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Obesity

Differential Diagnoses

Cushing's syndrome
Deficiency in thyroid activity (hypothyroidism)
Genetic disorders (e.g., Down syndrome)
Severe familial high cholesterol (hyperlipidemia)
Severe familial obesity
Tumors of the adrenal or pituitary gland

Specialists

Clinical Psychologist
Endocrinologist
General Surgeon
Internal Medicine Physician
Neurologist
Psychiatrist

Comorbid Conditions

Diabetes
High blood pressure (hypertension)
Osteoarthritis

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Factors Influencing Duration

Factors that may influence length of disability include type of job and compliance with treatment protocol.

Duration Trends from Reference Data

DURATION TRENDS

ICD-9-CM: 278, 278.0, 278.00, 278.01

Cases	Mean	Min	Max	No Lost Time	Over 6 Months
11912	39	0	124	0.1%	0%

Percentile:	5^th	25^th	Median	75^th	95^th
Days:	14	27	38	47	73

Differences may exist between the duration tables and the reference graphs. Duration tables provide expected recovery periods based on the type of work performed by the individual. The reference graphs reflect the actual experience of many individuals across the spectrum of physical conditions, in a variety of industries, and with varying levels of case management. Selected graphs combine multiple codes based on similar means and medians.

Medical Codes

	ICD-9-CM:
	278 -	Obesity and Other Hyperalimentation
	278.0 -	Obesity, Simple
	278.00 -	Obesity, Unspecified
	278.01 -	Obesity, Morbid
	278.1 -	Localized Adiposity; Fat Pad

History

History: Obese individuals are often cognizant of being overweight. Complaints may include shortness of breath (dyspnea); fatigue; joint pains in the hips, knees, and ankles; and a general dissatisfaction with state of health. Family history may point to diabetes or obesity.

Physical exam: The exam includes a method for measuring body fat based on height and weight measurements called the body mass index (BMI). Other measurements include the waist-to-hip ratio, and skinfold measurements, which are taken by skinfold calipers and are measured at various locations on the individual's body. It is derived by dividing an individual's weight in kilograms by his or her height in meters squared (BMI = kg/m2). Multiplying an individual's weight in pounds by 704 and then dividing it twice by individual's height in inches can also compute BMI. For example, a woman who weighs 150 pounds and is 68 inches tall has a BMI of 22.8. The result is graded on a scale to indicate levels of body fat. Federal guidelines define overweight as a BMI of 25 to 29.9 and obesity as a BMI of 30 or greater. Individuals with a BMI greater than 40 are considered morbidly obese. The prevalence of diseases related to obesity (e.g., diabetes, hypertension, dyslipidemia, ischemic heart disease) begins to rise at BMIs greater than 25 kg/m2.

To compute an individual's waist-to-hip ratio, divide the waist measurement (measured at narrowest point) by the hip measurement (measured at fullest point). Women with waist-to-hip ratios of more than 0.8 or men with waist-to-hip ratios of more than 1.0 are "apples" (because of their apple shape). Apples are at considerably greater health risk because of their fat distribution than are "pears."

Tests: Blood sugar (glucose) measurements at various times, including after fasting or after ingestion of glucose (tolerances), are used to evaluate diabetes. Blood tests may also reveal high cholesterol, high fats (hyperlipidemia), and elevated uric acid levels (hyperuricemia). Thyroid stimulating hormone (TSH) should be measured to exclude thyroid deficiency.

Source: Medical Disability Advisor

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