Lecture 3: Obesity Part 1 Flashcards
What are the two ways someone’s excess adipose tissue is estimated?
BMI
Waist circumference
How prevalent is obesity in the US?
42% of all adults.
What are the main risk factors for obesity?
Female
Black, Native american, or Mexican american
Lower income
How is BMI calculated?
Wt in kg divided by pt height (m^2)
In what situations might someone overestimate or underestimate BMI?
In pts with high muscle mass, it may be OVERestimated.
In pts with low muscle mass, it may be UNDERestimated.
What BMI does overweight begin at? Obese?
25-29.9 kg/m2 is overweight.
30+ is obese.
What are the 3 classes of obesity?
Class 1 is 30-34.9
Class 2 is 35-39.9
Class 3 is 40+
What qualifies as morbid obesity?
100+ lbs over IBW
BMI >=40 (Class 3 obese)
BMI >= 35 + at least 1 obesity-related condition
What fat is more concerning? What fat distribution is most concerning?
Visceral fat is more concerning than subcutaneous fat.
Truncoabdominal fat distribution is more concerning that gluteofemoral fat distribution.
What waist circumference is obese for men? Women?
Men is > 40in/102cm
Women is > 35in/88cm
What waist-hip ratios are obese for men? Women?
Men: > 1.0
Women > 0.88
What fruit shape is more ideal between an apple and a pear for body shape?
Pear!
How often should we screen for obesity and BMI?
EVERY ROUTINE PHYSICAL!
What are the most impactful etiology factors in obesity?
Lifestyle and diet.
How much of a role does genetics play in obesity cases?
40-70%
What conditions are linked to the onset of obesity?
Hypothalamic obesity (Damage to thalamus causes hyperphagia)
Cushing’s
Hypothyroidism
Polycystic ovarian syndrome
Growth Hormone Deficiency
Altered Gut Flora
Psychiatric disease
What medication classes are linked to obesity?
Antipsychotics
Mood stabilizers
Antidepressants
Insulins
Oral diabetic meds
Glucocorticoids
Betablockers
Hormonal agents
What are the unmodifiable risk factors for obesity?
Genetics
Intrauterine factors
Ethnicity
What factors in adulthood affect the onset of obesity?
Women:
Pregnancy
OCPs
Menopause
Men:
Lifestyle becomes more sedentary
Testosterone declines
In terms of ethnicity, how does obesity prevalence vary in adulhood?
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
What 3 things in socioeconomic status affect the onset of adulthood obesity?
Literacy/education
Financial
Environment
What 3 things in our behavior affect the onset of adulthood obesity?
Physical activity (We get more sedentary)
Sleep deprivation (decreased leptin, increase ghrelin)
Smoking cessation (you gain 4-5kg of weight after quitting)
What 2 things about our eating habits affect the onset of adulthood obesity?
Diet (diets high in fat and sugars associated with obesity)
Eating habits (overeating, binge eating, night eating)
How do we know genetics plays a role in obesity?
Twins 60-90% of the time become obese together.
Adoptees BMI corresponded more with their biological parents than their adoptive family
What 3 metabolic/homeostatic factors play a role in adulthood obesity?
Adaptation (lowers BMR)
Gut hormones
Gut flora
What is metabolic syndrome?
Increases the risk of:
Heart disease
Stroke
T2DM
What is the criteria for metabolic syndrome?
At least 3 of the following:
Central/abdominal obesity
Low HDL
HTN
Hyperglycemia
Hypertriglyceridemia
Does overweight BMI correspond with all-cause mortality increases?
No!
It only corresponds with obese BMI.
What are some PE findings to be wary of that may suggest obesity?
BMI
Waist circumference
BP
Thyroid goiters
Moon facies/buffalo hump
Hirsutism (male facial hair pattern on a female)
What kind of labs help us evaluate obesity?
Fasting glucose
Lipid panel
Thyroid panel
Hba1c
When you are performing a risk assessment for obesity, what 4 factors must you always include?
BMI
Abdominal obesity
Obesity-related cormorbidities
CVD risk factors
What qualifies as low risk obesity and what is the suggested intervention?
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.
What qualifies as minimal risk obesity and what is the suggested intervention?
25-29.9
Cannot have CVD or any comorbidities
Intervention: counseling on avoiding wt gain, diet advice, physical activity recommendations.
What qualifies as moderate risk obesity and what is the suggested intervention?
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
What qualifies as high risk obesity and what is the suggested intervention?
35+
Intervention: specific diet and exercise plans.
Multicomponent behavioral intervention
Pharmacotherapy
Bariatric surgery