Summary
Definition
History and exam
Key diagnostic factors
- height
- weight
Other diagnostic factors
- waist circumference
- comorbid conditions
Risk factors
- hypothyroidism
- hypercortisolism
- age ≥40 years
- peri- and postmenopause
- prior pregnancy
- marital status
- sleep deprivation
- tobacco
- education level
- poor in utero nutrition
- socioeconomic status
- sedentary lifestyle
- television watching or video gaming
- diet high in sugar, cholesterol, fat, and fast food
- heavy alcohol intake
- binge-eating disorder
- night eating syndrome
- leptin deficiency
- corticosteroid therapy
- antidepressant therapy
- antipsychotic therapy
- beta-blocker therapy
- adjuvant breast cancer therapy
- psychiatric diagnosis
Diagnostic tests
1st tests to order
- clinical exam
Tests to consider
- CBC
- serum aminotransferases
- thyroid function tests
- ECG
- abdominal ultrasound scan
- polysomnography (sleep study)
Treatment algorithm
BMI ≥30 kg/m²; or else BMI ≥27 kg/m² with an obesity-related comorbidity
BMI ≥35 kg/m² with or without comorbidities
Contributors
Authors
Constantine T. Frantzides, MD, PhD, FACS

Director, Chicago Institute of Minimally Invasive Surgery (CIMIS)
Director, Laparoscopic and Bariatric Fellowship Program
Clinical Professor of Surgery, University of Illinois
Chicago
IL
Disclosures
CTF declares that he has no competing interests.
Kelsey R. Tieken, MD

General Surgery Resident
University of Nebraska Medical Center
Omaha
NE
Disclosures
KRT declares that she has no competing interests.
Nathan D. Bills, PhD, MBA
Associate Professor
Department of Surgery
University of Nebraska Medical Center
Omaha
NE
Disclosures
NDB declares that he has no competing interests.
Acknowledgements
Dr Constantine T. Frantzides, Dr Kelsey R. Tieken, and Dr Nathan D. Bills would like to gratefully acknowledge Dr Mark A. Carlson, Dr Minh B. Luu and Dr Scott N. Welle, previous contributors to this topic.
Disclosures
MAC, MBL and SNW declare that they have no competing interests.
Peer reviewers
Carel Le Roux, MRCP, PhD, FRCPath
Consultant in Metabolic Medicine
Imperial College London
Charing Cross Hospital
London
UK
Disclosures
CLR declares that he has no competing interests.
Arya M. Sharma, MD, PhD, FRCPC
Professor of Medicine
Chair for Obesity Research & Management
University of Alberta
Royal Alexandra Hospital
Edmonton
Canada
Disclosures
AMS declares that he has no competing interests.
Edward H. Livingston, MD, FACS
Chair in Surgery
Division of Gastrointestinal and Endocrine Surgery
University of Texas
Southwestern Medical Center
Dallas
TX
Disclosures
EHL declares that he has no competing interests.
References
Key articles
Jensen MD, Ryan DH, Apovian CM, et al; American College of Cardiology/American Heart Association Task Force on Practice Guidelines; Obesity Society. 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society. Circulation. 2014 Jun 24;129(25 suppl 2):S102-38.Full text Abstract
Bull FC, Al-Ansari SS, Biddle S, et al. World Health Organization 2020 guidelines on physical activity and sedentary behaviour. Br J Sports Med. 2020 Dec;54(24):1451-62.Full text Abstract
Garvey WT, Mechanick JI, Brett EM, et al. American Association of Clinical Endocrinologists and American College of Endocrinology comprehensive clinical practice guidelines for medical care of patients with obesity. Endocr Pract. 2016 Jul;22 Suppl 3:1-203.Full text Abstract
National Institute for Health and Care Excellence. Obesity: identification, assessment and management. September 2022 [internet publication].Full text
American Society for Metabolic and Bariatric Surgery. Metabolic and bariatric surgery fact sheet. July 2021 [internet publication].Full text
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Hypothyroidism, primary
- Hypothyroidism, central
- Cushing syndrome
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- 2022 ASMBS and IFSO: indications for metabolic and bariatric surgery
- AGA clinical practice guideline on pharmacological interventions for adults with obesity
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