Author:

Editor(s):

Updated:

ULY CLINIC

20 Septemba 2025, 04:04:38

Excessive weight gain

Excessive weight gain occurs when caloric intake exceeds the body’s energy requirements, resulting in increased adipose tissue storage. It may also result from fluid retention causing generalized or localized edema. Emotional factors (e.g., anxiety, guilt, depression) and social influences commonly contribute to overeating.

In the elderly, weight gain often reflects sustained food intake alongside a progressive decline in basal metabolic rate. Women may experience progressive weight gain during pregnancy or periodic weight fluctuations with menstruation. Weight gain is also a primary sign of endocrine disorders and may result from limited activity due to cardiovascular or pulmonary diseases. Certain medications or edematous states from cardiovascular, renal, or hepatic dysfunction can further contribute to weight gain.

History and Physical Examination

History

Previous patterns of weight gain or loss.
Family history: obesity, thyroid disease, diabetes mellitus.
Lifestyle assessment: diet, activity, exercise frequency.
Associated symptoms: polyuria, polydipsia, nocturia, visual changes, hoarseness, paresthesia, menstrual irregularities, impotence, fatigue.
Mental status: anxiety, depression, cognitive changes.
Medication review: drugs affecting appetite, fluid retention, or metabolism.

Physical Examination

Measure body mass index (BMI) and skinfold thickness to estimate fat reserves.
Assess fat distribution and edema.
Inspect skin, hair, nails for endocrine or nutritional abnormalities.
Take vital signs.

Medical causes

Cause	Onset	Key Features	Associated Findings	Pathophysiology	Management
Acromegaly	Gradual	Moderate weight gain	Coarsened facial features, enlarged hands/feet, back/joint pain, lethargy	GH excess → soft tissue overgrowth	Surgery, somatostatin analogs
Diabetes mellitus	Gradual	Variable, often weight gain with polyphagia	Fatigue, polyuria, polydipsia, nocturia	Insulin dysregulation → increased appetite	Glycemic control, lifestyle modification
Hypercortisolism (Cushing’s)	Gradual	Truncal obesity, buffalo hump, moon face	Purple striae, weakness, emotional lability, hirsutism/acne (women), gynecomastia (men)	Cortisol excess → fat redistribution	Surgical removal of adenoma, pharmacologic therapy
Hyperinsulinism	Gradual	Increased appetite	Weakness, diaphoresis, tachycardia, visual changes, syncope	Excess insulin → increased fat deposition	Treat underlying cause (tumor, medication), diet control
Hypogonadism	Gradual	Prepubertal: eunuchoid body, sparse hair; Postpubertal: loss of libido	Impotence, infertility	Low sex steroids → fat accumulation	Hormone replacement therapy
Hypothalamic dysfunction	Gradual	Hyperphagia, weight gain	Altered sleep, thermoregulation	Central appetite dysregulation	Treat underlying syndrome, lifestyle management
Hypothyroidism	Gradual	Weight gain despite anorexia	Fatigue, cold intolerance, constipation, dry skin, hair loss, bradycardia	Low thyroid hormone → slowed metabolism	Levothyroxine therapy
Metabolic syndrome	Gradual	Central obesity	Hypertension, dyslipidemia, insulin resistance	Visceral fat accumulation → cardiometabolic risk	Lifestyle modification, medical management
Nephrotic syndrome	Acute/chronic	Edema-related weight gain	Anasarca, orthostatic hypotension, lethargy	Protein loss → fluid retention	Treat underlying renal disease, diuretics
Pancreatic islet cell tumor	Gradual	Hyperphagia → weight gain	Weakness, diaphoresis, palpitations, syncope	Excess insulin → appetite stimulation	Surgical excision, medical therapy
Preeclampsia	Acute (pregnancy)	Rapid weight gain	Nausea, vomiting, epigastric pain, hypertension, visual changes	Fluid retention from endothelial dysfunction	Obstetric management, antihypertensives
Sheehan’s syndrome	Gradual	Weight gain in postpartum women	Fatigue, amenorrhea	Pituitary ischemia → endocrine deficiency	Hormone replacement
Drugs	Variable	Weight gain, fluid retention	Appetite changes	Corticosteroids, phenothiazines, tricyclics, hormonal contraceptives, lithium	Medication review, adjust or substitute

Evaluating Nutritional Status

Skinfold thickness: Estimates subcutaneous fat.
- Triceps or subscapular skinfold <60% of standard: severe depletion.
- 60–90%: moderate depletion.
- 90%: adequate reserves.
Midarm circumference (MAC): Reflects muscle + fat; <90% indicates caloric/protein deficiency.
Midarm muscle circumference (MAMC): Isolates muscle mass.

Measurement Technique:

Triceps skinfold: Measure midpoint of upper arm, pinch 1 cm above midpoint, apply calipers for 3 seconds, repeat thrice, record average.
Subscapular skinfold: Pinch skin below scapular angle, apply calipers, record as above.
Midarm circumference: Measure at same midpoint.
MAMC calculation: MAMC = MAC – (3.143 × triceps skinfold thickness in cm).

Special considerations

Psychological counseling: For emotional or body-image–related weight gain.
Exercise: Monitor carefully in obese or cardiopulmonary patients.
Laboratory assessment: TSH, dexamethasone suppression test, fasting glucose, lipid profile.
Behavior modification: Diet, lifestyle, and medication review.

Patient counseling

Educate on weight control strategies, including balanced diet and regular physical activity.
Encourage behavioral modification and compliance with medical therapy if endocrine or metabolic disorder is present.
Emphasize realistic weight goals and psychosocial support.

Pediatric pointers

Causes: endocrine disorders (hypercortisolism), genetic syndromes (Prader-Willi, Down syndrome), neuromuscular disorders (Werdnig-Hoffmann, cerebral palsy), sedentary lifestyle, poor eating habits.
Intervention: Avoid fad diets; provide structured nutrition and exercise programs.
Monitor growth and development alongside weight management.

Geriatric pointers

Optimal weight increases with age; mild weight gain may be physiologic.
Consider comorbidities, including cardiometabolic and musculoskeletal limitations.
Evaluate for secondary causes (e.g., hypothyroidism, fluid retention, endocrine disorders).

References

Buttaro TM, Tybulski J, Bailey PP, Sandberg-Cook J. Primary Care: A Collaborative Practice. St. Louis (MO): Mosby Elsevier; 2008. p. 444–447.
Colyar MR. Well-Child Assessment for Primary Care Providers. Philadelphia (PA): F.A. Davis; 2003.
Lehne RA. Pharmacology for Nursing Care. 7th ed. St. Louis (MO): Saunders Elsevier; 2010.
McCance KL, Huether SE, Brashers VL, Rote NS. Pathophysiology: The Biologic Basis for Disease in Adults and Children. Maryland Heights (MO): Mosby Elsevier; 2010.
Schuiling KD. Women’s Gynecologic Health. Burlington (MA): Jones & Bartlett Learning; 2013.
Sommers MS, Brunner LS. Pocket Diseases. Philadelphia (PA): F.A. Davis; 2012.
Bray GA. Obesity: Etiology, pathogenesis, and treatment. Nat Rev Endocrinol. 2016;12:139–152.
Garvey WT, Mechanick JI, Brett EM, et al. American Association of Clinical Endocrinology guidelines for obesity management. Endocr Pract. 2016;22(Suppl 3):1–203.
Kershaw EE, Flier JS. Adipose tissue as an endocrine organ. J Clin Endocrinol Metab. 2004;89:2548–2556.
Yanovski SZ, Yanovski JA. Obesity. N Engl J Med. 2002;346:591–602.
Grundy SM. Metabolic syndrome pandemic. Arterioscler Thromb Vasc Biol. 2008;28:629–636.
Vgontzas AN, Bixler EO, Chrousos GP. Obesity-related sleepiness and fatigue: Role of cytokines. Int J Obes Relat Metab Disord. 2005;29:1–10.
Prentice AM, Jebb SA. Obesity in Britain: Causes and consequences. Proc Nutr Soc. 2003;62:251–258.