OBESITY
12/06/2003
Obesity
Obesity is the excessive accumulation of body fat.
Criteria for pathological obesity include; Weight deviation to >3 standard deviation,
body mass index >30, Skin fold thickness >95 percentile and weight for height index > 115%.
All investigations must be reviewed by a dieticien 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) (ÈÕãÉ ÇáÏã ):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 sensitisation. → cytokines →
Tumor necrosis factor (TNF) α àdecrease enzymes responsible for converting fat to Energy.
This 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, Type II Non I.D.D.M.
· ENDOGENOUS OBESITY
A) Endocrinal imbalance
Pituitary
- Cushing
Moon face,hypertension, hirsutism.
Increased ACTH & Cortisol in blood & 24 hour 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 Cpeptide.
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.
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