Acquired obesity

Introduction Acquired obesity: fat cell simple hypertrophy or adult onset obesity. The patient's adulthood is due to genetic factors, and on the other hand, due to excessive nutrition, which causes the trunk fat cells to be hypertrophy but no hyperplasia. This type is sensitive to insulin, and the effect of weight loss treatment is more obvious. The most healthy and effective way to lose weight is exercise and nutritional meal replacement. Physical exercise after meals or during free time, replace some of the meals with balanced nutrition health foods to reduce calorie intake, so as to achieve the purpose of weight loss.

Cause

First, eating habits and exercise

Caused by overeating, too little activity is the main external cause of acquired obesity. Sweet food in food, greasy food. Fat is distributed on the trunk. Especially found in the abdominal back, buttocks and thighs and other fat distribution.

Second, family genetic inheritance

Patients often have parental obesity, their brethren and patients themselves are also obese from childhood, family habits are more than sweets, food intake and frequency are more like snacks.

an examination

Related inspection

Body mass index serum cholesterol serum cholesterol ester

First, medical history

1. Ask the patient's eating habits and exercise, roughly calculate the daily calorie intake, too much diet and too little activity is the main external cause of simple obesity.

2. Ask about family history. Simple obesity patients often have parental obesity, and their brethren and patients themselves are also obese at first age. Family habits are more like sweets, more food intake and frequency, and like to eat snacks.

3. Understand personal birth history and physical development status, secondary sexual development and sexual function status, simple obesity patients have no secondary sexual development disorder, sexual function is more normal, and secondary, sexual obesity patients have more Secondary sexual developmental disorders and sexual dysfunction, in addition, should ask about past health conditions, with or without meningitis, encephalitis, craniocerebral trauma, history of cancer, because of secondary obesity have a clear cause, obesity is only its One of the clinical manifestations, especially pay attention to the history of neuropsychiatric, endocrine and metabolic diseases, such as hypothyroidism, hypercortisolism, giant disease and acromegaly, hirsutism, hypothalamic syndrome and other medical history.

Second, physical examination

1. Measure the patient's height (m), weight (kg), body temperature, blood pressure, abdominal circumference and hip circumference to understand whether the patient is obese or not, whether there is abnormal temperature regulation (hypothalamic syndrome abnormalities in hypothalamic syndrome) ) and blood pressure rises.

2. Observe the body shape and fat distribution. In simple obesity patients, male fat distribution is mainly in the neck, head and trunk; women are mainly in the abdomen, lower abdomen, breast and hip, and secondary obesity varies. The disease is different, such as the heart to win obesity, full moon face, buffalo back, multi-blood appearance, purple lines, hemorrhoids are the characteristics of hypercortisolism; female obesity hairy amenorrhea infertility may be caused by polycystic ovary, body obesity, The face is swollen, the skin is dry and rough, and the slow response is characterized by hypothyroidism, the extremities of the extremities are enlarged, and the ugly face is characterized by acromegaly.

3. Vision and visual field examination, hypothalamic and pituitary obesity, especially in this part of the tumor can cause visual impairment, hemianopia, etc., detailed physical examination is the main clue for the diagnosis of secondary obesity.

Third, buy a laboratory inspection

(1) Laboratory testing of hypothalamic and pituitary functions.

1. Hormone determination, ACTH, FSH, LH, TSH, GH, PRL measurement, to understand the hypothalamic and pituitary functions, the diagnosis of hypothalamic and pituitary obesity.

2. TRH, LH-RH excitation test.

(1) TRH stimulation test: Intravenous injection of TRH200~500, g in the early morning, before and after injection, 15, 30, 60, 90, min, respectively, blood sampling, TSH level, normal people 30, min serum after injection, TSH peaked, up to 10~30, g, /L. When hyperthyroidism, TSH did not increase (no response), the baseline value of serum TSH increased when primary hypothyroidism, and the TSH value increased significantly after intravenous injection of TRH ( Obvious excitement); secondary hypothyroidism such as lesions in the hypothalamus, TSH is significantly increased after TRH stimulation; such as lesions in the pituitary gland after TRH stimulation TS, H no increase, pituitary tumor, Xi Han syndrome, limb In the late stage of hypertrophy, pituitary disease caused insufficient secretion of TSH, serum TSH level was low, and response after TRH stimulation was poor, suggesting that the pituitary TSH reserve function was poor.

(2) LH-RN (LRH) stimulation test: differential hypogonadism is primary or secondary, LRH, 100g intravenously at 8:00 am, before, and after injection, 15, 30, 60, min blood test LH; then intravenously (or intramuscularly) LRH 100g every other day, a total of 3 times, repeat the above test, normal women in the 15min after the injection of LH peak, increased to more than 3 times the base value, the absolute value increased, 7.5, nmol / Above L, men are twice as low as women, and primary sexual dysfunction, LH base value is increased, LH peak after injection of LRH is 4 to 5 times higher than the base value (reaction is obvious in human pituitary, LH base value is low, injection Poor or no response after LRH, lesions in the hypothalamus, low LH baseline, normal or delayed response after injection of LRH (peak appeared 60 or 9 min after LRH injection).

(B) Determination of peripheral gland hormones.

1. Thyroid hormone determination TT3, TT4, FT3, FT4 determination to understand thyroid function.

2. Determination of adrenal cortex hormones: blood cortisol, 24h urine 17-hydroxysteroids and 17-ketosteroids 24, h urine free cortisol determination, the diagnosis of cortisol-induced obesity, early and simple cortisol Sexual obesity is still difficult to identify by the above tests, and a small dose of dexamethasone (2mg/d) inhibition test should be performed. The former is not inhibited.

3. Islet function test.

(1) Fasting and postprandial 2h blood glucose measurement: It is necessary to do oral glucose (75, g) tolerance test (OGTT) to help diagnose diabetes (DM) and impaired glucose tolerance (IGT).

(2) Determination of insulin and C-peptide: It is helpful for the diagnosis of pancreatic obesity, especially the insulin release test can reflect the reserve function of islet B cells (in OGTT) and simultaneously determine plasma insulin concentration).

4. Determination of blood lipids.

5. Vertical position water test: It shows that the patient has water retention phenomenon when standing in the standing position. After urinating in the morning, the patient drinks 1000ml of water in 20min, then urinates once every hour for 4h, records the urine volume, and takes the first day. In the lying position (without the pillow), the next day, if the standing position is the activity or the normal position of the working person, the drainage rate is 81.8+, 3.7% of the drinking water, and the urine output in the lying position is equal to the drinking water or even more than the drinking water; In the case of retention obesity, the amount of urine in the standing position is lower than that in the lying position, more than 50%.

Fourth, equipment inspection.

(1) Examination of the diagnostic method for obesity.

1. Diagnosis according to height and weight: firstly find the standard weight according to the patient's age (see the standard body weight scale), or calculate the following formula: standard weight = "height (cm) - 100" x 0.9, if the actual weight of the patient exceeds the standard weight 20% can be diagnosed as obesity, but must be excluded due to factors such as muscle development or water retention.

2. Skin wrinkle calipers measure subcutaneous fat thickness: 25 years old normal shoulder swelling subcutaneous fat thickness average 12.4mm over 14, mm is obese; deltoid muscle sebum thickness male average price. 4mm, female 17.5mm (normal person 25 years old value).

3. X-ray soft tissue filming calculation of skin fat thickness, ultrasonic reflection imaging method to estimate subcutaneous fat thickness and other methods (standard with caliper method).

4. Calculate body weight (kg) / body 2 (m2) > 24 according to body mass index. Obesity, World Health Organization standards: men > 27, women > 25 for obesity.

(2) CT, MRI. Diagnosis of hypothalamic, pituitary tumors, vacuolar sella, adrenal tumors, and insulinoma.

(C) Type B is helpful for the diagnosis of adrenal hyperplasia, tumor and islet cell tumor.

(d) 131I-19-Iodocholinol and a computer program for adrenal scanning. It is helpful for the diagnosis of adrenal hyperplasia or tumor.

Differential diagnosis

Mainly identified with the following symptoms:

1. Simple obesity: also known as primary obesity, is the most common type of obesity, accounting for about 95% of obese people.

The main cause: the family often has a history of obesity, mainly caused by genetic factors and excess nutrients.

Symptoms: This group of people has a more uniform distribution of systemic fat, no endocrine disorders, and no metabolic disorders. The so-called "middle-age obesity" is simply obesity.

A. Constitutional obesity: When you are young (more than 25 years old), you should not pay attention to diet control, eat and drink too much, and have excess nutrition, which is caused by genetic factors.

B. Acquired obesity: also known as exogenous obesity, mostly due to excess nutrients after 20 to 25 years old, resulting in increased fat cell volume. Many women do not pay attention to controlling diet after middle age, and their body begins to deform and get fat. The reason is here.

2. Secondary obesity: also known as pathological obesity, mostly caused by certain diseases in the body. Such obese patients are rare or rare in clinical practice, accounting for less than 5% of the entire obese population.

The main cause: obesity caused by disease disrupting the balance of endocrine and metabolism.

Symptoms: Obesity is only one of the important symptoms of this type of patients, as well as a variety of other clinical manifestations, such as hypercortisolism, hypothyroidism, islet beta cell tumor, hypogonadism, polycystic ovary Syndrome, intracranial hyperplasia, etc.

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