Primary prevention of chronic disease is a priority, rather than waiting for a coronary event to occur or type II diabetes to develop. Identification of candidates for chronic disease by increased waist circumference, coupled with raised markers: BP; glucose; and cholesterol, and proactively treating obesity is essential.

A 10% weight reduction has been shown to reverse the progression of type II diabetes in 50% of cases, reduce obesity-related mortality by 40% and reduce or minimise significant morbidities associated with obesity¹.

Critical essential measurements & investigations needed to assess a patients risk

• BMI (weight & height)
• Waist circumference
• Blood Pressure
• Fasting blood glucose
• Fasting lipid profile
• Thyroid function

Useful baseline information

History

• Medical history including all other co-morbidities
• Ethnicity
• Family history of diabetes, CHD, stroke, endocrine disorder
• History of gestational diabetes
• History of infertility, Polycystic ovaries, hirsutism, dysfunctional uterine bleeding
• Contraceptive history
• Dietary history

Direct Questioning for symptoms of co-morbidities

• Polyuria, polydipsia
• Breathlessness on exertion
• Chest pain, palpitations
• Abnormal fatigue or daytime somnolence: snoring
• Intermittent claudication, peripheral vascular disease or symptoms or other circulatory disorders
• Menstrual disorders
• Erectile dysfunction
• Depression
• Hip & knee joint problems

Assess Readiness to Change, consider:

• Motivation to change behaviour
• Confidence to make the changes
• Barrriers to change

Social History

• Fitness rating
• Alcoholism/smoking status
• Mental history-depression, low self esteem, psychosis, suicide ideation, anorexia, bulimia
• Drug use, especially ‘slimming drugs/amphetamines, metformin, anti-inflammatory medication, diuretics

Note> Drugs that may cause Weight Gain

• antipsychotics esp: olanzepine (Zyprexa)
• antidepressants : tricyclics, SSRIs, MAOIs & mirtazepine (Zispin) and Lithium
• corticosteroids : all corticosteroids may promote weight gain by 2 mechansisms : fat redistribution causing truncal obesity, buffalo hump & moon face, and fluid retention via mineralocorticoid effects.
• OCP : progestogenic compounds
• ß-blockers : not only do these agents cause weight gain, they may restrict physical activity due to fatigue.
• oral hypoglycaemics : Numerous agents shown to increase weight. Most sulphonylureas (except glimepiride) Glitazones.
• insulin
• anticonvulsants : weight gain has been documented with some agents (phenytoin sodium)
• valproate). Topiramate (topamax) is weight neutral or may cause weight loss.
• antihistamines : many antihistamines may cause weight gain though these effects are more pronounced with older agents.

Blood Tests

• FBC
• LFT for NASH
• HbA1c / glucose tolerance test if appropriate 
• Microalbuminuria if indicated
• Hormone profile if indicated
• Sleep studies, CXR, ecg or other tests as indicated