All investigations must be reviewed by a dietician and or endocrinologist who will in turn use a computer enhanced Body analyser to determine the fluid, fat, muscle and bone content of each patient to prescribe a program tailored for each patient.
 
Exogenous Obesity
 
This occurs when energy intake exceeds energy expenditure. 60-70% of cases of obesity are exogenous in origin. We should keep In mind that diet control only reduces the size of the fat cells but not the number of fat cells which are predetermined by the individuals nutrition in the prenatal and early postnatal period. Diagnosis is based on:
 
A) Routine Chemistry:
Lipid profile, Blood sugar, SGPT, Creatinine, Uric Acid.
 
B) Novo protocol:
This is a useful method for detection of reactive foods exacerbating symptoms of chronic illnesses through neutrophil sensitization. The resulting inflammatory process is implicated in excessive weight gain through:-
Salt & water retention. Neutrophil sensitization Interleukin (1) blood stream? Hypothalamus? Release of A.C.T.H? Adrenal Cortex? Release of steroid hormones?
salt & H20 retention .FAT  Deposition Immunogenic food? Neutrophil sensitization? cytokines? Tumor necrosis factor (TNF)? A decrease in the enzyme responsible for converting fat to Energy. NuTron diet eliminates intake of foods causing neutrophil activation and release of harmful inflammatory chemicals in the blood. Therefore in addition to diet control, it may have a useful role in many inflammatory illnesses as Acne, Rhinitis, Crohn's disease, Ulcerative colitis, Eczema, Fibromyalgia, Irritable Bowel Syndrome, Migraine, Psoriasis, and Type II Non I.D.D.M.
 
Endogenous Obesity
 
A) Endocrinal imbalance
 
Pituitary
 
Cushing:
Moon face, hypertension & hirsutism. Increased ACTH & cortisol in blood & 24hour urine. Dexamethasone suppression test.
 
Growth hormone deficiency
Short stature & minute features.
Growth hormone stimulation (clonidine & insulin), IGF1 & IGFBP .
 
Craniopharyngioma
Short stature & blurring of vision .
Growth hormone stimulation .
 
Pituitary adenoma
Acromegaly & Gigantism .
Growth hormone supression test.
Hypothyroidism
Coarse features, short stature, somnolence, depression, hypercholesterolemia,
Primary hypothyroidism shows decreased free(T3 & T4) with increased TSH.
Secondary hypothyroidism shows decreased free(T3 & T4) with decreased TSH.
 
Adrenal
· Cushing's syndrome
· Late onset congenital Adrenal  hyperplasia
Hirsutism, disturbed menses .
Free testosterone,17-H progesterone,DHEA,DHEAS, ? 4 Androstenedione . before and after aqueous synecthen ( A.C.T.H stimulation test) .
 
Polycystic ovary syndrome:
Hirsutism, disturbed menses.
FSH, LH, free Testosterone, DHEA,LH/RH test.
 
Hypogonadism
Delayed puberty & impotence in males. Disturbed menses & infertility in females.
      Testosterone, E2, FSH, LH and Pregnyl test in males .
 
Pseudo hypoparathyroidism
Calcium ionised, Phosphous , Parathormone.
 
Insulinoma
Fasting blood Glucose & Insulin C-peptide.
 
B) Genetic Syndromes
Chormosomal Aberrations leading to genetic syndromes including obesity.
Prader Willi,  Becwith Wiedmamn syndrome, Laurance Moon Biedle, Pickwickian, Kleinfilter, Multiple X Chromosome, Frolich's synodrome & Cohen.
 
C) Hypothalamic obesity                                   
Due to hypothalamic injury, trauma, malignancy, inflammation and pseudo tumor cerebri.D) Drug induced obesity
      Phenothiazines, Tricyclic Antidepressants, Corticosteroids and Anti histaminics