Obesity is a chronic disease of excess body fat, defined in adults as a BMI of 30 or more, that raises the risk of diabetes, heart disease, sleep apnea, fatty liver and some cancers. It comes from a mix of genes, environment, sleep, stress and medicines, not simply willpower.
Key symptoms
- Weight gain over time
- Shortness of breath with exertion and fatigue
- Snoring or daytime sleepiness (sleep apnea)
- Joint pain in the knees, hips and back
- Reflux, low mood or reduced quality of life
What you find on exam
- Height, weight, BMI and waist circumference
- Blood pressure with a properly sized cuff
- Acanthosis nigricans and skin tags (insulin resistance)
- Signs of Cushing syndrome or hypothyroidism if suspected
Tests
- HbA1c or fasting glucose
- Lipid panel
- Liver tests for fatty liver; TSH if symptoms suggest it
- Sleep study if apnea is suspected
Treatment basics
- Respectful counseling with motivational interviewing
- Calorie reduction, more physical activity and behavior support
- GLP-1 based medicines such as semaglutide or tirzepatide
- Metabolic and bariatric surgery for BMI 35 or more, or 30 or more with type 2 diabetes
- Treat linked conditions: blood pressure, diabetes, sleep apnea
Red flags
- Loud snoring with pauses in breathing, or falling asleep while driving
- Rapid weight gain with purple stretch marks or muscle weakness
- Chest pain or shortness of breath at rest
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.