Adult Obesity & Metabolic Syndrome

Question 1

BMI definition of obesity

Answer 1

• Normal → 18.5 - 25 kg/m2
• Overweight → 25 - 29.9 kg/m2
• Obese → ≥ 30 kg/m2
• Morbid Obesity → ≥ 40 kg/m2; in US qualifies for bariatric surgery

Question 2

BMI formula

Answer 2

Formula = wt (kg)/ height² (m²)

Question 3

Waist circumference definition of obesity

Answer 3

• High medical risk is defined as a waist circumference in
  
  • Men > 40 inches / 102 cm
  • Women > 35 inches / 88 cm
• Measure waist at top of iliac crests

Question 4

Possible causes of obesity

Answer 4

• Bottom Line: Calories in > Calories out.
  
  • Major conveniences ==> decreased physical activity
  • Food is better tasting, more dangerous, bigger portions, widely available
• Genetic interactions with environment
  
  • Pima Indians in Mexico vs. AZ.
    
    • Same Genes but way higher DM in AZ
• Psychiatric disease
• Sedentary lifestyle and barriers to activity
• Medications that cause weight gain

Question 5

Health problems associated w/obseity

Answer 5

• Obstructive sleep apnea → 40% prev
• Type 2 diabetes
• Hypertension
• Hyperlipidemia
• Cardiovascular disease
• Non-alcoholic fatty liver disease
• Erectile dysfunction and infertility
• Certain forms of cancer (e.g., breast, colon)
• Depression
• Low back pain
• Osteoarthritis

Question 6

General definition of metabolic syndrome

Answer 6

• specific body phenotype of abdominal obesity
• associated with a group of metabolic disorders that are risk factors for cardiovascular disease, including coronary artery disease, stroke, and congestive heart failure.

Question 7

Criteria for Metabolic syndrome in men

Answer 7

• Abd obesity = > 40 in / 102 cm
• Triglycerides = ≥ 150 mg/dL OR on ↑ TG drug
• HDL = < 40 mg/dL OR on drug for ↓ HDL
• BP = ≥ 130 systolic OR ≥ 85 diastolic OR on Anti HT drug
• Fasting glucose = ≥ 100 mg/dL OR on hypoglycemic drug

Question 8

Criteria for Metabolic syndrome in women

Answer 8

• Abd obesity = > 35 in / 88 cm
• Triglycerides = ≥ 150 mg/dL or on ↑ TG drug
• HDL = < 50 mg/dL or on drug for ↓ HDL
• BP = ≥ 130 systolic OR ≥ 85 diastolic OR on Anti HT drug
• Fasting glucose = ≥ 100 mg/dL OR on hypoglycemic drug

Question 9

Medical History taking in the obese patient

Answer 9

• Chronological history of body weight changes
• Previous weight loss attempts
• Obesity related medical complic.
• Medications that cause weight gain
• Current diet and physical activity patterns
• Goals of treatment
• Readiness and motivation for treatment including screening for depression
• Goals for weight loss

Question 10

Social/Family hx taking in the obese patient

Answer 10

• Social Hx: Smoking and other
• Family Hx: obesity and co-morbidities

Question 11

Physical exam in the obese patient

Answer 11

• Height, weight, BMI, Waist circum.
• BP with appropriate cuff size
• Skin changes → acanthosis?
• Signs of pulmonary HT/venous insufficiency → edema?
• Signs of thyroid disease → goiter?
• Signs of dyslipidemia
• Signs of diabetes

Question 12

Lab/diagnostic tests in the obese patient

Answer 12

• Thyroid stimulating hormone (TSH)
• Fasting blood glucose and Hb A1c
• Fasting lipid panel
• Liver panel
• Remainder of tests determined by individual assessment and clinical suspicion (e.g., sleep study)