B5-013 CBCL: Obesity Flashcards
excess body weight compared to set standards
overweight
specific to having an abnormally high proportion of body fat
obesity
calculation of BMI
weight (kg)/height (m)^2
BMI of 30-34.9
what class of obesity
Class I
BMI of 35.0-39.9
what class of obesity
class II
BMI of 40+
what class of obesity
class III
fat stored in the […] is more harmful and associated with heart disease or diabetes
abdomen
apple shaped
fat under the skin that lines the entire body
subcutaneous fat
the fat in the abdomen below the intra-abdominal wall, most linked to metabolic and CV disease
omental/visceral fat
fat stored in the wrong places
ectopic fat
abnormal retention of lipids in a cell
steatosis
larger fat cells lead to increased
inflammation
gastric restrictive operations help people lose weight by
2
producing early satiety
decreasing appetite
in order for a gastric restrictive operation to be successful, the patient must also
restrict calorie intake
a reduction of […]% of initial body weight reduces the risk of diabetes in an at risk person
5-10%
inhibits gastric and pancreatic lipases
orlistat
which weight loss medication causes steatorrhea
orlistat
the rate of heritability of BMI ranges from
%
40-70%
less than […]% of individual variation in BMI and adiposity traits can be accounted for by over […] indentified loci
5%
300
insulin secretion in the fasting and fed states increases linearly with
BMI
main cell type found in human adipose tissue
white adipocytes
energy yielding TGs and cholesterol ester are stored in
intracellular lipid droplets
leptin, adiponectin, and adipokines are secreted by
white adipocytes
when are medications indicated to treat obesity?
- after 6 months of diet/exercise fail
- BMI greater than 30 OR
- greater than 27 with 2 comorbid conditions
when is bariatric surgery indicated?
- after 6 months of diet/exercise fail
- patients with BMI > 40 OR
- greater than 35 with 1 serious comorbid condition
elevated waist circumference increases the risk of
hyperlipidemia
hyperinsulinemia
atherogenesis
abdominal waist circumference
differentiate men and women
men >40
women > 35
waist circumference corresponds with […] fat
abdominal visceral
what type of fat is more metabollically active and releases FFA into the portal system?
visceral
successful common behaviors among weight loss maintainers
2
- frequent weighing
- 60+ min of exercise a day
AT browning can be achieved by
diet and exercise
the “fat but fit” hypothesis can be attributed to an increase in…
AT browning
brown adipocytes are differentiated primarily by the expression of
UCP1
phenomenon of fat stored in the wrong places is called
ectopic fat deposition
where is ectopic fat commonly distributed?
- heart
- liver
- skeletal muscle
- visceral adipose
BMI calculation
weight (kg)/m2
which surgical option provides the best chance of long term weight reduction with the least morbidity?
small pouch gastric bypass
which intervention has been shown most likely to produce a weight loss of 4-7 kg over a 12 month period?
high intensity intervention visits
12-26/year
orlistat is associated with a […]% reduction in body weight
3-4
more important for maintenance of weight loss rather than active weight loss
exercise
diet composition is generally less important than
total calories consumed
current dietary recommendations include a balanced diet with a negative caloric balance of
500-1000 kcal/d
what amount of weight loss/ week is optimal?
1-2 lbs per week
weight loss is typically regained following the cessation of […] therapy
pharmacologic
how many off the NCEP-ATP III criteria does a patient need to have to have metabolic syndrome?
3+
what should be done to evaluate for DM and impaired glucose tolerance?
fasting glucose and glycosylated hemoglobin
least invasive and safest weight loss surgery
gastric banding
why is gastric banding less commonly used in the US?
concerns about efficacy and high reoperation rates
predictors of the risk of developing metabolic and CVD
3
body composition
fat distribution
adipose tissue function
among equally overweight individuals, the amount of […] is predictive of increased risk of cardiometabolic disease
visceral fat
most common cause of obesity
simple exogenous
consuming more calories than are used, which are then stored as fat
exogenous obesity
adipocyte hypertrophy is due to
increased triglyceride storage
a moderate weight loss is likely to be associated with selective loss of
visceral fat
the majority of patients with obesity exhibit an impaired expandability of
subcutaneous adipose tissue
a sequence of pathogenic factors causing impaired adipose tissue function can be initiated by
impaired expandability of subcutaneous adipose tissue
BMI does not take into account
body fat distribution
or distinguish lean mass from fat mass
the association of obese patient with systolic heart failure or post percutaneous coronary intervention having a better prognosis is called
the obesity paradox
only exists as a function of BMI
while visceral fat is positively associated with CVD risk, subcutaeous fat accumulation is
modestly/negatively related to cardiometabolic and mortality risk
the obesity paradox does not exist when what indices are used over BMI?
2
waist circumference
waist hip ratio
indicates limitations of BMI as obesity index
well-established independent predictor of CVD risk and total mortality
fitness
having good fitness levels reduces mortality risk by
%
44%
in the presence of metabolic abnomalities, there is an increased risk of CVD in
normal or obese individuals
both normal and obese individuals
why is BMI problematic in predicting CVD risk?
does not account for central adiposity
strong predictor of the insulin resistant obese phenotype
macrophage infiltration into omental adipose tissue
could represent the mechanistic link between adipose tissue dysfunction and whole body insulin resistance
macrophage infiltration into adipose tissue
UCP1 is a marker of
browning
causes muscle cells to secrete a molecule than can induce a thermogenic gene program in cells
PGC1-a
what is the most changeable aspect of adipocyte cellularity?
size
weight loss from caloric restriction increases the […] and decreases […]
internal drive to eat
total daily energy expenditure
dieting lowers resting metabolic rate, which causes an overall reduction in
caloric expenditure
upregulates drive to eat
dieting upregulates the internal drive to eat, which can cause
regression
