Weight gain

• Hypothyroidism: Fatigue, cold intolerance, constipation, dry skin, bradycardia, weight gain despite poor appetite
• Cushing’s Syndrome: Central obesity, moon face, buffalo hump, purple striae, hypertension, hyperglycaemia
• Polycystic Ovary Syndrome (PCOS): Weight gain, hirsutism, menstrual irregularities, acne, infertility
• Insulinoma: Hypoglycaemia, sweating, tremor, palpitations, associated with weight gain due to excessive eating to avoid hypoglycaemia
• Growth Hormone Deficiency: Increased fat mass, particularly central, decreased muscle mass, fatigue
• Hyperprolactinaemia: Amenorrhoea, galactorrhoea, weight gain, associated with pituitary adenomas

• Obesity: Excessive caloric intake, sedentary lifestyle, weight gain, often with associated comorbidities (e.g., type 2 diabetes, hypertension)
• Metabolic Syndrome: Central obesity, dyslipidaemia, insulin resistance, hypertension
• Prader-Willi Syndrome: Hypotonia, hyperphagia, obesity, intellectual disability, hypogonadism
• Leptin Deficiency: Early onset obesity, hyperphagia, associated with rare genetic mutations
• Bardet-Biedl Syndrome: Obesity, retinitis pigmentosa, polydactyly, renal abnormalities, intellectual disability

• Depression: Weight gain due to increased appetite or comfort eating, often with low mood, anhedonia, and fatigue
• Binge Eating Disorder: Recurrent episodes of eating large amounts of food with a sense of loss of control, often leading to weight gain
• Medication-Related: Weight gain associated with certain medications such as antipsychotics, antidepressants, corticosteroids, insulin
• Sedentary Lifestyle: Reduced physical activity leading to weight gain, often associated with a high-calorie diet
• Stress and Emotional Eating: Weight gain due to eating in response to stress or emotional triggers rather than hunger

Assess the specific symptoms presented by the patient:

• Onset and Duration: Gradual vs. sudden weight gain, any associated events such as change in diet, activity level, or stress
• Dietary and Exercise Habits: Detailed history of caloric intake, dietary habits, physical activity levels, and any recent changes
• Psychiatric Symptoms: Screening for depression, anxiety, or eating disorders, changes in mood, sleep patterns, or stress levels
• Associated Symptoms: Symptoms suggestive of endocrine disorders (e.g., fatigue, hair changes, skin changes, menstrual irregularities)
• Medication Use: Review of current and past medications, including over-the-counter and herbal supplements
• Family History: Obesity, diabetes, thyroid disease, other endocrine disorders, or genetic conditions

Gather a detailed background including:

• Past Medical History: History of weight issues, endocrine disorders, chronic illnesses, or previous surgical interventions
• Drug History: Detailed history of medication use, including duration and dose, as some medications may contribute to weight gain
• Social History: Lifestyle factors such as occupation, level of physical activity, diet, alcohol consumption, and smoking
• Psychosocial Factors: Exploration of stressors, life changes, or psychological factors that may contribute to weight gain
• Reproductive History (in females): History of pregnancy, menstrual cycle changes, or menopause that might affect weight

• Thyroid Function Tests (TFTs): To rule out hypothyroidism as a cause of weight gain
• Fasting Blood Glucose and HbA1c: To assess for diabetes or prediabetes
• Lipid Profile: To assess for dyslipidaemia, which may be associated with metabolic syndrome
• Cortisol Levels: To evaluate for Cushing’s syndrome, particularly if there are other suggestive features
• Liver Function Tests: To assess for non-alcoholic fatty liver disease (NAFLD) often associated with obesity
• Serum Insulin and C-Peptide: To assess for hyperinsulinaemia or insulin resistance
• Prolactin Levels: If hyperprolactinaemia is suspected based on clinical history
• 24-hour Urinary Free Cortisol: For suspected Cushing’s syndrome
• Genetic Testing: If a genetic syndrome such as Prader-Willi or Bardet-Biedl syndrome is suspected

• Abdominal Ultrasound: To assess for NAFLD, liver pathology, or adrenal masses
• DEXA Scan: To assess body composition, particularly to distinguish between fat and muscle mass
• MRI/CT Scan: If a pituitary or adrenal mass is suspected based on clinical features and biochemical tests
• Sleep Study: If obstructive sleep apnoea is suspected, which can contribute to weight gain and metabolic dysfunction
• ECG: If cardiovascular disease is a concern, particularly in the context of metabolic syndrome or obesity