CLINICAL FEATURES

OBESITY Excess fat accumulation in the body is the main clinical appearance of obese patient. Differentiation of obesity is based on the distribution of adipose tissue (Uwaifo, 2010) 1. !eneral or diffuse obesity. 2. "ndroid or #entral obesity excess fat deposited around the waist and flan$, %i&in% the ima%e of apple shape body. 't is associated with a %reater deposition of &isceral or intraabdominal fat and is intensely related to hi%h ris$ for metabolic and cardio&ascular illnesses. (. !ynecoid obesity excess deposition of fat in the thi%hs and buttoc$s, also called pear shape body. )atient has %reater subcutaneous fat deposition around the hip and associated to a hi%her ris$ for arthrosis and &arices. *ecause *+' closely correlates with adipose tissue, it is used to dia%nosin% e&aluatin% obesity. "ccordin% to ,-., adult patient *+' should be more than (0 $%/m2. 0ess than those patients are considered o&erwei%ht, normal or underwei%ht (1edin%er, 2002).

Image 2.XX. #entral obesity and !ynecoid obesity ilustration -istorical information obtained may about a%e at onset, recent wei%ht chan%es, family history of obesity, occupational history, eatin% and exercisin% beha&ior, ci%arette and alcohol use, pre&ious wei%ht loss experience, and psychosocial

factors includin% assessment for depression and eatin% disorders. )atient may indicatin% problems with wei%ht or repeated failure in achie&in% sustained wei%ht loss.*ecause almost (03 of patients who are obese ha&e eatin% disorders, they ha&e possibility of bin%in%, pur%in%, lac$ of satiety, food4see$in% beha&ior, and other abnormal feedin% habits (1edin%er, 2002). 5ome patients may show comorbidities such as (Uwaifo, 2010) 1. 1espiratory obstructi&e sleep apnea, obesity hypo&entilation syndrome ()ic$wic$ian 5yndrome) 2. #ardio&ascular essential hypertension, coronary artery disease, accelerated atherosclerosis (. !astrointestinal reflux esopha%itis, %all bladder disease 6. .rthopedic .steoarthritis, 7oint deformities (coxa &ara) 8. +etabolic insulin resistance, hyperinsulinemia, type 2 diabetes mellitus, and dyslipidemia 9. 1eproducti&e ano&ulation, early puberty, infertility 2. )el&ic stress incontinence :. #utaneous intertri%o (fun%al or bacterial), acanthosis ni%ricans, hirsutism, cellulitis and carbuncles ;. Extremities <enous &aricosities, lower extremity &enous and/or lymphatic edema, and pressure ulceration 10. 1educed mobility and dificult maintainin% personal hy%iene METABOLIC SYNDROME 1. -yper%lycemia (=astin% %lucose > 100 m%/d0). "dipose cell enlar%ement and infiltration of macropha%es into adipose tissue result in the release of proinflammatory cyto$ines and promote insulin resistance (,an% 55, 2010). )atient may complain increased hun%er, thirst or urination besides fati%ue. )atient may ha&e acanthosis ni%ricans, hirsutism, peripheral neuropathy, and retinopathy (!rundy et al, 2008). 2. -ypertension (*lood pressure > 1(0/:8 mm -%). )atient may complain for headache and other hypertension si%n (!rundy et al, 2008). (. -ypertri%lyceridemia (?ri%lycerides > 180 m%/d0). +ost patient ha&e no physical findin% attributable directly to increased concentrations of tri%lycerides. )atient may complain about claudicatio or an%inal pain especially in the chest due to atherosclerosis (,an% 55, 2010). )atient

with se&ere dyslipidemia may ha&e xanthomas or xanthelasmas (!rundy et al, 2008). 6. 1educed -D04# (-D04# @60 m%/d0 in men or @80 m%/d0 in women) (,an% 55, 2010). 8. #entral obesity. )atient has &isceral or intraabdominal fat accumulation around the waist and flan$s %i&in% a manifestation of an apple shape body that measured as waist circumference (!rundy et al, 2008). 1eff 1edin%er 1A. 2002. ?he )atophysiolo%y of .besity and 'ts #linical +anifestation. !astroenterolo%y and -epatolo%y 2002B(B11B :894:9(.
Uwaifo GI. 2010. Obesity: overview. http://emedicine.medscape.com/article/123 02!overview accesed "ecember 10th 2010

!rundy 5+, #leeman C', Daniels 51, Donato D". 2008. Dia%nosis and +ana%ement of the +etabolic 5yndrome "n "merican -eart "ssociation/Aational -eart, 0un%, and *lood 'nstitute 5cientific 5tatement. Circulation 2008B112B22(842282. ,an% 55. 2010. +etabolic 5yndrome. http //emedicine.medscape.com/article accesed December 10th 2010