Overweight (Obesity): Medical History

Medical history (history of illness) represents an important component in the diagnosis of obesity (overweight). Family history

• Is there a frequent occurrence of obesity in your family?

Social history

• What is your profession?
• Is there any evidence of psychosocial stress or strain due to your family situation?

Current medical history/systemic history (somatic and psychological complaints).

• Do you suffer from symptoms such as shortness of breath, increased sweating, back and joint pain?
• Do you suffer from your excess weight?
• Do you feel depressed because of body weight?
• Do you have feelings of inferiority?
• Do you have trouble sleeping?
• Do you have a depressive mood?

Vegetative anamnesis including nutritional anamnesis.

• Do you get enough exercise every day?
• Do you sleep enough?
• Were you breastfed as a child?
• Do you eat a balanced diet every day? Which foods are part of this for you?
  • Do you tend to eat high-fat foods?
• Do you smoke? If so, how many cigarettes, cigars or pipes per day?
• Do you drink alcohol? If yes, what drink(s) and how many glasses per day?
• Do you use drugs? If yes, what drugs and how often per day or per week?

Self-history

• Pre-existing conditions (metabolic disorders; psychological problems).
• Operations
• Allergies
• Pregnancies

Medication history (Subsequent medications increase appetite or decrease energy expenditure – increased body weight is the result).

• Antidepressants (weight gain is usually in the second and third years of treatment).
  • Monoamine oxidase inhibitors (MAO inhibitors) – moclobemide
  • Noradrenergic and specific serotonergic antidepressants (NaSSA) – mirtazapine (moderate).
  • Selective serotonin–norepinephrine reuptake inhibitors (SSNRIs) – duloxetine (moderate), venlafaxine (moderate).
  • Selective serotonin reuptake inhibitors (SSRI) – citalopram (moderate), escitalopram (moderate), fluoxetine (low), fluvoxamine, paroxetine (moderate), sertraline (moderate).
  • Tetracyclic antidepressants (maprotiline, mianserine).
  • Tricyclic antidepressants (TCAs) – amitriptyline, clomipramine, doxepin, imipramine, nortriptyline, opipramol, trimipramine.
• Antiepileptic drugs
  • AMPA receptor antagonist (perampanel).
  • KCNQ2/3 opener (retigabine).
  • Classical antiepileptic drugs (valproate).
• Antihistamines (ketotifen).
• Antipsychotics (neuroleptics)
  • Amisulpride, aripiprazole, clozapine, haloperidol, melperone, olanzapine (strong), quetiapine, risperidone (moderate), ziprasidone (low), zuclopenthixol.
  • Alimemazine, chlorpromazine (strong), perphenazine, promethazine (moderate), promazine (light), thioridazine, triflupromazine
  • Aripiprazole, olanzapine, and risperidone resulted in increases in total body fat and visceral and subcutaneous fat in children and adolescents aged 6 to 19 years as early as 12 weeks
• Hormones
  • Anabolic steroids (strong)
  • Androgens: testosterone and androstenedione (medium).
  • Cortisol and its derivatives (strong)
  • Progestogens (chlormadinone acetate, cyproterone acetate, desogestrel, dienogest, drospirenone, gestodene, levonorgestrel, norethisterone, norgestimate, nomegestrol) (very low).
  • GnRH analogues (goserelin acetate, leuporelin acetate, buderelin acetate, nafarelin acetate, triptorelin acetate).
  • Insulin (strong)
  • Contraceptives: ethinyl estradiol (low).
  • Estrogens, except ethinyl estradiol (very low).
• Pizotifen
• Phase prophylactics
  • Lithium, valproate (strong), carbamzepine (moderate), gabapentin, lamotrigine, topiramate (low).
• Other pharmaceuticals with adipogenic effects
  • Alpha-2 agonists (α2-adrenoceptor agonists) (very low) such as midodrine.
  • Beta-blockers (low): nonselective beta-blockers (eg, carvedilol, propranolol, soltalol) [inhibition of insulin secretion; more potent than selective beta-blockers]; selective beta-blockers (eg, atenolol, bisoprolol, metoprolol)
  • Glinides (nateglinide, repaglinide).
  • Glitazones (thiazolidinediones: pioglitazone, rosiglitazone).
  • Sulfonylureas (medium) (glibenclamide, gliclazide, glimepiride, gliquidone, tolbutamide).
  • Thiazolidinediones (low) such as rosiglitazone.

Environmental history

• Bisphenol A (BPA) as well as bisphenol S (BPS) and bisphenol F (BPF) are associated with obesity in children; detection of BPF (versus no detection) showed an association with abdominal obesity (OR 1.29) and BMI (BPA is considered an endocrine disruptor and obesogen)
• Phthalates (plasticizers used in the plastics industry), these occur especially in fatty products (cheese, sausage, etc.) overNote: Phthalates belong to the endocrine disruptors (synonym: xenohormones), which even in the smallest amounts can damage health by altering the hormonal system.