Adult Obesity and Metabolic Syndrome Flashcards
how to calculate BMI
weight (kg) divided by height (square meters)
the same formula for BMI is used in
men and women
different ethnicities
3 groups of people that BMI may be inaccurate for
Overestimates risk:
-very muscular= athletes
Underestimates risk:
- sarcopenic obesity: lost large muscle mass but have clinically important obesity: elderly
- abdominal obesity without BMI criteria
BMI and
morbidity and mortality
- mortality increases with BMI >25
- significant rise BMI >30
- sharp rise at >35 and >40
BMI and age
lowest morbidity and mortality with BMI 25-29.9
BMI Ethnic Differences
- recommended lower waist circumference cutoff for east asian and south asian vs white
- weight related disease risk may be lower in AA compared to white
- currently use same standards for all ethnic groups
Waist circumference is a useful measurement in what patients?
- intermediate risk
- Overweight & Stage 1 obesity
- BMI 25-34.9
- if BMI is suspected to not be an accurate surrogate measurement of body fat
abdominal fat is associated with
-deposition internal organs
abdominal fat is an independent risk factor for what 5 outcomes even when BMI is not elevated?
CV disease T2DM HTN Hypercholesterolemia mortality
how to measure waist circumference
- horizontal plane around abdomen at level of superior border of iliac crest
- end of normal expiration
alternative: mark a point halfway between iliac crest and lower border of ribs
5 levels of BMI categories
Normal: 18.5-24.9 Over: 25-29.9 Stage 1: 30-34.9 Stage 2: 35-39.9 Stage 3: >40
severe obesity equivalent
Stage II 35-39 + major weight related condition (T2DM)
5 detailed examples of obesity related conditions
- T2DM/ Impaired Glucose Tolerance
- dislipidemia
- CAD
- Sleep Apnea
- Non-Alcoholic Fatty Liver Disease
T2DM and obesity
- 70% of adults with T2DM have BMI of at least 27
- RR of diabetes in women with BMI 23-23.9 is 3.6 times women with BMI less than 22
- risk of diabetes increase linearly with BMI
Dislipidemia and obesity
- elevated triglycerides, low HDL, high LDL
- Men: hypercholesterolemia increases progressively with BMI
- Women: increases until BMI 25-27
CAD and obesity
- increased risk with abdominal distribution
- begins to increase at Men 23, women 22
- remains independent risk factor even after correction for associated risk factors
sleep apnea info and consequences
-partial or complete airway obstruction during sleep: episodes of apnea
repeated episodes of hypoxemia –>
daytime somnolence, morning headache, HTN –>
pulmonary HTN, RHF
sleep apnea study
- 40% obese men and 3% obese women had sleep apnea that warranted intervention vs 0 controls
- 8% obese men and 5.5% obese women had sleep apnea that warranted sleep evaluation
Non-Alcoholic Fatty Liver Disease (NAFLD) and obesity
20% of obese patient may have
- hepatomegaly
- abnormal liver enzymes
- abnormal liver histology: macrovesicular steatosis, stetohepatitis, fibrosis, cirrhosis
moderate weight loss benefits
5-10% body weight
- glycemia
- blood pressure
- lipids
- fatty liver disease
- osteoarthritis symptoms
- severity of obstructive sleep apnea
larger weight loss benefit
reduced mortality from CV disease and cancer
Derm comorbidities and complications of obesity
acanthosis nigricans
cellulitis
striae
lymphedema
genitourinary comorbidities and complications of obesity
polycystic ovarian syndrome erectile dysfunction benign prostate hypertrophy menstrual abnormalities infertility pregnancy complications stress incontinence
metabolic comorbidities and complications of obesity
T2DM gout insulin resistance metabolic syndrome hyperuricemia vitamin d deficiency nephrolithiasis
cancer comorbidities and complications of obesity
postmenopausal breast colon prostate endometrial kidney gallbladder
metabolic syndrome
-specific body phenotype of abdominal obesity associated with group of metabolic disorders that are risk factors for cv disease
5 characteristics of metabolic syndrome
- abdominal obesity
- elevated blood pressure
- high triglycerides
- low HDL
- Impaired glucose tolerance/ T2DM
*metabolic syndrome with at least 3 criteria
metabolic syndrome criteria:
Abdominal obesity:
Men vs Women
waist circumference
men: >102 cm (> 40 inches)
women: >88cm (>35 in)
metabolic syndrome criteria:
triglycerides
> 150mg/dL or
drug treatment for abnormal lipids
metabolic syndrome criteria:
HDL:
Men vs Women
men:
metabolic syndrome criteria:
blood pressure:
> 130 systolic
85 diastolic
or anti HTN drug
metabolic syndrome criteria:
fasting glucose
> 110
or hypoglycemic drug
obesity focused history
- chronological body weight change
- previous weight loss attempts
- related medical complications
- medications causing gain
- smoking and social history
- family history
- dietary and physical patterns
- Goals
- Readiness and Motivation
- Screening for Depression
obesity focused physical exam
- height, weight, BMI
- waist circumference
- BP
- Pulse & O2 sat
- signs of pulm htn/ venous insufficiency (edema, hyper pigmentation)
- thyroid disease (goiter)
- signs of insulin resistance/ DM (acanthuses nigricans)
Labs in obesity focused exam
- thyroid stimulating hormone
- Diabetes screen: fasting blood glucose or Ha1c
- lipid planel
- liver associated enzymes
- other: sleep study
percentage of america adults >20 overweight and obese
obese: 35%
overweight: 33.5%
