Obesity

Life expectancy is shortened by obesity. Obesity will only develop when dietary intake exceeds energy expenditure.

Ask about:

Family history Obstetric history Psychological stress Anxiety and depression Binge eating Alcohol and other fluid intake

Symptoms of diabetes

Scoliosis Sequence

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Benign intracranial hypertension

Sleep apnoea

Exertional breath lessness Reflux symptoms Increased blood pressure Gall stones Abdominal striae

Impaired fertility Stress/urge incontinence Gynaecological malignancy

Osteoarthrosis

Varicose veins

Dependent oedema

Pes planus

TABLE 2.5 Some causes of short stature

Hereditary

Constitutionally small

Genetic

Down's syndrome Turner s syndrome Achondroplasia

Nutritional

Intrauterine growth retardation Protein and energy deprivation Rickets

Systemic disease

Chronic wasting diseases including renal failure and biliary disease

Endocrine

Juvenile hypothyroidism (cretinism) Hypopituitarism, craniopharyngioma

Alimentary

Malabsorption including gluten enteropathy, Crohn's disease, cystic fibrosis

Cardiorespiratory

Congenital heart disease Suppurative lung disease

Locomotor

Severe scoliosis

Fig. 2.6 Complications of obesity.

The causes are probably multifactorial, but in some subjects, a Vicious circle situation may develop whereby weight gain results in 'comfort eating' and further weight gain. Obesity is associated with hypertension, hyperlipidaemia and diabetes mellilus. Its presence should alert ¡he clinician to consider these possibilities and various other complications (see Fig. 2.6).

Regional distribution of fat is of greater prognostic significance than the absolute degree of obesity. Waist-hip ratio provides a simple assessment of visceral adipose fat. Subjects with a 'pear-shaped' configuration and a waist-hip ratio of 0.8 or less in females or < 0.9 in males have a good prognosis; 'apple-shaped" subjects with a greater waist-hip ratio have an increased risk of developing cardiovascular-disease.

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