Obesity is a medical condition characterized by the excessive accumulation and distribution of fat in the body. It is classified as a medical disease and has acquired epidemic proportions worldwide.

Obesity is a medical diagnosis and diagnosing it is no rocket science. It requires the doctor to take the personal history of the patient, his family history, a physical examination, calculation of the body fat (BMI), measurement of the waist circumference and a few pathological tests to rule out complications, if necessary.

Your body mass index (BMI) tells your weight status: whether you are underweight, of normal weight, overweight, obese or morbidly obese.

A BMI of 30 or more classifies you as obese and beyond 35 as morbidly obese. Your obesity can be central or peripheral.

Central obesity, also known as abdominal obesity, is the deposit of excess fat around the abdomen, which has built up to the extent that it is likely to have an adverse impact on health. You become prone to various obesity complications including diabetes type 2, metabolic syndrome and heart disease.

Central obesity is more dangerous because, in this type of obesity, the fat is accumulated around the vital organs in the abdomen and their blood supply. This makes it easy for the fat to leak into the bloodstream and cause obesity’s negative health effects.

Peripheral obesity is the deposit of subcutaneous fat around the hips, on the buttocks and thighs. This does not pose dangers as central obesity does.

It is the obesity medicine clinician whose help you should take to diagnose and treat this condition.

Once diagnosed, obesity needs to be treated with a modified weight loss diet, regular physical exercise, improved lifestyle habits, and if necessary medical intervention.

Differential diagnoses

However, obesity can be mistaken for other medical conditions. The differential diagnoses include:

  • Acromegaly is thickening of the skin, soft tissues, abnormal growth of the hands, feet, and face, caused by the excessive production of the growth hormone secreted by the pituitary gland.
  • Ascites is the excessive accumulation of fluid in the peritoneal cavity of the abdomen caused by conditions such as liver cirrhosis, cancer, heart failure, tuberculosis, pancreatitis, and blockage of the hepatic vein.
  • Iatrogenic Cushing Syndrome, caused by prolonged use of glucocorticoids, leads to fatty deposits around the abdomen, on the face, between the shoulders and the upper back (causing a buffalo hump)

Criteria to diagnose obesity

An obese BMI requires a detailed medical history, a thorough physical examination, and a few blood tests.

Personal and family history

The doctor will take your personal history and will try to find out

  • Since when you had gained your extra pounds
  • what efforts you have made to lose them
  • your lifestyle habits vis-à-vis your eating habits, physical activity, alcohol and smoking patterns, if present
  • Present medication, if any
  • Your family history for the presence of obesity and its complications in any family member – Genes also play a contributory role in you becoming obese.

The personal history is aimed at finding out the contributory cause of your obesity.

Physical exam

The physical examination includes measurement of

  • weight and height to determine your BMI,
  • vital signs such as blood pressure, pulse, temperature
  • auscultation of your heart beats and lung sounds

Measurement of waist circumference: What is its importance?

BMI, alone, is not sufficient to determine the extent of the risk of developing obesity-related complications. It is the amount of abdominal fat around your waist irrespective of your BMI, that will decide the degree of risk. That is why the abdominal circumference becomes important.

Women with a waist circumference of more than 35 inches (80 cms) and men with a waist measurement of more than 40 inches (102 cms) harbor more health risks than people who have a smaller waistline.

The waist circumference tells you of the amount of fat deposited in the abdomen. More the circumference more is the fat and the health risks.

Waist-hip ratio (WHR)

The waist-hip ratio helps to determine and measure your central obesity. The score of this ratio also helps to measure the quantum of risk you face of developing the various complications that obesity can cause.

You should measure the waist circumference at the level of the naval in an exhaled and relaxed state. The hip measurement should be taken at the buttocks’ largest circumference.

WHR Cut-off levels

A WHR greater than 0.8 for women and 0.9 for men indicates excess fat distribution around the abdomen (presence of central obesity). You must then make efforts to reduce your weight and waist through exercise and dietary control. See your doctor if necessary.

If your WHR is higher than the cut-off levels mentioned above, you are at higher risk of developing the following comorbidities:

  • Hypertension
  • Diabetes type 2
  • Stroke
  • Asthma due to reduced lung function (obesity hypoventilation syndrome in a significant increase in waist: hip ratio)
  • High cholesterol and triglyceride levels
  • High uric acid levels

Lab and other tests

These lab tests are conducted to determine if the obesity has had any negative effects on any of your health. The tests usually recommended are:

  • ·         Lipid profile
  • ·         Liver function tests
  • ·         Kidney function tests
  • ·         Thyroid tests
  • ·         Blood sugar tests along with HBA1c

All the above diagnostic guidelines will help the doctor to chart out a treatment plan to

  • Deal with your obesity in the most effective manner
  • Treat any complications that may have set in such as hypertension, diabetes, heart problems, and more.

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