Epidemiology Flashcards
What are the classifications of BMI
Normal(18-24.9)
Overweight (25-29.9)
Obesity (30-39.9)
Severe/Extreme Obesity (>40) Kg/m2
What are the classes of Obesity?
Class I - 30-34.9 kg/m2
Class II - 35 - 39.9 kg/m2
Class III - >40 mg/kg/m2
Describe Stage 0 of Edmonton Obesity Staging System(EOSS)
No signs of obesity complications:
Metabolic factors(BP, BS, Lipids, Liver enyzmes etc) are normal.
No physical symptoms
No Mental/psychological symptoms
No functional limitations
Describe Stage 1 of Edmonton Obesity Staging System(EOSS)
Subclinical Obesity related chronic diseases:
Prehypertension
Prediabetes
Transaminitis
Occasional joint pain, dyspnea on moderate exertion
Mild anxiety/depression
Describe Stage 2 of Edmonton Obesity Staging System(EOSS)
Established Obesity related chronic disease:
HTN, DM2, PCOS, OA, OSA, GERD, Major Depression, Anxiety
Describe Stage 3 of Edmonton Obesity Staging System(EOSS)
End organ damage from obesity related chronic disease:
MI, CHF, Diabetic retinopathy, Diabetic nephropathy, diabetic neuropathy, incapacitating OA
Describe Stage 4 of Edmonton Obesity Staging System(EOSS)
Severe(potentially end-stage) disability from obesity-related chronic diseases:
Advanced heart failure, cirrhosis, Advanced kidney failure, profound physical impairments(bedridden), regarding assistance with ADLs.
Severe mental health disorders that result in major impairments in functioning or a need for long term care
What is normal weight percentile in Peds?
5-84.9 percentile
What is considered overweight in Peds?
85-94.9 percentile
What is considered obesity in Peds?
> =95 percentile(assoc with > CM risk)
What Peds percentile is associated with >cardiometabolic risk?
> =95
What is Class I, II, III in pediatric obesity
Class I is >=95-<120 percentile of the 95%
Class II is >=120-140percentile of the 95 %
Class III is >=140 percentile of the 95 percentile
What does the EOSS classification take into account of?
Describes health based on Medical, mental and functional impact on a patient with obesity.
Which class of obesity for pediatric population is severe and puts them at greater risk of Cardiometabolic disease>
Class II
(>120% of 95th percentile or BMI >= 35, whichever is lower) % Class III (>=140% of 95th percentile or BMI >=40, whichever is lower)
What is issue with BMI?
Based on morbidity/mortality on White people so may not represent all races
Doesn’t take into acct muscle mass
What did the indian consensus group define as overweight and obesity in regards to BMI?
> 23 - 25 Overweight
25 Obesity
What BMI risks puts a Chinese person at risk for Diabetes?
25
What BMI risks puts a black person at risk for Diabetes?
26
What BMI risks puts a White person at risk for Diabetes?
30
In 2015, the ADA rec a Diabetes screen at 23 for what ethinic group?
South Asians
Who has a higher obesity rate from age 20-60? Men or Women?
Men(except Black Women who have higher risk than Black Men)
At what age do Men have less risk of Obesity compared to Women?
60
What age group in both sexes had higher rates of obesity?
Ages 40-59
Which age group had lowest rate of obesity?
Ages 20-39
What percent of adults in US has a BMI >30?
42%
What percent of adults in US has a BMI >25?
73%
What is the expected rate of Obesity in US adults by 2030?
50%
What is the rate of Obesity of Asians in the US?
16%
What is the rate of Obesity of nonhispanic white adults?
41%
What is the rate of Obesity in the US of black people?
49.9%
What states have lowest rate of Obesity?
Hawaii and Washington D.C.
What states have the highest rates of Obesity?
Midwest and Southeast
What is the rate of Obesity in the US of hispanic people?
46%
How does income factor in obesity rates in Men and Women?
Higher rates in lower income women
Higher rates in middle income men
Which pediatric populations have highest rates of obesity?
Black girls and Hispanic boys
How does income factor in obesity rates in pediatric population?
Highest income have lowest obesity rates
How does education affect Obesity rates in Men and Women?
Highest in Men with some college
Lowest in Women with college education
What was the obesity rate in children ages 6-11 between 1963-1975 and what was it in 2018?
5%, 2018 - 19.3% and has been stable in last 5 years.
What is the rate of Severe Obesity in children?
6.1%
What percent loss of muscle mass can occur between ages 20-70 if nothing done to maintain it?
40%
What condition has a bidirectional link to Obesity?
Depression(Depression can cause Obesity and vice versa)
What does Ghrelin stand for?
Growth Hormone Releasing Inducing Peptide
Where is Ghrelin secreted from?
Fundus and body of stomach
Proximal Small Intestine
When is Ghrelin secreted?
When stomach is empty. Will surge and peak prior to meals
Do levels of Ghrelin increase or decrease with fasting?
Increase
What does Ghrelin do?
Increases appetite and decreases energy expenditure
When does Ghrelin drop?
When stomach is full/stretched.(However, less of a drop in obese patients)
What is the prevalence of Adult Obesity in 2017-2018?
42%
What are some facts across lifespan in childhood obesity rates?
Rates stable in last 5 years
Prevalence increases as we get older
Overall trends worsened in last 50 years
What are some determinants of obesity?
Genetics/Epigenetics, Behavioral, SDOH, Cultural, medications/iatrogenic, Fetal environment
What are 2 questions to ask to screen for food insecurities?
In last 12 weeks, have
1. you worried that food would run out before having money to buy more
2. food ran out before we had money to buy more
(Positive if answers sometimes true or often true to either question)
How do SDOH factors affect obesity rates?
Disproportionately affects those already at risk
Which SDOH contributes to depression?
Food insecurity
What are some factors that indicate housing instability?
Frequent moving
Sleeping in places not meant for sleep
Lack of nighttime residence
Living with relatives or in overcrowded areas
Children will lack inconsistent health coverage
What is housing instability often associated with?
Food insecurity
Who does housing instability disproportionately affect?
Households with children
Blacks/hispanics
Previously incarcerated
How do ACE’s affect health?
Dose dependant. The more ACE’s, the more decline in health
What are some cultural considerations for risk of Obesity?
Early feeding for babies
Mode of feeding for babies
Caregiving feeding practices
Cultural beliefs of beauty and health
Cultural traditions with food
What are main categories of medical determinants of obesity?
Endocrine
Iatrogenic
Neuropsych
What are endocrine conditions that can influence obesity?
Thyroid
Adrenal
Diabetes
Female hormonal imbalance
What are iatrogenic medical causes of obesity?
Weight promoting medications
Neurostructural damage
What are neuropsych causes of obesity?
Mood d/o
Sleep d/o
Eating d/o
When did obesity rates increase suddenly?
Stable from 1960-1980 but then starts to rise
What are genetic determinants of obesity?
Genetic syndromes
Genetic variants
What are genetic syndromes that can affect obesity?
Prader Willi
Bardt Biedel
Fragile X
Down Syndrome
What are genetic variants that can affect obesity?
MC4R deficiency
Leptin deficiency
POMC deficiency
What is the most common monogenic genetic variant that contributes to obesity?
MC4R(Monogenic)
What are 2 general characteristics of Genetic variants of obesity?
Hyperphagia
Early onset Obesity
What is epigenetics?
How aging, behaviors and environment affect gene expression.
It is variable and reversible
What are some epigenetic changes that influence obesity?
Care giving feeding practices
ACEs
Early Obesity
Food insecurity
