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A 40 –year- old woman, 5 feet 1 inch tall and weighing 188 pounds came for consultation to a physician complaining of frequent episodes of dizziness and numbness in her legs. She was too worried for her weight. Her waist measured 41 inches and hip measured 39 inches. Her only child who was 15-year-old, her sister and both of the parents were overweight. The patient recalled that she had been obese throughout her childhood and adolescence. Over the past 6 years she had been on seven different diets for periods of two weeks to three months, losing from 5 to 25 pounds. On discontinuation of each diet, she regained weight returning to 185 to 190 pounds.

During routine physical examination the patient was observed to be hypertensive (blood pressure of 200/120 mm Hg) but no abnormality was detected upon examination  of Chest, CNS and Abdomen .

The patient was asked to return to the clinic a week later in the fasting state,during which time a blood specimen was obtained. Blood Biochemistry revealed fasting hyperglycemia, hyperinsulinemia, dyslipidemia, and glucose intolerance.

What is the probable diagnosis?

What other investigations should be carried out to confirm the diagnosis?

Calculate the BMI for this woman and comment on the grade of obesity.

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4 Responses to Case study- Obesity

  • 1. The patient has developed Type 2 Diabetes Mellitus; more specifically Insulin Resistance. This could have been precipitated by her obesity.
    Also, the patient presented with paraesthesia. This is yet another sign of DM which is due to underlying neurotoxicity.
    Since patient has hypertension, dyslipidaemia, insulin resistance, hyperglycaemia, hyperinsulinaemia and most probably T2DM, the patient is likely to progress to a state of Metabolic Syndrome.

    2. One further blood test that could be carried out could be an estimation of Glycated Haemoglobin levels – which will be more of prognostic value. Further diagnostic tests will be a complete urine analysis for glucosuria and proteinuria. Serum Urea levels could also have been estimated to determine whether patient has hyperuricaemia – which is a common presentation of metabolic syndrome.

    3. The calculations are as follows:
    Height : 5 feet 1 inch = 1.55 m
    Weight : 188 pounds = 85.45 Kg
    BMI = (Body Weight / kg) / (Height / m)2
    = (85.45) / (1.55)2
    = 35.6
    The patient falls in Grade II category – classified as overweight by WHO but considered as obese in clinical practice.

  • Perfect answer, except for one mistake, we estimate serum uric acid for detecting hyperuricemia and not blood urea, perhaps by mistake you have written. High blood urea level will cause uraemia.
    Rest all absolutely perfect, proud of you. Keep workng hard!

  • The answers to the case studies would be released on 29/10/11, in my next post.

  • Thank you for pointing out this mistake ma'am. I was actually “subconsciously” using uraemia and uricaemia interchangeably. Now I shall be more particular…