Clinical evaluation of the overweight patient

Evaluation of an overweight patient is the first step in any therapeutic pr ogram. The syndromes of obesity can be classified in several ways. The firs t is an anatomic classification based on the size, number, and distribution of fat cells and fat tissue. The second is an etiologic classification bas ed on identification of specific diseases and settings that produce obesity . Hypothalamic injury and endocrine disease such as Gushing's disease and t he polycystic ovary syndrome are three identifiable causes of obesity. In t his medicated society drugs are always candidates to produce weight gain. T he most common causes, however, are stopping smoking, overconsumption of hi gh-fat foods, a decrease in the level of activity, and aging. The natural h istory of obesity provides a useful framework in which to view both prevent ive and therapeutic strategies. Some individuals will never become overweig ht, but of those who do, about one-third will do so during the first two de cades, and the remaining two-thirds will become overweight after age 20. A number of epidemiological and metabolic factors can serve as a guide to tho se individuals who are at high risk. Having overweight parents tops the lis t, but multiple births, cessation of smoking, and a sedentary lifestyle are additional factors. Therapeutic decisions should be based on risk-benefit decisions. The risk can be assessed from the body mass index, the distribut ion of fat in upper or lower body obesity, the rate of weight gain, and the degree of physical inactivity. After assessing risk, the therapeutic choic es can be selected from the age category of the patient. With any therapeut ic activity, involvement of the patient in a realistic approach to the trea tment process is essential.