In the clinical examination, anthropometric parameters are measured and the standard, detailed examination required in evaluating patients with any chronic, multisystem disorder, such as obesity, is performed.

Waist and hip circumference are useful surrogates in estimating visceral fat; serial tracking of these measurements helps in estimating the clinical risk over time. Neck circumference is predictive of the risk of sleep apnea, and its serial measurement in the individual patient is clinically useful for risk stratification.

Examination of organ systems should include the following:

• Cutaneous – Search for intertriginous rashes from skin-on-skin friction; also search for hirsutism in women, acanthosis nigricans, and skin tags, which are common with insulin resistance secondary to obesity;
• Cardiac and respiratory - Exclude cardiomegaly and respiratory insufficiency;
• Abdominal - Attempt to exclude tender hepatomegaly, which may suggest hepatic fatty infiltration or NASH, and distinguish the striae distensae from the pink and broad striae that suggest cortisol excess.

When examining the extremities, search for joint deformities (eg, coxa vara), evidence of osteoarthritis, and any pressure ulcerations. Localized and lipodystrophic fat distribution should also be identified, because of their common association with insulin resistance.