Serious disorders not to be missed
Hypothalamic disorders (hyperphagia):
Idiopathic oedema syndrome
Drugs (e.g. OCP, steroids, pizotifen, sulphonylureas, insulin)
Thyroid disorder (hypothyroidism) and other endocrine (as above)
Is the patient trying to tell me something?
Yes: the reasons for obesity should be explored.
Ascertain food and beverage intake including typical daily meals. Exercise, drug, psychological and family history.
Measure body weight and height and calculate BMI, waist circumference, waist–hip circumference, upper arm circumference
Assess the degree and distribution of body fat and the overall nutritional status
Search for evidence of diabetes, atherosclerosis, hypothyroidism, Cushing syndrome and signs of alcohol abuse
These are more appropriate if patient unwell:
Consider TFTs, serum cortisol, ECG and CXR.
The onset of obesity can occur at any age.
Abdominal obesity gives a higher cardiovascular risk at any rate.
Ask the patient what they believe is the cause of their weight gain/obesity.