The internal evaluation is to identify diseases that could have led to obesity, even if these are very rare in terms of numbers. These include diseases of the thyroid gland and adrenal glands.
Diseases associated with underactive thyroid glands can cause obesity. However, mild subfunctions of the thyroid gland, which many people suffer from, are clearly overestimated in their importance for the development of overweight and obesity.
The situation is different with Cushing's syndrome, a disease of the adrenal gland that is associated with increased cortisol production. Although it is rather rare, it regularly leads to so-called trunk adiposity, in which the trunk has considerable fat deposits but the extremities are very thin. Typical are also over 1 cm wide reddish stretch marks of the skin. After all, around 1% of all obese people who present themselves in a centre for obesity surgery suffer from this adrenal disease. If obesity has developed rapidly within a short period of time, a tumour of the pituitary gland must also be considered.
Another focus of the internal evaluation is the identification of typical secondary diseases of obesity such as diabetes mellitus type 2, high blood pressure and cardiovascular diseases. Existing complications such as cardiac insufficiency, myocardial infarction, strokes, etc. are surveyed. Screening for sleep-related respiratory disorders makes sense.
The nutritional status should also be examined with regard to an adequate supply of micro- and macronutrients and a screening for deficiencies should be carried out (e.g. vitamin D, B12 and iron status). In many centres examinations for ulcers using gastrointestinal and duodenal endoscopy are also performed, as ultrasound examinations of the abdominal cavity (gallstones? liver size?). For women, bone density measurement is also recommended.
The evaluation of eating behaviour should be carried out by a nutritionist:
- the frequency of daily meals
- ingredients of meals
- the amount of food consumed during and, if necessary, between meals.
- feeling hungry and satiated
- eating circumstances (alone, in company, at home, eat outside)
- experiences with diets
Bilbiography sources:
Deutsche Adipositas-Gesellschaft, Deutsche Diabetes Gesellschaft, Deutsche Gesellschaft für Ernährung, deutsche Gesellschaft für Ernährungsmedizin (2014) Interdisziplinäre Leitlinie der Qualität S3 zur „Prävention und Therapie der Adipositas“. AWMF-Register Nr. 050/001. Klasse: S3. Version 2.0.
Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie, Chirurgische Arbeitsgemeinschaft für Adipositastherapie (CAADIP), Deutsche Adipositas-Gesellschaft (DAG), Deutsche Gesellschaft für Psychosomatische Medizin und Psychotherapie, Deutsche Gesellschaft für Ernährungsmedizin (2010) S3-Leitlinie: Chirurgie der Adipositas.
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Freedhoff Y, Sharma AM Hellbardt M, Schilling-Maßmann B, Haberl PM (2012) Best Weight. Ein Leitfaden für das Adipositas-Management. Pabst Science Publishers, Lengerich
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Kushner RF Elbelt U, Scholze JE (2012) Diagnostik und Management der Adipositas. In: Longo DL, Fauci AS, Kaspar DL, et al. (Hrsg) Harrisons Innere Medizin, 18. Aufl. ABW Wissenschaftsverlag, Berlin, S 673–681
Mechanik JI, Youdim A, Jones DB, et al. (2013) Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient-2013 Update: cosponsored by American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery. Obesity 21: S1–27
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