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Baseline data

Details
Published on Monday, 10 July 2006

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 ¬ëslimming 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
  • √ü-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