Epidemiology

Question 1

BMI def & cutoffs

Answer 1

-kg/m^2
-estimates excess body adiposity
-higher BMI = higher cardiometabolic risk

> =18.5- normal
=25- overweight
=30- obesity
=40- extreme obesity

Question 2

Adult Obesity Classes

Answer 2

-severity based on BMI

I- 30
II- 35
III- 40

Question 3

Edmonton Staging (same for adults & peds)

Answer 3

-based on HEALTH impacts

0: none
1: mild symptoms/impairments
2: moderate
3: end-organ damage, significant psych or other impairments
4: end-stage disease, severe limitations/disability

Question 4

Pediatrics BMI %ile cutoffs

Answer 4

-Used in 2-20yo

> =5%ile- normal
=85%ile overweight
=95%ile obesity (higher cardiometabolic risk)

Question 5

Pediatric Obesity Classes

Answer 5

I: 95% of 95%ile BMI
II: 120%
III: 140%

Question 6

Ethnic-specific BMI cutoffs for obesity

Answer 6

*Based on 10%(?) incidence of DM

24- South Asian
25- Chinese
26- Black
30- White

Question 7

Prevalence of Obesity (US adults with BMI >= 30)
-now
-2040 estimate

(2017-2018 NHANES survey)

Answer 7

-42.4% now
-estimated >50% US pop by 2030

Question 8

Prevalence by Age & Gender

Answer 8

-highest in middle age 40-59 yo
-men > women across all age groups
-women 40-59 yo same as 60+ (BMI 43.3)

Question 9

Increasing Trend in Obesity
-1999 vs 2017 NHNES

Answer 9

-Obesity: 30.5 up to 42.4%

-Severe obesity (BMI >=40)
4.7% up to 9.2%, almost DOUBLED

Question 10

Demographic Distribution of BMI:
-Asian
-White
-All Hispanic
-Black

(BRFSS data)

Answer 10

Asian < White < All Hispanic < Black
*disproportionally affects minority communities who also have compounding risk factors for more severe disease

-Asian: most states <20%** (except SC 20-25, AK 25-30)
-White: central/east 30-40%, west 20-30%
-All Hispanic: most states >35% (MI & IN >40)
-Black: central/east >40%, rest 30-40

** BUT asians have comorbidities at lower BMI

Question 11

Highest prevalence group

Answer 11

Black women/girls > men/boys

Question 12

Obesity Prevalance by Income
-Women
-Men

(NHANES)

Answer 12

-Women: obesity lowest w HIGHEST $

-Men: obesity lowest at LOWEST income (low income < high > middle income), middle income highest

Question 13

Obesity Prevalance by Education
-Women
-Men

(NHANES)

Answer 13

-Women: obesity lowest w HIGHEST ed

-Men: obesity lowest at HIGHEST ed (coll < HS < some coll), some college income highest

Question 14

Obesity Prevalence in kids 2-19yo
-Obesity
-Severe Obesity

Answer 14

-Obesity 19.3%
-Severe Obesity 6.1%
-increases with age
-worse over past 50y, stable x5 yrs

Question 15

Most prevalent age group overall

Answer 15

Middle age 40-59

Question 16

Food insecurity
-spectrum
-2Q screen

Answer 16

-spectrum: very low food security to high
-2Q screen:
Last 12mo, often/sometimes/never
1. Worried food run out before $ to buy more
2. Food didn’t last, no $ to buy more

+ screen if either true

Question 17

Food Insecurity Behaviors

Answer 17

-66% choose btw food and medical care
-79% buy inexpensive but unhealthy food
-40% water down food/drinks
-associated w depression
-many others

Question 18

When did obesity prevalence start increasing?

Answer 18

-1960’s-80’s little change, 10% prevalence
-Until last 3 decades, steady increase

Question 19

Genetic Syndromes (4)

Answer 19

-Down’s
-Prader-Willi
-Bardet-Biedl
-Fragile X

Question 20

Genetic variants (3)

Answer 20

-MC4R deficiency (most common)
-POMC def
-Leptin def

** ALL deficiencies(?)
** ALL w hyperphagia & early onset severe obesity

Question 21

Epigenetic changes asssociated wtih… (4)
*most common mechanism

Answer 21

-ACE’s
-Food insecurity
-Caregiver feeding practices
-Early onset severe obesity

*most commonly thought due to DNA methylation

Question 22

Genes vs. Enviroment?

Answer 22

Genes & epigenetics predispose individuals to enviromnental susceptibility for obesity