Lecture 3 Flashcards by Billie Roberts

What is obesity?

Excess of adipose tissue

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How do we determine obesity?

BMI
Waist circumference
Visual inspection of patient

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How much of US adults are obese?
How much youth ages 2-19?

42%
19.7 of youth

40% audlts in WV and 26% children 10-17age

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What are risk factors for obesity?

Female
Black, Native American, Mexican American
Lower income

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How do we calculate BMI?

Pt weight(kg)/Pt height(m)^2

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What factor can wrongly diagnose a BMI?

Amount of muscle mass

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What is considered morbid obesity?

100 lbs over IBW(ideal body weight)
BMI >40
BMI >35 with 1+ obesity-related condition present

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How do we classify class I obesity? class II? class III?

Class I: 30-34.9
Class II: 35-39.9
Class III: ≥ 40

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What type of fat is more concerning?

Visceral fat is more concerning than subcutaneous fat
Truncoabdominal fat is more concerning than gluteofemoral fat distribution

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What is the circumference and waist-hip ratio for obesity?

Men: >102cm(40in) ratio>1.0
Women: >88cm(35in) ratio>0.88

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When should BMI be obtained and obesity be screened?

Every visit
Every routine physical(for obesity)

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What factors can contribute to obesity?

Genetics (40-70% of obesity case)
Behavioral
Medical
Psychological
Socioeconomics
Lifestyle
Diet

LIfestyle and diet are the most impactful factors.

Dont Let My Grandma Play Bad Songs

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What medical conditions are linked to obesity?

Hypothalamic obesity (Damage to hypothalamus → hyperphagia)
Cushing’s Syndrome
Hypothyroidism
Polycystic Ovarian Syndrome
Growth Hormone Deficiency
Altered Gut Flora
Psychiatric Disease

HPGAPHC

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What psychiatric medications can contribute to obesity?

Antipsychotics (clozapine, olanzapine, risperidone)
Mood stabilizers (lithium, valproate, carbamazepine)
Antidepressants (TCAs, SSRIs)

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What diabetic medications can contribute to obesity?

Insulins (especially intensive insulin therapy)
Oral (sulfonylureas, thiazolidinediones (TZDs))

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What other medications can contribute to obesity?

Glucocorticoids
Beta-blockers
Hormonal agents

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What factors in women can contribute to obesity?

Pregnancy, as well an postpartum retention
Oral contraceptives
Menopause

What factors in men can contribute to obesity?

Lifestyle
Testosterone decrease (more fat, less muscle)

How does ethnicity affect obesity?

Hispanic: increase likely to be obese
Blacks: more likely in women
Young hispanic and black women become obese younger compared to white women

How does socioeconomic status affect obesity?

Literacy/education: food choices and activity
Financial: affordability of food choices, gym
Environment: availability of food and activity

How does behavioral factors influence obesity?

Physical activity
Sleep deprivation(negative metabolic consequences)
Smoking cessation
Diet
Eating habits

How does sleep deprivation affect weight gain?

Decreases leptin(anorexigenic)
Increases gherlin(orexigenic)
Increased hunger and appetite

How does genetics play a role in obesity?

Twin studies: 60-90% heritability of obesity
Adoptee studies: BMI of children generally corresponds to biological parents

How do metabolic/homestatic factors influence obesity?

Adaption: losing 10-20% body weight slows BMR
Gut hormones: leptin, gherlin, orexin, GLP-1,np-Y
Gut flora: abnormal microbiome correlated with obesity

How many symptoms do you need to be considered to have a metabolic syndrome? How many obese patients meet the criteria?

At least 3 of the following... Central(abdominal) obesity Low HDL HTN Hyperglycemia Hypertriglyceridemia 3/5 obese patients meet it

What do people with metabolic syndrome have an increase risk of?

Heart disease Stroke Type II DM

What cardiovascular effects result from obesity?

HTN Coronary artery disease Heart failure Stroke

What endocrine effects result from obesity?

Type 2 Diabetes Mellitus Hyperlipidemia Metabolic Syndrome

What MSK effects result from obesity?

Degenerative joint disease Increased body pain Limited movement/function

What psychological effects result from obesity?

Psychosocial disability Lower quality of life Mood and anxiety disorders Social discrimination

What gastrointestinal effects result from obesity?

Cholecystitis/Cholelithiasis GERD/Reflux Fatty liver disease Gallbladder cancer Liver cancer Colon cancer

What pulmonary effects result from obesity/

Sleep apnea Dyspnea on exertion Pulmonary embolism

What OB/GYN effects result from obesity?

Pregnancy complications Breast cancer Endometrial cancer

What are other effects that results from obesity?

Increased surgical risk Multiple skin conditions Increased all-cause mortality (decreased with age)

What factors to we evaluate on obese patients?

Weight-related history Substance use Medical history Psych history Lifestyle Physical exam Labs

What are possible secondary causes of obesity?

Thyroid goiter Moon facies/buffalo hump Hirsutism

What labs do we order for obese patients?

Fasting glucose Lipid profile (HDL, LDL, VLDL, triglycerides) Thyroid function testing +/- HbA1c

When we evaluate for weight and health status what should we include?

BMI Abdominal obesity Obesity-related comorbidities Cardiovascular risk factors

What is considered a low risk assessment, what should we do?

BMI 25-29.9 No CVD or obesity-related comorbidities Intervention Counsel to avoid weight gain, diet advice, and physical activity recommendation

For those that are at a minimal risk what exception should we take caution with?

High weight circumference or weight gain of >10kg since 18yo

How should we intervene for those with moderate risk?

Increase physical activity Tools and strategies for dietary changes Behavioral intervention Pharmacotherapy

How should we intervene for those with high risk?

Specific diet and exercise plans Multicomponent behavioral intervention Pharmacotherapy Bariatric surgery