdatafromtheNationalHealthandNutritionExaminationSurvey(NHANES),obesity
wasmorestronglyandinverselyrelatedtomoderatelyvigorousphysicalactivitythaneithertelevision
(TV)timeortotalsedentary[23].Smalldifferencesindailylevelsofmoderatelyvigorousphysicalactivity
(5to10min)wereassociatedwithrelativelylargedifferencesinriskofobesity.
AccordingtotheSurgeonGeneral'sReportofPhysicalActivity,thepercentofadultAmericans
participatinginphysicalactivitydecreasessteadilywithage,andreducedenergyexpenditureinadults
andchildrenispredictiveofweightgain[24].
Ofallsedentarybehaviors,prolongedTVwatchingappearstobethemostpredictiveofobesityand
diabetesrisk.IntheNurses'HealthStudy,afteradjustmentforage,smoking,exerciselevel,anddietary
factors,everytwohourincrementspentwatchingTVwasassociatedwitha23percent(95%CI1730
percent)increaseinobesityanda14percent(95%CI523percent)increaseintheriskofdiabetes[25].
Lessriskwasseenwithothersedentarybehavior,suchassittingatwork.TheeffectsofTVonobesity
aremediated,inpart,bychangesinenergyintake,ratherthanchangesinphysicalactivityalone[26,27].
Obesityismoreprevalentinadultswithphysical,sensory,ormentalhealthdisabilities.Thosewithimpaired
lowerextremitymobilityareathighestrisk[28].Theroleofphysicalactivityinthepreventionandtreatmentof
obesityisreviewedseparately.(See"Obesityinadults:Roleofphysicalactivityandexercise".)
SleepdeprivationTheproportionofadultsintheUnitedStatessleepinglessthansevenhourspernight
hasincreasedfrom16to37percentoverthepast40years[29],alifestylechangethatmayhavenegative
metabolicconsequences.Thiswasillustratedinastudyof12healthy,normalweight,adultmenwho
underwenttwonightsofsleeprestriction(fourhourspernight)andtwonightsofsleepextension(10hoursper
night)inarandomizedorder,spacedsixweeksapartwithcontrolledconditionsofcaloricintakeandphysical
activity[30].Sleeprestriction,whencomparedwithsleepextension,wasassociatedwithadecreaseinserum
leptin(ananorexigenichormone),anincreaseinserumghrelin(anorexigenichormone),andincreasedhunger
andappetite(inparticularforcaloriedensefoodswithhighcarbohydratecontent)[30,31].
Observationaldataalsosuggestapossibleassociationbetweensleeprestrictionandobesity[32,33].In
addition,sleepdeprivationmayreducetheproportionofweightlostasfatduringcaloricrestriction[34].These
findingssuggestthatinadequatesleepcouldresultinexcessiveeating,obesity,andalteredresponsetodietary
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therapy.(See"Sleepinsufficiency:Definition,consequences,andmanagement".)
CessationofsmokingWeightgainisverycommonwhenpeoplestopsmoking.Thisisthoughttobe
mediatedatleastinpartbynicotinewithdrawal,whichisassociatedwithincreasedfoodintakeandreduced
energyexpenditure[35].Weightgainof1to2kginthefirsttwoweeksisoftenfollowedbyanadditional2to3
kgweightgainoverthenextfourtofivemonths.Theaverageweightgainis4to5kgbutcanbemuchgreater
[35,36].Ithasbeenestimatedthatsmokingcessationincreasestheoddsratioofobesitycomparedwith
nonsmokersby2.4inmenand2.0inwomen.(See"Benefitsandrisksofsmokingcessation",sectionon
'Weightgain'.)
Becauseofthepredictableweightgainaftercessationofsmoking,ithasbeensuggestedthatanexercise
programanddecreasedcaloricintakeberecommendedtoallpatientsabouttostopsmoking[37].(See
"Overviewofsmokingcessationmanagementinadults".)
DIETChangesintheglobalfoodsupply,includingtheavailabilityofcheap,palatable,convenient,energy
densefoodsmayberesponsible,inpart,fortherisingprevalenceofobesity[38].Sincethe1970s,thequantity
ofrefinedcarbohydratesandfatsincreasedintheUnitedStatesfoodsupply,resultinginadramaticincreasein
totalcalorieintake.Increasingtrendsinglycemicindexoffoods,sugarcontainingbeverages,portionsizesfor
preparedfoods,fastfoodservice,diminishingfamilypresenceatmeals,andschoolmealnutritioncontent,
combinedwithacontinueddeclineinphysicalactivity,hascontributedtotheriseinobesityintheUnited
Statesandworldwide.
Thereareseveralsettingsinwhichdietaryfactorsbecomeimportant.
DietaryhabitsEpidemiologicaldatasuggestthatadiethighinfatandsugarisassociatedwithobesity.Ina
prospectiveevaluationofthreecohorts(120,877menandwomen),increasedconsumptionofpotatochips,
potatoes,sugarsweetenedbeverages,unprocessedredmeat,andprocessedmeatswasdirectlyassociated
withweightgain[39].Incontrast,intakeofvegetables,wholegrains,fruits,nuts,andyogurtwasinversely
associatedwithweightgain.Inaddition,accumulatingevidencesuggeststhatconsumptionofsugar
sweetenedbeverages(includingfruitjuice)isanimportantcontributortothedevelopmentofobesityinsome
individuals[40].
Theremayalsobeaninteractionbetweendietaryhabitsandageneticpredispositionforobesity[41,42].Asan
example,inanevaluationof32bodymassindex(BMI)lociassociatedwithobesityintwolargeprospective
cohortstudies,therewasaninteractionbetweenthegeneticpredispositionscoreandtheintakeofsugar
sweetenedbeverages,suchthatadultswithahighergeneticpredispositionscoreappearedtobemore
susceptibletotheadverseeffectsofsugarsweetenedbeveragesonBMI[41].Theeffectsofsaturatedfaton
obesityarealsoaccentuatedinindividualswiththeFTOgenotype[43].Theunderlyingmechanismforthis
interactionrequiresfurtherstudy.(See'Geneticandcongenitaldisorders'below.)
Eatingpatterns
OvereatingandrestrainedeatingManypeoplehaveapatternofconsciouslimitationoffoodintake,
termed"restrained"eating[44].Thisrestraintpatterniscommoninmany,ifnotmost,middleagedwomenwho
areof"normalweight."Itmayalsoaccountfortheinverserelationshipbetweenbodyweightwithsocialclass
womenofhighersocioeconomicstatusmoreoftenmaintaintheirweight.Overeatingrelativetoenergy
expenditurewilluniformlycauseobesity[45]mostobesesubjectshavelostcontroloftheireating
(disinhibition).
FrequencyofeatingTherelationshipbetweenthefrequencyofmealsandthedevelopmentofobesityis
unsettled.Afivemealadaypatternwasassociatedwithsignificantlylowerriskofoverweightandobesityina
FinnishBirthCohort[46]andinaGermancohortofyoungerchildren[47].Eatingbreakfastisassociatedwith
lowerriskofoverweight[48,49].
Oneexplanationfortheeffectsoffrequentsmallmeals(nibbling)versusafewlargemealscouldbethe
differenceininsulinsecretionassociatedwiththesemealsizes(eg,increasedwithlargemeals)[50].
NighteatingsyndromeNighteatingsyndromeisdefinedasconsumptionofatleast25percent(and
usuallymorethan50percent)ofenergybetweentheeveningmealandthenextmorning[51].Itisawell
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knownpatternofdisturbedeatingintheobese[52].Itisrelatedtosleepdisturbancesandmaybeacomponent
ofsleepapnea,inwhichdaytimesomnolenceandnocturnalwakefulnessarecommon.(See"Clinical
presentationanddiagnosisofobstructivesleepapneainadults".)
BingeeatingdisorderBingeeatingdisorderisapsychiatricillnesscharacterizedbyuncontrolled
episodesofeatingthatusuallyoccurintheevening[51].Thepatientmayrespondtotreatmentwithdrugsthat
modulateserotoninreleaseorreuptake.(See"Obesityinadults:Drugtherapy".)
DRUGINDUCEDWEIGHTGAINAnumberofdrugscancauseweightgain,includingpsychoactivedrugs,
antiepilepticdrugs,antihyperglycemicagents,andhormones(table3)[53].
AntipsychoticsAntipsychoticdrugshaveavariableeffectonbodyweight(table4)[53].Amongthe
conventional(firstgeneration)antipsychotics,theestimatedaverageweightgainafter10weeksoftherapywas
highestforthioridazine(3.2kg).Molindonedidnotcauseweightgain.
Amongtheatypical(secondgeneration)antipsychotics,clozapineandolanzapinewereassociatedwiththe
greatestweightgain(4.4and4.2kg,respectively),followedbyrisperidone(2.10kg)[53].(See
"Pharmacotherapyforschizophrenia:Sideeffectmanagement",sectionon'Metabolicsideeffects'and"First
generationantipsychoticmedications:Pharmacology,administration,andcomparativesideeffects"and
"Secondgenerationantipsychoticmedications:Pharmacology,administration,andsideeffects".)
Lithium,amoodstabilizerusedforthetreatmentofbipolardisorder,isassociatedwithweightgain.(See
"Bipolardisorderinadults:Choosingmaintenancetreatment",sectionon'Lithium'.)
AntidepressantsTricyclicantidepressants,inparticular,amitriptyline,clomipramine,doxepin,and
imipramineareassociatedwithsignificantweightgain(table4).(See"Tricyclicandtetracyclicdrugs:
Pharmacology,administration,andsideeffects".)
Theeffectsofselectiveserotoninreuptakeinhibitors(SSRIs)onbodyweightarelesswellcharacterized.
Shorttermuseoffluoxetineandsertralinehasbeenassociatedwithweightloss.Incontrast,longtermuseof
some,butnotall,SSRIsmaybeassociatedwithweightgain,asillustratedinarandomizedtrialamong284
patientswithdepressionreceivingfluoxetine,sertraline,orparoxetinetherapyfor26to32weeks[54].A
significantweightincreasewasseenintheparoxetinegroup,whileanonsignificantincreaseandnonsignificant
decreaseinweightwereseeninthesertralineandfluoxetinegroups,respectively.(See"Obesityinadults:
Drugtherapy",sectionon'Antidepressants'.)
AntiepilepticdrugsTheantiepilepticdrugsvalproate(valproicacid)andcarbamazepine,whichare
commonlyusedinthemanagementofbipolardisorder,areassociatedwithweightgain.Gabapentinmayalso
causeweightgain.Topiramateandzonisamidedonothavethiseffect(table4).(See"Bipolardisorderin
adults:Epidemiologyandpathogenesis"and"Overviewofthemanagementofepilepsyinadults",sectionon
'Choosinganantiseizuredrug'.)
DiabetesdrugsInsulinandthesulfonylureasareassociatedwithmodestweightgain[53].
Thiazolidinediones,suchaspioglitazoneandrosiglitazone,arealsoassociatedwithweightgain.Metformin,on
theotherhand,causedasmall(approximately2kg),butsignificantandprolonged,weightlossinpatientswith
impairedglucosetoleranceintheDiabetesPreventionProgram[55].Stillotherdiabetesmedicationsareeither
weightneutralorassociatedwithsmalldegreesofweightloss(glucagonlikepeptide1[GLP1]agonists,
dipeptidylpeptidase4[DPP4]inhibitors,alphaglucosidaseinhibitors,andsodiumglucosetransport2[SGLT
2]inhibitors).(See"Thiazolidinedionesinthetreatmentofdiabetesmellitus"and"Metformininthetreatmentof
adultswithtype2diabetesmellitus".)
Intensiveinsulintherapycomparedwithconventionalinsulintherapyresultsinmodestweightgain.Asan
example,intheDiabetesControlandComplicationsTrial,themeanincreaseinweightwas5.1kginthe
patientsintheintensivetreatmentgroupand2.4kginthoseintheconventionaltreatmentgroup[56].Ina
subsequentreviewofweightgainwithinsulintreatmentintype1and2diabeticpatients,weightgainwas
greaterinthosewithworsecontroloftheirdiabetesandinthosewhohadgreaterintentionalweightlosspriorto
initiationofinsulin[57].(See"Glycemiccontrolandvascularcomplicationsintype2diabetesmellitus".)
OtherOtherdrugsassociatedwithweightgainincludecyproheptadine(anantihistamine),betablockers,
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andglucocorticoids[53].(See"Majorsideeffectsofbetablockers"and"Majorsideeffectsofsystemic
glucocorticoids".)
NEUROENDOCRINEOBESITYSeveralneuroendocrinedisordersmaybeassociatedwiththe
developmentofobesity(table1).
HypothalamicobesityHypothalamicobesityisararesyndromeinhumansthatcanberegularlyproduced
inanimalsbyinjurytotheventromedialorparaventricularregionofthehypothalamusortheamygdala[58].
Theseregionsofthebrainareresponsibleforintegratingmetabolicinformationregardingnutrientstoreswith
afferentsensoryinformationaboutfoodavailability.Whentheventromedialhypothalamusisdamaged,
hyperphagiadevelopsandobesityfollows.
Thissyndromecanbecausedbytrauma,tumor,inflammatorydisease,surgeryintheposteriorfossa,or
increasedintracranialpressure.Inareviewof77patients,threepatternsofpresentationweredescribed:
headache,vomiting,anddiminishedvisionimpairedreproductivefunctionwithamenorrheaorimpotence,
diabetesinsipidus,andthyroidoradrenalinsufficiencyorneurologicandphysiologicalderangementsincluding
convulsions,coma,somnolence,andhypothermiaorhyperthermia(table5).
Inasecondreportof42adultswithtumorsinthehypothalamicregion(treatedwithsurgeryand/or
radiotherapy),52percentofpatientswereobeseafteramedianoffiveyearsoffollowup(versus24percentat
baseline)[59].Inamultivariateanalysis,desmopressinuseandgrowthhormonereplacementwereassociated
withneworworsenedobesitynocorrelationwasfoundbetweentumorlocationorsizeandsubsequentweight
gain.
Cushing'ssyndromeAcommonclinicalfeatureinpatientswithCushing'ssyndromeisprogressivecentral
(centripetal)obesity(picture1),usuallyinvolvingtheface,neck(leadingtoabuffalohumpandobscuringofthe
clavicles),trunk,abdomen,and,internally,themesenteryandmediastinum(picture2).Theextremitiesare
usuallysparedandareoftenwasted.ThiseffectofglucocorticoidsinCushingssyndromecanbeexplainedby
theinductionof11betahydroxysteroiddehydrogenasetype1invisceralfat,whichenhancesthelipogenic
capacityofthistissue[60].(See"EpidemiologyandclinicalmanifestationsofCushing'ssyndrome".)
Incontrasttoadults,nearlyallchildrenwithCushing'ssyndromehavegeneralizedobesity,accompaniedbya
decreaseinlineargrowth.Asaresult,anychildwhoseweightrisesandheightfallsinpercentilerankwhen
comparedwithagematchednormalchildrenshouldbeevaluatedforCushing'ssyndrome.(See"Establishing
thediagnosisofCushing'ssyndrome".)
HypothyroidismPatientswithhypothyroidismoftengainweightduetoslowingofmetabolicactivity.Some
ofthisgainisfat.Theweightgainisusuallymodest,andmarkedobesityisuncommon.Increasingserum
thyroidstimulatinghormone(TSH)concentrationswithinthenormalrangehavealsobeenassociatedwitha
modestincreaseinbodyweightinadults[61,62],buttreatmentofsubclinicalhypothyroidismdoesnotappear
tobeassociatedwithweightloss.(See"Subclinicalhypothyroidism",sectionon'Potentialconsequences'.)
PolycysticovarysyndromeAbout50percentofwomenwithpolycysticovarysyndrome(PCOS)are
obese.Thefactorsresponsibleforthisassociationarenotunderstood.(See"Clinicalmanifestationsof
polycysticovarysyndromeinadults".)
GrowthhormoneGrowthhormonedeficiencyinadultsisassociatedwithanincreaseinabdominaland
visceralfat.(See"Growthhormonedeficiencyinadults".)
PSYCHOLOGICFACTORSPsychologicalfactorsareimportantinthedevelopmentofobesity,although
attemptstodefineaspecificpersonalitytypeassociatedwithobesityhavebeenunsuccessful.Onecondition
thathasbeenlinkedtoweightgainisseasonalaffectivedisorder,whichreferstodepressionthatoccursduring
thewinterseasoninpeoplelivinginthefarnorthitcanbetreatedbyexposuretolight.Thesepatientstendto
haveawinterincreaseinbodyweightthatcanbeeffectivelytreatedwithdrugsthatmodulateserotoninrelease
orreuptake.(See"Seasonalaffectivedisorder:Epidemiology,clinicalfeatures,assessment,anddiagnosis".)
GENETICANDCONGENITALDISORDERSStudiesoftwins,adoptees,andfamiliesallsuggestthe
existenceofgeneticfactorsinhumanobesity[10].Geneticfactorsinfluenceobesityintwoways.First,there
aregenesthatareprimaryfactorsinthedevelopmentofobesitysuchasleptindeficiency.Second,thereare
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susceptibilitygenesonwhichenvironmentalfactorsacttocauseobesity.Inadditiontotheheritabilityof
weight,metabolicrate,thermicresponsetofood,andspontaneousphysicalactivityaretosomeextent
heritable.Thistopicisdiscussedinmoredetailelsewhere.(See"Pathogenesisofobesity".)
SOCIOECONOMICANDETHNICFACTORSObesityismoreprevalentinlowersocioeconomicgroupsin
theUnitedStatesandelsewhere[63].Thereasonforthisassociationisnotknown,butislikelyrelatedto
severalfactorsincludingnutritioneducation,neighborhoodfoodenvironments,andelementsofthebuilt
environment(eg,availabilityofsidewalksandplaygrounds)[64,65].
Ethnicityalsoinfluencestheincidenceofobesity.Blackmen,asanexample,arelessobesethanwhitemen.
Incontrast,blackwomenofallagesaremoreobesethanwhitewomen,whiletheprevalenceofobesityin
Hispanicmenandwomenishigherthaninwhitemenandwomen[1].Inaddition,obesityonsetinyoung
adulthoodisfasterinbothblackandHispanicwomenthaninwhitewomen[66].
INFECTIOUSAGENTSAnumberofinfectiousagents,inparticular,adenovirusinfections,havebeen
identifiedinanimalmodelsthatappeartobeassociatedwithobesity[6769].Inonehumanstudyofobeseand
nonobesesubjects,adenovirus36wasassociatedwithhigherbodymassindexes(BMIs)butlowerserum
cholesterolandtriglycerideconcentrations[70].
Gutmicrobiotacanaffectbodyweightinexperimentalanimals(andprobablyinhumans)byoneofseveral
mechanisms,includingeffectsonenergymetabolism,lowgradeinflammation,andalteredgutpermeability[71
73].
INFORMATIONFORPATIENTSUpToDateofferstwotypesofpatienteducationmaterials,TheBasics
andBeyondtheBasics.TheBasicspatienteducationpiecesarewritteninplainlanguage,atthe5thto6th
gradereadinglevel,andtheyanswerthefourorfivekeyquestionsapatientmighthaveaboutagiven
condition.Thesearticlesarebestforpatientswhowantageneraloverviewandwhoprefershort,easytoread
materials.BeyondtheBasicspatienteducationpiecesarelonger,moresophisticated,andmoredetailed.
Thesearticlesarewrittenatthe10thto12thgradereadinglevelandarebestforpatientswhowantindepth
informationandarecomfortablewithsomemedicaljargon.
Herearethepatienteducationarticlesthatarerelevanttothistopic.Weencourageyoutoprintoremailthese
topicstoyourpatients.(Youcanalsolocatepatienteducationarticlesonavarietyofsubjectsbysearchingon
patientinfoandthekeyword(s)ofinterest.)
Basicstopics(see"Patientinformation:Healthrisksofobesity(TheBasics)"and"Patientinformation:
Weightlosstreatments(TheBasics)")
BeyondtheBasicstopics(see"Patientinformation:Weightlosstreatments(BeyondtheBasics)")
SUMMARY
Manyfactorscontributetothedevelopmentofobesity(table1).Amongthevariousetiologies,lifestyle
anddietarethemostimportant.(See'Lifestyle'aboveand'Diet'above.)
Asedentarylifestylelowersenergyexpenditureandpromotesweightgain.Inanaffluentsociety,energy
sparingdevicesintheworkplaceandathomereduceenergyexpenditureandmayenhancethetendency
togainweight.Ofallsedentarybehaviors,prolongedtelevision(TV)watchingappearstobethemost
predictiveofobesityanddiabetesrisk.TheeffectsofTVonobesityaremediated,inpart,bychangesin
energyintake,ratherthanchangesinphysicalactivityalone.(See'Physicalactivity'above.)
Excessintakeofcaloriesfromanysource,associatedwithasedentarylifestyle,causesweightgainand
obesity.Dietshighinpartiallyhydrogenatedfats,redorprocessedmeats,refinedcarbohydrates,and
sugarareassociatedwithweightgain,whereasintakeofvegetables,wholegrains,yogurt,fruits,and
nutsarenot.(See'Diet'above.)
Numerousdrugsareassociatedwithweightgain,includingpsychoactivedrugs,antiepilepticdrugs,
antihyperglycemicagents,andhormones(table3).(See'Druginducedweightgain'above.)
Geneticfactorsinfluenceobesityintwoways.First,therearegenesthatareprimaryfactorsinthe
5/14/2016
developmentofobesity.Second,therearesusceptibilitygenesonwhichenvironmentalfactorsactto
causeobesity.(See"Pathogenesisofobesity",sectionon'Geneticfactorsinpeoplewithobesity'.)
UseofUpToDateissubjecttotheSubscriptionandLicenseAgreement.
REFERENCES
1.NationalInstitutesofHealth.NationalHeart,Lung,andBloodInstitute.Clinicalguidelinesonthe
identification,evaluation,andtreatmentofoverweightandobesityinadults:Theevidencereport.Obes
Res19986Suppl2:515.
2.WHOConsultationonObesity.Obesity:Preventingandmanagingtheglobalepidemic.Geneva,35June
1997.WorldHealthOrganization,Geneva,1998.
3.JensenMD,RyanDH,ApovianCM,etal.2013AHA/ACC/TOSguidelineforthemanagementof
overweightandobesityinadults:areportoftheAmericanCollegeofCardiology/AmericanHeart
AssociationTaskForceonPracticeGuidelinesandTheObesitySociety.Circulation2014129:S102.
4.WHOExpertConsultation.AppropriatebodymassindexforAsianpopulationsanditsimplicationsfor
policyandinterventionstrategies.Lancet2004363:157.
5.OzanneSE.Epigeneticsignaturesofobesity.NEnglJMed2015372:973.
6.OkenE,TaverasEM,KleinmanKP,etal.Gestationalweightgainandchildadiposityatage3years.Am
JObstetGynecol2007196:322.e1.
7.BaptisteRobertsK,NicholsonWK,WangNY,BrancatiFL.Gestationaldiabetesandsubsequentgrowth
patternsofoffspring:theNationalCollaborativePerinatalProject.MaternChildHealthJ201216:125.
8.BrayGA.AGuidetoObesityandtheMetabolicSyndrome,CRCPress,BocaRaton,FL2011.
9.OkenE,LevitanEB,GillmanMW.Maternalsmokingduringpregnancyandchildoverweight:systematic
reviewandmetaanalysis.IntJObes(Lond)200832:201.
10.LoosRJ.Geneticdeterminantsofcommonobesityandtheirvalueinprediction.BestPractResClin
EndocrinolMetab201226:211.
11.TheNS,SuchindranC,NorthKE,etal.Associationofadolescentobesitywithriskofsevereobesityin
adulthood.JAMA2010304:2042.
12.MustA,PhillipsSM,NaumovaEN.Occurrenceandtimingofchildhoodoverweightandmortality:
findingsfromtheThirdHarvardGrowthStudy.JPediatr2012160:743.
13.DeshmukhTaskarP,NicklasTA,MoralesM,etal.Trackingofoverweightstatusfromchildhoodto
youngadulthood:theBogalusaHeartStudy.EurJClinNutr200660:48.
14.MannanM,DoiSA,MamunAA.Associationbetweenweightgainduringpregnancyandpostpartum
weightretentionandobesity:abiasadjustedmetaanalysis.NutrRev201371:343.
15.SmithDE,LewisCE,CavenyJL,etal.Longitudinalchangesinadiposityassociatedwithpregnancy.
TheCARDIAStudy.CoronaryArteryRiskDevelopmentinYoungAdultsStudy.JAMA1994271:1747.
16.GundersonEP,SternfeldB,WellonsMF,etal.Childbearingmayincreasevisceraladiposetissue
independentofoverallincreaseinbodyfat.Obesity(SilverSpring)200816:1078.
17.RobinsonWR,ChengMM,HoggattKJ,etal.Childbearingisnotassociatedwithyoungwomen'slong
termobesityrisk.Obesity(SilverSpring)201422:1126.
18.LovejoyJC.Themenopauseandobesity.PrimCare200330:317.
19.SowersM,ZhengH,TomeyK,etal.Changesinbodycompositioninwomenoversixyearsatmidlife:
ovarianandchronologicalaging.JClinEndocrinolMetab200792:895.
20.ChenZ,BassfordT,GreenSB,etal.Postmenopausalhormonetherapyandbodycompositiona
substudyoftheestrogenplusprogestintrialoftheWomen'sHealthInitiative.AmJClinNutr2005
82:651.
21.VasanRS,PencinaMJ,CobainM,etal.EstimatedrisksfordevelopingobesityintheFraminghamHeart
Study.AnnInternMed2005143:473.
22.ChurchTS,ThomasDM,TudorLockeC,etal.Trendsover5decadesinU.S.occupationrelated
physicalactivityandtheirassociationswithobesity.PLoSOne20116:e19657.
23.MaherCA,MireE,HarringtonDM,etal.Theindependentandcombinedassociationsofphysicalactivity
andsedentarybehaviorwithobesityinadults:NHANES200306.Obesity(SilverSpring)201321:E730.
24.USDepartmentofHealthandHumanServices.PhysicalActivityandHealth:AReportoftheSurgeon
5/14/2016
General.Atlanta,GA1996.
25.HuFB,LiTY,ColditzGA,etal.Televisionwatchingandothersedentarybehaviorsinrelationtoriskof
obesityandtype2diabetesmellitusinwomen.JAMA2003289:1785.
26.BorgheseMM,TremblayMS,LeducG,etal.Independentandcombinedassociationsoftotalsedentary
timeandtelevisionviewingtimewithfoodintakepatternsof9to11yearoldCanadianchildren.Appl
PhysiolNutrMetab201439:937.
27.BellisleF.Mealsandsnacking,dietqualityandenergybalance.PhysiolBehav2014134:38.
28.WeilE,WachtermanM,McCarthyEP,etal.Obesityamongadultswithdisablingconditions.JAMA
2002288:1265.
29.NationalSleepFoundation.SleepinAmericaPoll,NationalSleepFoundation,Washington,DC2002.
30.SpiegelK,TasaliE,PenevP,VanCauterE.Briefcommunication:Sleepcurtailmentinhealthyyoung
menisassociatedwithdecreasedleptinlevels,elevatedghrelinlevels,andincreasedhungerand
appetite.AnnInternMed2004141:846.
31.GreerSM,GoldsteinAN,WalkerMP.Theimpactofsleepdeprivationonfooddesireinthehumanbrain.
NatCommun20134:2259.
32.PatelSR,HuFB.Shortsleepdurationandweightgain:asystematicreview.Obesity(SilverSpring)
200816:643.
33.CappuccioFP,TaggartFM,KandalaNB,etal.Metaanalysisofshortsleepdurationandobesityin
childrenandadults.Sleep200831:619.
34.NedeltchevaAV,KilkusJM,ImperialJ,etal.Insufficientsleepunderminesdietaryeffortstoreduce
adiposity.AnnInternMed2010153:435.
35.FilozofC,FernndezPinillaMC,FernndezCruzA.Smokingcessationandweightgain.ObesRev
20045:95.
36.LeslieWS,KoshyPR,MackenzieM,etal.Changesinbodyweightandfoodchoiceinthoseattempting
smokingcessation:aclusterrandomisedcontrolledtrial.BMCPublicHealth201212:389.
37.ParsonsAC,ShraimM,InglisJ,etal.Interventionsforpreventingweightgainaftersmokingcessation.
CochraneDatabaseSystRev2009:CD006219.
38.SwinburnBA,SacksG,HallKD,etal.Theglobalobesitypandemic:shapedbyglobaldriversandlocal
environments.Lancet2011378:804.
39.MozaffarianD,HaoT,RimmEB,etal.Changesindietandlifestyleandlongtermweightgaininwomen
andmen.NEnglJMed2011364:2392.
40.MalikVS,PanA,WillettWC,HuFB.Sugarsweetenedbeveragesandweightgaininchildrenand
adults:asystematicreviewandmetaanalysis.AmJClinNutr201398:1084.
41.QiQ,ChuAY,KangJH,etal.Sugarsweetenedbeveragesandgeneticriskofobesity.NEnglJMed
2012367:1387.
42.McCafferyJM,PapandonatosGD,PeterI,etal.ObesitysusceptibilitylocianddietaryintakeintheLook
AHEADTrial.AmJClinNutr201295:1477.
43.PhillipsCM,KesseGuyotE,McManusR,etal.Highdietarysaturatedfatintakeaccentuatesobesity
riskassociatedwiththefatmassandobesityassociatedgeneinadults.JNutr2012142:824.
44.KonttinenH,HaukkalaA,SarlioLhteenkorvaS,etal.Eatingstyles,selfcontrolandobesityindicators.
Themoderatingroleofobesitystatusanddietinghistoryonrestrainedeating.Appetite200953:131.
45.BouchardC,TremblayA,DesprsJP,etal.Theresponsetolongtermoverfeedinginidenticaltwins.N
EnglJMed1990322:1477.
46.JskelinenA,SchwabU,KolehmainenM,etal.Associationsofmealfrequencyandbreakfastwith
obesityandmetabolicsyndrometraitsinadolescentsofNorthernFinlandBirthCohort1986.NutrMetab
CardiovascDis201323:1002.
47.ToschkeAM,ThorsteinsdottirKH,vonKriesR,GMEStudyGroup.Mealfrequency,breakfast
consumptionandchildhoodobesity.IntJPediatrObes20094:242.
48.RampersaudGC,PereiraMA,GirardBL,etal.Breakfasthabits,nutritionalstatus,bodyweight,and
academicperformanceinchildrenandadolescents.JAmDietAssoc2005105:743.
49.OdegaardAO,JacobsDRJr,SteffenLM,etal.Breakfastfrequencyanddevelopmentofmetabolicrisk.
DiabetesCare201336:3100.
50.BhutaniS,VaradyKA.Nibblingversusfeasting:whichmealpatternisbetterforheartdisease
prevention?NutrRev200967:591.
5/14/2016
51.AllisonKC,GriloCM,MashebRM,StunkardAJ.Bingeeatingdisorderandnighteatingsyndrome:a
comparativestudyofdisorderedeating.JConsultClinPsychol200573:1107.
52.MostadIL,LangaasM,GrillV.Centralobesityisassociatedwithlowerintakeofwholegrainbreadand
lessfrequentbreakfastandlunch:resultsfromtheHUNTstudy,anadultallpopulationsurvey.Appl
PhysiolNutrMetab201439:819.
53.LeslieWS,HankeyCR,LeanME.Weightgainasanadverseeffectofsomecommonlyprescribed
drugs:asystematicreview.QJM2007100:395.
54.FavaM,JudgeR,HoogSL,etal.Fluoxetineversussertralineandparoxetineinmajordepressive
disorder:changesinweightwithlongtermtreatment.JClinPsychiatry200061:863.
55.KnowlerWC,BarrettConnorE,FowlerSE,etal.Reductionintheincidenceoftype2diabeteswith
lifestyleinterventionormetformin.NEnglJMed2002346:393.
56.Weightgainassociatedwithintensivetherapyinthediabetescontrolandcomplicationstrial.TheDCCT
ResearchGroup.DiabetesCare198811:567.
57.LargerE.Weightgainandinsulintreatment.DiabetesMetab200531:4S51.
58.HochbergI,HochbergZ.Expandingthedefinitionofhypothalamicobesity.ObesRev201011:709.
59.DaousiC,DunnAJ,FoyPM,etal.Endocrineandneuroanatomicfeaturesassociatedwithweightgain
andobesityinadultpatientswithhypothalamicdamage.AmJMed2005118:45.
60.MortonNM,SecklJR.11betahydroxysteroiddehydrogenasetype1andobesity.FrontHormRes2008
36:146.
61.KnudsenN,LaurbergP,RasmussenLB,etal.Smalldifferencesinthyroidfunctionmaybeimportantfor
bodymassindexandtheoccurrenceofobesityinthepopulation.JClinEndocrinolMetab200590:4019.
62.FoxCS,PencinaMJ,D'AgostinoRB,etal.Relationsofthyroidfunctiontobodyweight:crosssectional
andlongitudinalobservationsinacommunitybasedsample.ArchInternMed2008168:587.
63.DrewnowskiA,RehmCD,SoletD.Disparitiesinobesityrates:analysisbyZIPcodearea.SocSciMed
200765:2458.
64.DrewnowskiA.Theeconomicsoffoodchoicebehavior:whypovertyandobesityarelinked.NestleNutr
InstWorkshopSer201273:95.
65.DubowitzT,GhoshDastidarMB,SteinerE,etal.Areouractionsalignedwithourevidence?Theskinny
onchangingthelandscapeofobesity.Obesity(SilverSpring)201321:419.
66.McTigueKM,GarrettJM,PopkinBM.Thenaturalhistoryofthedevelopmentofobesityinacohortof
youngU.S.adultsbetween1981and1998.AnnInternMed2002136:857.
67.DhurandharNV.Contributionofpathogensinhumanobesity.DrugNewsPerspect200417:307.
68.SoPW,HerlihyAH,BellJD.Adiposityinducedbyadenovirus5inoculation.IntJObes(Lond)2005
29:603.
69.WhighamLD,IsraelBA,AtkinsonRL.Adipogenicpotentialofmultiplehumanadenovirusesinvivoand
invitroinanimals.AmJPhysiolRegulIntegrCompPhysiol2006290:R190.
70.AtkinsonRL,DhurandharNV,AllisonDB,etal.Humanadenovirus36isassociatedwithincreasedbody
weightandparadoxicalreductionofserumlipids.IntJObes(Lond)200529:281.
71.ZhangH,DiBaiseJK,ZuccoloA,etal.Humangutmicrobiotainobesityandaftergastricbypass.Proc
NatlAcadSciUSA2009106:2365.
72.TremaroliV,BckhedF.Functionalinteractionsbetweenthegutmicrobiotaandhostmetabolism.Nature
2012489:242.
73.MurphyEF,ClarkeSF,MarquesTM,etal.Antimicrobials:Strategiesfortargetingobesityandmetabolic
health?GutMicrobes20134:48.
Topic5377Version18.0
http://www.uptodate.com/contents/obesityinadultsetiologyandnaturalhistory?topicKey=ENDO%2F5377&elapsedTimeMs=16&source=search_result 10/20
5/14/2016
GRAPHICS
Etiologicclassificationofobesity
Iatrogeniccauses
Drugsthatcauseweightgain
Hypothalamicsurgery
Dietaryobesity
Infantfeedingpractices
Progressivehyperplasticobesity
Frequencyofeating
Highfatdiets
Overeating
Neuroendocrineobesities
Hypothalamicobesity
Seasonalaffectivedisorder
Cushing'ssyndrome
Polycysticovarysyndrome
Hypogonadism
Growthhormonedeficiency
Pseudohypoparathyroidism
Socialandbehavioralfactors
Socioeconomicstatus
Ethnicity
Psychologicalfactors
Restrainedeaters
Nighteatingsyndrome
Bingeeating
Sedentarylifestyle
Enforcedinactivity(postoperative)
Aging
Genetic(dysmorphic)obesities
Autosomalrecessivetraits
Autosomaldominanttraits
Xlinkedtraits
Chromosomalabnormalities
Other
Lowbirthweight
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Graphic55594Version3.0
5/14/2016
Determiningbodymassindexfromweightandheight
BMI,
kg/m 2
Goodweights
19
20
21
22
23
Height,
Overweight
24
25
26
27
Obesity
28
29
30
35
40
Weight,pounds*
inches*
58"
91
96
100
105
110
115
119
124
129
134
138
143
167
191
59"
94
99
104
109
114
119
124
128
133
138
143
148
173
198
60"
97
102
107
112
118
123
128
133
138
143
148
153
179
204
61"
100
106
111
116
122
127
132
137
143
148
153
158
185
211
62"
104
109
115
120
126
131
136
142
147
153
158
164
191
218
63"
107
113
118
124
130
135
141
146
152
158
163
169
197
225
64"
110
116
122
128
134
140
145
151
157
163
168
174
204
232
65"
114
120
126
132
138
144
150
156
162
168
174
180
210
240
66"
118
124
130
136
142
148
155
161
167
173
179
186
216
247
67"
121
127
134
140
146
153
159
166
172
178
185
191
223
255
68"
125
131
138
144
151
158
164
171
177
184
190
197
230
262
69"
128
135
142
149
155
162
169
176
182
189
196
203
236
270
70"
132
139
146
153
160
167
174
181
188
195
202
209
243
278
71"
136
143
150
157
165
172
179
186
193
200
208
215
250
286
72"
140
147
154
162
169
177
184
191
199
206
213
221
258
294
73"
144
151
159
166
174
182
189
197
204
212
219
227
265
302
74"
148
155
163
171
179
186
194
202
210
218
225
233
272
311
75"
152
160
168
176
184
192
200
208
216
224
232
240
279
319
76"
156
164
172
180
189
197
205
213
221
230
238
246
287
328
ThehealthriskfromanylevelofBMIisincreasedifthepatienthasgainedmorethan5kg
(11pounds)sinceage25years,orifthewaistcircumferenceisabove100cm(40in)due
tocentralfatness.
BMI:bodymassindex.
*Divideweightby2.2toconvertpoundsintokilogramsmultiplyheightby2.54toconvertinches
intocentimeters.
5/14/2016
Determiningbodymassindexusingkilogramsandcentimeters*
BMI,
kg/m 2
19
20
21
22
23
24
Height,
cm*
25
26
27
28
29
30
35
40
Weight,kg*
147
41
43
45
48
50
52
54
56
58
61
63
65
76
86
150
43
35
47
50
52
54
56
59
61
63
65
68
79
90
152
44
46
49
51
53
55
58
60
62
65
67
69
81
92
155
46
48
50
53
55
58
60
62
65
67
70
72
84
96
158
47
50
52
55
57
60
62
65
67
70
72
75
87
100
160
49
51
54
56
59
61
64
67
69
72
74
77
90
102
162
50
52
55
58
60
63
66
68
71
73
76
79
92
105
165
52
54
57
60
63
65
68
71
74
76
79
82
95
109
168
54
56
59
62
65
68
71
73
76
79
82
85
99
113
170
55
58
61
64
66
69
72
75
78
81
84
87
101
116
173
57
60
63
66
69
72
75
78
81
84
87
90
105
120
175
58
61
64
67
70
74
77
80
83
86
89
92
107
123
178
60
63
67
70
73
76
79
82
86
89
92
95
111
127
180
62
65
68
71
75
78
81
84
87
91
94
97
113
134
183
64
67
70
74
77
80
84
87
90
94
97
100
117
134
185
65
68
72
75
79
82
86
89
92
96
99
103
120
137
188
67
71
74
78
81
85
88
92
95
99
102
106
124
141
190
69
72
76
79
83
87
90
94
97
101
105
108
126
144
193
71
74
78
82
86
89
93
97
101
104
108
112
130
149
BMI:bodymassindex.
*ThehealthriskfromanylevelofBMIisincreasedifthepatienthasgainedmorethan5kg(11
pounds)sinceage25years,orifthewaistcircumferenceisabove100cm(40in)duetocentral
fatness.
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Medicationsassociatedwithweightgain
Glucocorticoids(prednisone)
Diabetesmedications(insulin,sulfonylureas,thiazolidindiones,meglitinides)
Firstgenerationantipsychotics(thioridazine)
Secondgenerationantipsychotics(risperidone,olanzapine,clozapine,quetiapine)
Neurologicandmoodstabilizingagents(carbamazepine,gabapentin,lithium,valproate)
Antihistamines(especiallycyproheptadine)
Antidepressants(paroxetine,citalopram,amitriptyline,nortriptyline,imipramine,mirtazapine)
Hormonalagents(especiallyprogestins,eg,medroxyprogesterone)
Betablockers(especiallypropranolol)
Alphablockers(especiallyterazosin)
FromAnnalsofInternalMedicine,TsaiAG,WaddenTA,IntheClinic:Obesity,Vol159,PgITCS1.
Copyright2013AmericanCollegeofPhysicians.AllRightsReserved.Reprintedwiththepermission
ofAmericanCollegeofPhysicians,Inc.
5/14/2016
Categorizationofantidepressants,anticonvulsants,andanti
psychoticdrugsbytheireffectsonbodyweight
Produceweightloss
Bupropion
Venlafaxine
Desvenlafaxine
Topiramate
Zonisamide
Lamotrigine
Ziprasidone
Areweightneutral
Haloperidol
Aripiprazole
Produceweightgain
Tricyclicantidepressants*
Monoamineoxidaseinhibitors
Paroxetine
Escitalopram
Lithium
Olanzapine
Clozapine
Risperidone
Carbamazepine
Valproate
Divalproex
Mirtazapine
*Nortriptyline,amitriptyline,doxepin.
Reproducedwithpermissionfrom:BrayGA,RyanDH.Medicaltherapyforthepatientwithobesity.
Circulation2012125:1695.Copyright2012LippincottWilliams&Wilkins.
5/14/2016
Clinicalfeaturesofhypothalamicobesityduetotumors
Totalpatientsstudied
Number
Percent
77
Headache
50
65
Impairedvision
49
64
Impairedreproductivefunction
39
52
Diabetesinsipidus
24
31
Impairedgrowth
Convulsions
Somnolence
28
36
Behavioralchanges
15
19
Pressuresymptoms
Endocrinesymptoms
Neurologicandphysiologicsymptoms
Adaptedfrom:BrayGA,GallagherTF.Manifestationsofhypothalamicobesityinman:a
comprehensiveinvestigationofeightpatientsandareviewoftheliterature.Medicine197554:301.
5/14/2016
ProgressiveobesityinCushing'ssyndrome
SequenceofpicturesinaboywithCushing'sdisease.
(A)Agesixyears,beforeapparentonsetofCushing'ssyndrome.
(B)Agesevenyears,stillwithlittleevidenceofcushingoidappearance.
(C)Ageeightyears,withearlyfacialrounding.
(D)Agenineyears,with"moon"facies.
(E)Age11years,withfloridCushing'sdisease.
ReproducedwithpermissionfromWilliamsTextbookofEndocrinology,8thed,FosterDW,Wilson
JD(Eds),WBSaunders,Philadelphia,1996.
5/14/2016
CentipetalobesityinCushing'ssyndrome
30yearoldwomanwithCushing'sdiseaseshowingcentripetal
obesity,relativelythinlimbs,dorsalkyphosis,andthickneck.
ReproducedwithpermissionfromWilliamsTextbookofEndocrinology,8thed,
FosterDW,WilsonJD(Eds),WBSaunders,Philadelphia,1996.
5/14/2016
ContributorDisclosures
GeorgeABray,MDSpeaker'sBureau:Takeda[Obesity(NaltrexoneHCl/bupropionHCl)].
Consultant/AdvisoryBoards:Herbalife[Obesity(Nutritionandweightmanagementproducts)]Janssen
Pharmaceuticals[Obesity(Weightlossprogram)]NovoNordisk[Obesity(Liraglutide)].FXavierPiSunyer,
MD,MPHConsultant/AdvisoryBoards:EliLilly[Diabetes(Newinsulins)]McNeilNutritionals[Diabetes,
obesity(Sucralose)]NovoNordisk[Diabetes,obesity(Liraglutide)]Zafgen[Obesity(Newdrugs)].KathrynA
Martin,MDNothingtodisclose.
Contributordisclosuresarereviewedforconflictsofinterestbytheeditorialgroup.Whenfound,theseare
addressedbyvettingthroughamultilevelreviewprocess,andthroughrequirementsforreferencestobe
providedtosupportthecontent.Appropriatelyreferencedcontentisrequiredofallauthorsandmustconformto
UpToDatestandardsofevidence.
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