Weight gain, excessive
Weight gain, excessive: Excerpt from Nursing: Interpreting Signs and Symptoms
Weight gain occurs when ingested calories exceed body requirements for energy, causing increased adipose tissue storage. It can also occur when fluid retention causes edema. When weight gain results from overeating, emotional factors—most commonly anxiety, guilt, and depression—and social factors may be the primary causes.
Among elderly people, weight gain commonly reflects a sustained food intake in the presence of a normal, progressive fall in basal metabolic rate. Among women, a progressive weight gain occurs with pregnancy, whereas a periodic weight gain usually occurs with menstruation.
Also a primary sign of many endocrine disorders, weight gain may occur with conditions that limit activity, especially cardiovascular and pulmonary disorders. It can also result from drug therapy that increases appetite or causes fluid retention or from cardiovascular, hepatic, and renal disorders that cause edema.
History and physical examination
Determine your patient's previous patterns of weight gain and loss. Does he have a family history of obesity, thyroid disease, or diabetes mellitus? Assess his eating and activity patterns. Has his appetite increased? Does he exercise regularly or at all? Ask about associated symptoms. Has the patient experienced vision disturbances, hoarseness, paresthesia, or increased urination and thirst? Has he become impotent? If the patient is female, has she had menstrual irregularities or experienced weight gain during menstruation? Is she menopausal or postmenopausal?
Form an impression of the patient's mental status. Is he anxious or depressed? Does he respond slowly? Is his memory poor? What medications is he taking?
During your physical examination, measure skin-fold thickness to estimate fat reserves. (See Evaluating nutritional status, pages 644 and 645.) Note fat distribution and the presence of localized or generalized edema and overall nutritional status. Inspect for other abnormalities, such as abnormal body hair distribution or hair loss and dry skin. Take and record the patient's vital signs.
Medical causes
Acromegaly.Acromegaly causes moderate weight gain. Other findings include coarsened facial features, prognathism, enlarged hands and feet, increased sweating, oily skin, deep voice, back and joint pain, lethargy, sleepiness, and heat intolerance. Occasionally, hirsutism may occur.
Diabetes mellitus.The increased appetite associated with diabetes mellitus may lead to weight gain, although weight loss sometimes occurs initially. Other findings include fatigue, polydipsia, polyuria, nocturia, weakness, polyphagia, and somnolence.
Hypercortisolism.Excessive weight gain, usually over the trunk and the back of the neck (buffalo hump), characteristically occurs in hypercortisolism. Other cushingoid features include slender extremities, moon face, weakness, purple striae, emotional lability, and increased susceptibility to infection. Gynecomastia may occur in men; hirsutism, acne, and menstrual irregularities may occur in women.
Hyperinsulinism.Hyperinsulinism increases appetite, leading to weight gain. Emotional lability, indigestion, weakness, diaphoresis, tachycardia, vision disturbances, and syncope also occur.
Hypogonadism.Weight gain is common in hypogonadism. Prepubertal hypogonadism causes eunuchoid body proportions with relatively sparse facial and body hair and a high-pitched voice. Postpubertal hypogonadism causes loss of libido, impotence, and infertility.
Hypothalamic dysfunction.Conditions such as Laurence-Moon-Biedl syndrome cause a voracious appetite with subsequent weight gain, along with altered body temperature and sleep rhythms.
Hypothyroidism.With hypothyroidism, weight gain occurs despite anorexia. Related signs and symptoms include fatigue; cold intolerance; constipation; menorrhagia; slowed intellectual and motor activity; dry, pale, cool skin; dry, sparse hair; and thick, brittle nails. Myalgia, hoarseness, hypoactive deep tendon reflexes, bradycardia, and abdominal distention may occur. Eventually, the face assumes a dull expression with periorbital edema.
Metabolic syndrome.Metabolic syndrome, previously called syndrome X, consists of a group of disorders that affect metabolism, including excessive weight gain (usually in the central abdomen), hypertension (blood pressure greater than 135/85 mm Hg), abnormal cholesterol levels (high low-density lipoprotein and triglyceride levels, low high-density lipoprotein level), and high insulin levels.
Nephrotic syndrome.With nephrotic syndrome, weight gain results from edema. In severe cases, anasarca develops—increasing body weight up to 50%. Related effects include abdominal distention, orthostatic hypotension, and lethargy.
Pancreatic islet cell tumor.Pancreatic islet cell tumor causes excessive hunger, which leads to weight gain. Other findings include emotional lability, weakness, malaise, fatigue, restlessness, diaphoresis, palpitations, tachycardia, vision disturbances, and syncope.
Preeclampsia.With preeclampsia, rapid weight gain (exceeding the normal weight gain of pregnancy) may accompany nausea and vomiting, epigastric pain, elevated blood pressure, and blurred or double vision.
Sheehan's syndrome.Most common in women who experience severe obstetric hemorrhage, Sheehan's syndrome may cause weight gain.
Other causes
Drugs.Corticosteroids, phenothiazines, and tricyclic antidepressants cause weight gain from fluid retention and increased appetite. Other drugs that can lead to weight gain include hormonal contraceptives, which cause fluid retention; cyproheptadine, which increases appetite; and lithium, which can induce hypothyroidism.
Nursing considerations
▪ Refer the patient for psychological counseling, as necessary.
▪ If the patient is obese or has a cardiopulmonary disorder, monitor exercise closely.
▪ Perform studies to rule out possible secondary causes should include serum thyroid-stimulating hormone determination and dexamethasone suppression testing.
▪ Perform laboratory tests for thyroid function and serum cholesterol, triglyceride, and glucose levels.
Patient teaching
▪ Explain to the patient the cause of weight gain, if known.
▪ Teach the patient about appropriate dietary choices and discuss an individualized exercise plan.
Book Source Details
- Book Title: Nursing: Interpreting Signs and Symptoms
- Author(s): Springhouse
- Year of Publication: 2007
- Copyright Details: Nursing: Interpreting Signs and Symptoms, Copyright © 2007 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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