Contributors/epidemiology

Question 1

% Americans with obesity

Answer 1

adults 42%, children 19%

Question 2

Diagnostic critera MetS

Men/women (canadian)

Answer 2

1. Abd Circumference > 88/102 cm
2. TG> 150 ( 1.7)
3. HDL < 50/40 ( 1.3/1.0)
4. Elevated fasting glucose 100 (5.6) or medicated
5. BP 130/85 or medicated

Question 3

Melanocortin 4 Receptor deficiency presentation 4

, genetic abnormality 3

Answer 3

Hyperphagia obesity early on
“big boned” ( increased BMD)
Accelerated linear growth
reduced sympathetic nervous activity

Auto dominant or recessive
Most common genetic defect causing obesity
Chromosome 18

Question 4

Prader-Willi Syndrome presentation 6, genetic facts 3

Answer 4

Hyperphagia
Short stature
Weak muscle tone
Insatiable appetite
Developmentally delayed ,intellectually impaired
Fair skin/light hair

Not inherited
chromosome 15
most common obesity syndrome

Question 5

AlBRIGHT’s Hereditary OsteoDystrophy presentation 5, genetic abnormality 2

Answer 5

Short
Dysmorphic extremities (ie/short 4/5 MCs)
dental hypoplasia
pseudohypoPTH
Intellectual disability

Auto dominant
defect in GNAS on chr 20

Question 6

Cohen Syndrome

little blind Leonard with a beer belly

Answer 6

Small head, intellectual and developmental disability
Joint hypermobility
Central obesity
Retinal dystrophy
Thick hair/eyebrows/eyelashes
Friendly

X-linked recessive, girls can carry
Mutation of Zinc finger gene

Question 7

Lipodystrophy is limitation in proliferation and differentiation of fat cells. Presentation, clinical/lab findings

Answer 7

Muscular appearance
Prominent peripheral veins from birth
Possible hyperphagia

Congential or acquierd (ie HIV related)

Reduced Leptin relative to body fat
Insulin resistance
High TGs
Hepatic steatosis- can have big belly

Question 8

Setmelanotide is a melanocortin-4 receptor agonist. Max dose 3 mg/day, can titrate down if needed.
What conditions is it indicated for?
skips leptin receptor and POMC system at level of arcuate nucleus, goes straight to Mc4r. Usually this is triggered by alphaMSH

Answer 8

6 years of age or older with obesity due to :

POMC deficiency
PCSK1 prohormone convertase mutation
Leptin receptor deficiency

Question 9

Lipidema is symetrical enlargement of legs due to increased subcutaneous fat deposits, may cause lymphedema. Treatments?
painful. Positive cuff sign

Answer 9

Nutrition
Physical activity
Psychological support
Manual lympatic drainage, compression hose.
Lymph sparing liposuction

Question 10

AACE definition of obesity

Answer 10

Obesity= BMI> 30 with no complications
Obesity Stage 1= BMI>25 with mild-moderate complications
Obesity Stage II= BMI > 25 with severe obesity related complications

Question 11

Abdominal obesity on S. Asians, Chinese, Japanese

Answer 11

men >90, women> 80 cm

Question 12

Environmental factors contributing to obesity 5

Answer 12

Stress
Sleep
Prenatal influences
Heavy metal pollutants
Chemical exposures-arsenic, cadmium, BPA, POPs

Question 13

What gene, on which chromosome, is associated with adiposity?

Answer 13

FTO gene ( FaT mass Obesity)
Chromosome 16

Question 14

How does PCOS cause obesity?

check

Answer 14

Increased levels of insulin cause energy to be converted to fat, and increase androgen production by the ovaries
Also estrogen converted to androgen

Question 15

How does insomnia and sleep disorder contribute to obesity?

Answer 15

Decreased sleep cause increase in ghrelin/cortisol and decreased leptin

Question 16

Impact of obesity and developing fetal brain? 3

Answer 16

Cognitive deficit, decreased IQ
Increased ADHD,
Increased autism spectrum disorder

Question 17

What is impact of BMI on mortality?

Answer 17

BMI >25-35 at age 40- survival reduced by 3 years

BMI 40-45 survival reduced by 8-10 years-comparable to smoking

Question 18

For each incremental increase of BMI by 1, there is an increased risk of Heart Failure development by…
increased risk of A. Fib by
increased risk of stroke by

Answer 18

HF
5% men
7% women
A.Fib
4%
Stroke Hemorrh. 6%, Ischemic 4%

Question 19

What percent of T2DM can be attributed to obesity?

Answer 19

> 80%

Question 20

Lipidema - What age, what % of women in women?

Answer 20

11% of women, starting in 30s

Question 21

What is Madelung’s Disease

Answer 21

Multiple symetric,disfiguring abnormal fat depositions in head,neck,trunk and nerve roots of upper and lower limbs

Question 22

What % OSA at >30BMI and >40 BMI

Answer 22

30%, 50-98%

BMI>35 is 40-70%

Question 23

Which patients should have polysomnography rather than portable monitor?

Answer 23

A.Fib
Heart failure
Refractory HTN
Pulmonary HTN

Question 24

Which anti-histamine has the lowest reported potential for weight gain?

Answer 24

Loratidine

Question 25

Cushing’s syndrome features

Answer 25

*proximal muscle weakness
wide>1cm purple striae
easy bruising
(supraclavicular fat pads
buffalo hump)