and intellectual disability), Albright hereditary osteodystrophy, and Bardet-Biedl syndrome also give rise to early-onset obesity.48 Hormonal alterations are also implicated in the pathogenesis of obesity, and


a history of such alterations may be elicited while obtaining a medical history. Hypersecretion of insulin leads to insulin resistance and metabolic syndrome.23 Growth hormone deficiency leads to visceral and truncal fat accumulation; and hypercortisolism, such as that seen in Cushing syndrome, leads to insulin insensi- tivity and visceral fat accumulation from decreased lipolysis.49


Decreased metabolic


rate and thermogenesis occur in patients with hypothyroidism and have been related to abnormalities in the feedback mechanism of thyrotropin, leading to higher thyro- tropin levels and lower thyroxine levels. The exact mechanism, however, is poorly understood.49–51


In addition, polycystic ovary syndrome is associated with obesity


and insulin secretion, leading to excess production of androgens by the ovaries.52 Iatrogenic causes of obesity should also be explored during the medical visit.


Several medications, including thiazolidinediones for type 2 diabetes, antidepres- sants, HIV antiretrovirals, and psychotropics such as risperidone and olanzapine, cause weight gain (antiretrovirals against HIV lead to fat redistribution).53,54 Corticosteroid therapy is a common offender that increases appetite, alters lipid metabolism, and, consequently, increases fat accumulation and dysregulated glucose metabolism.53


Cranial surgery or radiation can damage the hypothalamic


neural circuits involved in appetite and cause vagal-driven insulin hypersecretion and insulin resistance.55


Obesity-Related Disease


When assessing a patient for obesity therapies, it is important to assess comorbid- ities that may exist as a consequence of obesity. Type 2 diabetes is 20 times more common in people with obesity.56 a BMI of more than 25.57


Hypertension risk is also higher in those with Obstructive sleep apnea is prevalent in individuals with


obesity due to the relaxation of enlarged muscles surrounding the airway, which contributes to airway narrowing and subsequent hypoxia. These chronic hypoxic episodes are linked to the metabolic syndrome and dyslipidemia.58


Family History


A family history of obesity is a risk factor for both childhood-onset and adult- onset obesity.59


coronary artery disease are also risk factors for obesity. Studies show that a family history of obesity leads to earlier age of onset of obesity, and the class of obesity in the family is correlated with progressive metabolic syndrome.60


The effect of a


family history of type 2 diabetes has been attributed to hereditary conditions, as well as environmental factors such as family eating behaviors, urbanization, and access to healthy food.59


risk stratification of children of parents with obesity and empower clinicians to adopt early interventions.


Social History


The typical elements of the social history should no doubt be included in the assess- ment of patients with obesity. Obtaining information about an individual’s upbring- ing, with a specific focus on eating behaviors in childhood—including family and cultural mores around food, health, weight, and body image that can influence adult


84 SECTION 2: Interprofessional Assessment of Overweight and Obesity Obtaining this information from the patient can allow for In addition, a family history of type 2 diabetes, hypertension, and


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