Lecture 3 Flashcards
What is obesity?
Excess of adipose tissue
How do we determine obesity?
BMI
Waist circumference
Visual inspection of patient
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
What are risk factors for obesity?
Female
Black, Native American, Mexican American
Lower income
How do we calculate BMI?
Pt weight(kg)/Pt height(m)^2
What factor can wrongly diagnose a BMI?
Amount of muscle mass
What is considered morbid obesity?
100 lbs over IBW(ideal body weight)
BMI >40
BMI >35 with 1+ obesity-related condition present
How do we classify class I obesity? class II? class III?
Class I: 30-34.9
Class II: 35-39.9
Class III: ≥ 40
What type of fat is more concerning?
Visceral fat is more concerning than subcutaneous fat
Truncoabdominal fat is more concerning than gluteofemoral fat distribution
What is the circumference and waist-hip ratio for obesity?
Men: >102cm(40in) ratio>1.0
Women: >88cm(35in) ratio>0.88
When should BMI be obtained and obesity be screened?
Every visit
Every routine physical(for obesity)
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
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
What psychiatric medications can contribute to obesity?
Antipsychotics (clozapine, olanzapine, risperidone)
Mood stabilizers (lithium, valproate, carbamazepine)
Antidepressants (TCAs, SSRIs)
What diabetic medications can contribute to obesity?
Insulins (especially intensive insulin therapy)
Oral (sulfonylureas, thiazolidinediones (TZDs))
What other medications can contribute to obesity?
Glucocorticoids
Beta-blockers
Hormonal agents
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
