Table 4.

Evaluation of obesity and its related comorbidities

Obesity
1. BMI should be measured regularly at least once a year in all adults. People with a BMI between 23 and 24.9 kg/m2 are classified as with pre-obesity, while those with a BMI of 25 kg/m2 or above are classified as with obesity.
2. WC should be measured to assess abdominal obesity. Individuals with abdominal obesity are considered at elevated risk for obesity-related comorbidities.
3. Evaluate comorbidities in people with pre-obesity or obesity
History taking	Obtain a comprehensive history, including past medical history, family history, current medications, smoking and alcohol use, social history, previous weight loss attempts, history of weight change, reason for weight gain, dietary habits, eating disorders, physical activity level, exercise habits, mental health status including depression and stress, desired weight, and motivation for weight loss
Physical examination	Measure height, weight, WC, vital signs, body composition (using BIA or DXA if necessary), and visceral fat amount (using CT or MRI if necessary) and conduct a systemic physical examination to assess comorbidities
Laboratory evaluation	Measure fasting blood glucose, serum lipid profile, uric acid, thyroid-stimulating hormone, liver function tests, complete blood count, renal function tests, and inflammatory markers and conduct tests for evaluation of secondary obesity (if necessary)
Obesity-related comorbidities
System	Comorbidities	Suggested tests
Cardio-cerebrovascular	Coronary artery disease, hypertension, ischemic stroke, congestive heart failure, atherosclerosis, pulmonary embolism, varicose veins, deep vein thromboembolism, etc.	Blood pressure, pulse rate, electrocardiography. Conduct a thorough examination for suspected diseases if necessary.
Gastrointestinal	Gallstone, nonalcoholic fatty liver disease, gastroesophageal reflux, hernia	Liver function tests. Conduct abdominal ultrasound and/or upper endoscopy if necessary.
Pulmonary	Asthma, obstructive sleep apnea, obesity hypoventilation syndrome	Chest X-ray, pulmonary function tests, measurement of neck circumference, polysomnography if necessary.
Endocrine	Type 2 diabetes mellitus, insulin resistance, metabolic syndrome, dyslipidemia, hyperuricemia, gout	Fasting blood glucose, serum lipid profile, uric acid. Glycated hemoglobin and/or fasting insulin if necessary.
Tumor	Esophageal cancer, stomach cancer, colorectal cancer, hepatoma, pancreatic cancer, gallbladder cancer, kidney cancer, leukemia, multiple myeloma, lymphoma, prostate cancer (man), postmenopausal breast cancer (woman), endometrial cancer (woman), cervix cancer (woman)	Conduct a thorough examination for suspected diseases if necessary.
Urogenital	Hypogonadism, menstrual abnormalities, polycystic ovary syndrome, infertility, subfertility, precocious puberty, gynecomastia, erectile disorder, adverse maternal outcomes (gestational diabetes, preeclampsia, eclampsia, miscarriage, dystocia, elevated risk of cesarean sections), congenital disorders (neural tube defects, cleft lip and cleft palate, hydrocephalus, congenital heart diseases), stress incontinence	Conduct a thorough examination for suspected diseases if necessary.
Musculoskeletal	Disability, low back pain, osteoarthritis, spine diseases, foot disorders	Conduct a thorough examination for suspected diseases if necessary.
Nervous	Idiopathic intracranial hypertension, dementia, meralgia paresthetica	Conduct a thorough examination for suspected diseases if necessary.
Psychiatric	Depression, anxiety, low self-esteem, eating disorder, decreased work performance, low quality of life, body dissatisfaction	Conduct a thorough examination for suspected diseases if necessary.
Other	Acanthosis nigricans, skin infections, periodontal disease, increased risk of anesthesia complications, lymphedema	Conduct a thorough examination for suspected diseases if necessary.

BMI, body mass index; WC, waist circumference; BIA, bioelectrical impedance analysis; DXA, dual-energy X-ray absorptiometry; CT, computed tomography; MRI, magnetic resonance imaging.