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Diabetic Exam
 
 

Body Habitus

 
 
 
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Overview

The patient's body habitus provides insight into a patient's diet and metabolic status as well as their overall risk of cardiovascular and non-cardiovascular complications in the future. While static measures such as body habitus and waist-hip ratio can estimate future risk, unexpected change in weight may suggest active disease.

Weight

  • Look for

  • The patient’s current weight
  • Change in weight - compare to past weights
  • Time course - sudden / gradual
  • Causes of Weight Gain

  • ↑ Dietary intake
  • Physical exercise
  • Endocrine - hypothyroidism, Cushing’s, PCOS
  • Medications - steroids, antidepressants, antipsychotics, OCP
  • Fluid overload - excessive IV fluids, renal disease, heart failure
  • Genetic
  • Causes of Weight Loss

  • ↓ Dietary intake - anorexia, low access to food
  • ↑ Physical activity
  • Malignancy
  • Malabsorption - obstruction, IBD, pancreatitis, coeliac disease
  • Endocrine - hyperthyroidism, diabetes, phaeochromocytoma, addison’s
  • Neurological - stroke, Parkinson’s, dementia
  • Drugs - diuretics, chemotherapy, amphetamines, opioids
  • Organ failure - renal, hepatic, cardiac, respiratory, gut
  • Chronic infection - TB, HIV
  • Psychiatric - eating disorders, depression, alcoholism, schizophrenia

Body Mass Index

BMI =
WeightHeight²
  • Classification

  • Underweight - <18.5
  • Normal - 18.5 - 24.9
  • Overweight - 25 - 29.9
  • Obese - 30 - 34.9
  • Severely obese - 35 - 39.9
  • Morbidly obese - 40+
  • Associated with Obesity

  • Metabolic syndrome - type 2 diabetes mellitus, hypertension, dyslipidaemia
  • Ischaemic heart disease
  • Stroke
  • Respiratory - obstructive sleep apnoea, asthma
  • Gastrointestinal - reflux, cholelithiasis, non-alcoholic steatohepatitis (NASH)
  • Polycystic ovarian syndrome
  • Osteoarthritis
  • Varicose veins
  • Gout
  • Associated with Being Underweight

  • Hypoglycaemia
  • Vitamin deficiency - scurvy, rickets
  • Bone marrow suppression - anaemia, thrombocytopaenia, immunosuppression
  • Cardiac - arrhythmia, MI
  • Neurological - cognitive impairment, peripheral neuropathy, Wernicke-Korsakoff syndrome
  • Muscle wasting
  • Endocrine - osteoporosis, amenorrhoea

Waist-Hip Ratio

  • How to Assess

  • Measure the waist circumference at the midpoint between the lowest palpable rib and the top of the iliac crest. Measure the hip circumference around the widest part of the buttocks. Divide the first measurement by the second.
    • Normal Range

    • Males <0.9
    • Females <0.85
  • Significance

  • An estimate of central obesity. Waist circumference and WH ratio are used to estimate cardiovascular risk.
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