Lecture 3: Obesity Part 1

Question 1

What are the two ways someone’s excess adipose tissue is estimated?

Answer 1

BMI
Waist circumference

Question 2

How prevalent is obesity in the US?

Answer 2

42% of all adults.

Question 3

What are the main risk factors for obesity?

Answer 3

Female
Black, Native american, or Mexican american
Lower income

Question 4

How is BMI calculated?

Answer 4

Wt in kg divided by pt height (m^2)

Question 5

In what situations might someone overestimate or underestimate BMI?

Answer 5

In pts with high muscle mass, it may be OVERestimated.

In pts with low muscle mass, it may be UNDERestimated.

Question 6

What BMI does overweight begin at? Obese?

Answer 6

25-29.9 kg/m2 is overweight.
30+ is obese.

Question 7

What are the 3 classes of obesity?

Answer 7

Class 1 is 30-34.9
Class 2 is 35-39.9
Class 3 is 40+

Question 8

What qualifies as morbid obesity?

Answer 8

100+ lbs over IBW
BMI >=40 (Class 3 obese)
BMI >= 35 + at least 1 obesity-related condition

Question 9

What fat is more concerning? What fat distribution is most concerning?

Answer 9

Visceral fat is more concerning than subcutaneous fat.

Truncoabdominal fat distribution is more concerning that gluteofemoral fat distribution.

Question 10

What waist circumference is obese for men? Women?

Answer 10

Men is > 40in/102cm
Women is > 35in/88cm

Question 11

What waist-hip ratios are obese for men? Women?

Answer 11

Men: > 1.0
Women > 0.88

Question 12

What fruit shape is more ideal between an apple and a pear for body shape?

Answer 12

Pear!

Question 13

How often should we screen for obesity and BMI?

Answer 13

EVERY ROUTINE PHYSICAL!

Question 14

What are the most impactful etiology factors in obesity?

Answer 14

Lifestyle and diet.

Question 15

How much of a role does genetics play in obesity cases?

Answer 15

40-70%

Question 16

What conditions are linked to the onset of obesity?

Answer 16

Hypothalamic obesity (Damage to thalamus causes hyperphagia)

Cushing’s
Hypothyroidism
Polycystic ovarian syndrome
Growth Hormone Deficiency
Altered Gut Flora
Psychiatric disease

Question 17

What medication classes are linked to obesity?

Answer 17

Antipsychotics
Mood stabilizers
Antidepressants
Insulins
Oral diabetic meds
Glucocorticoids
Betablockers
Hormonal agents

Question 18

What are the unmodifiable risk factors for obesity?

Answer 18

Genetics
Intrauterine factors
Ethnicity

Question 19

What factors in adulthood affect the onset of obesity?

Answer 19

Women:
Pregnancy
OCPs
Menopause

Men:
Lifestyle becomes more sedentary
Testosterone declines

Question 20

In terms of ethnicity, how does obesity prevalence vary in adulhood?

Answer 20

Hispanics have an increased propensity.

Blacks have increased obesity in females, less obesity in males.

Hispanic and black women have a younger age of obesity onset compared to white women

Question 21

What 3 things in socioeconomic status affect the onset of adulthood obesity?

Answer 21

Literacy/education
Financial
Environment

Question 22

What 3 things in our behavior affect the onset of adulthood obesity?

Answer 22

Physical activity (We get more sedentary)
Sleep deprivation (decreased leptin, increase ghrelin)
Smoking cessation (you gain 4-5kg of weight after quitting)

Question 23

What 2 things about our eating habits affect the onset of adulthood obesity?

Answer 23

Diet (diets high in fat and sugars associated with obesity)

Eating habits (overeating, binge eating, night eating)

Question 24

How do we know genetics plays a role in obesity?

Answer 24

Twins 60-90% of the time become obese together.

Adoptees BMI corresponded more with their biological parents than their adoptive family

Question 25

What 3 metabolic/homeostatic factors play a role in adulthood obesity?

Answer 25

Adaptation (lowers BMR) Gut hormones Gut flora

Question 26

What is metabolic syndrome?

Answer 26

Increases the risk of: Heart disease Stroke T2DM

Question 27

What is the criteria for metabolic syndrome?

Answer 27

At least 3 of the following: Central/abdominal obesity Low HDL HTN Hyperglycemia Hypertriglyceridemia

Question 28

Does overweight BMI correspond with all-cause mortality increases?

Answer 28

No! It only corresponds with obese BMI.

Question 29

What are some PE findings to be wary of that may suggest obesity?

Answer 29

BMI Waist circumference BP Thyroid goiters Moon facies/buffalo hump Hirsutism (male facial hair pattern on a female)

Question 30

What kind of labs help us evaluate obesity?

Answer 30

Fasting glucose Lipid panel Thyroid panel Hba1c

Question 31

When you are performing a risk assessment for obesity, what 4 factors must you always include?

Answer 31

BMI Abdominal obesity Obesity-related cormorbidities CVD risk factors

Question 32

What qualifies as low risk obesity and what is the suggested intervention?

Answer 32

BMI of 20-25. Exception: If they have a high weight cirucmference or have been gaining at least 10kg per year since age 18. Intervention: nothing specific recommended.

Question 33

What qualifies as minimal risk obesity and what is the suggested intervention?

Answer 33

25-29.9 Cannot have CVD or any comorbidities Intervention: counseling on avoiding wt gain, diet advice, physical activity recommendations.

Question 34

What qualifies as moderate risk obesity and what is the suggested intervention?

Answer 34

25.9 + CVD risk factor 30-34.9 Intervention: specific tools and strategies for dietary changes. Increased physical activity from baseline (even if you are already active) Behavioral intervention Pharmacotherapy

Question 35

What qualifies as high risk obesity and what is the suggested intervention?

Answer 35

35+ Intervention: specific diet and exercise plans. Multicomponent behavioral intervention Pharmacotherapy Bariatric surgery