Lecture 4.1 - Obesity & Metabolic Syndrome Flashcards
Weight bias ranks….
just below race, gender and age as the 4th most common form of discrimination in the US
Explicit vs implicit bias
Explicit: bias within conscious awareness intentionally influences outward behavior
Implicit: unconscious attitudes & stereotypes affecting actions and decision, activated w/o awareness or control
HCP weight bias impacts care
- perceived med adherence is lower
2. HCP spend less time w/ pts in clinic
Reasons obese pts avoid care
- 36% uncomfortable with HCP
- 46% unsolicited advice
- 36% negative provider attitude
Weight bias impacting coverage
- Only few states include coverage of any anti-obesity medications
- Many think its for cosmetic reasons
Patients who experience stigma have….
2.4X more likely to have MDD, stress over body image
Consume more calories
More likely to avoid exercise and increased BP
Weight stigma impacts quality of care…..
Worse pt outcomes when HCPs provide less Patient centered care
20% of pts achieved > 10% weight loss if they did not perceive judgement by their HCP vs if they did
Strategies to mitigate weight bias in HC environment
Avoid stigmatizing words…fat, obese, unhealthy, etc
Implement sensitivity training & check materials for language/imagery
Increase obesity education in med schools
Include topics such as AOM, obesity care guidance on exams
Biomarkers used to estimate obesity?
BMI
Waist:circumference
Waist:hip ratio
Obesity is….
excessive fat accumulation impair health
Presence and severity measured directly by imaging
Underweight BMI
< 18.5
Normal Range BMI
18.5-25
Overweight BMI
25-30
Obese BMI
30+
Obese I BMI
30-35
Obese II BMI
35-40
Obese III BMI
> 40
Waist Circumference
Measure central obesity and predicts risk incidence of BMI, so measure both BMI + Waist circumference is recommended
It varies with ethnicity & BMI doesn’t always reflect obesity-related risk to health
Waist Circumference cut-offs
Men: > 94cm, 37in
Women: > 80cm, 31.5in
Obesity Staging Systems
Edmonton Obesity Staging System (EOSS)
better predictor of mortality than BMI alone
Domains: Medical, Mental, Functional
Key risk factor for cardiometbolic disease?
Obesity
Metabolic Syndrome is…
complex of interrelated risk factors for CVD and T2D, including dysglycemia, raised blood pressure, elevated TGs, low HDL and obesity
Clinical Diagnosis of Metabolic Syndrome
3 of the 5 following….
- Elevated Waist circumference
- Elevated TH
- Reduced HDL-C
- Elevated BP
- Elevated fasting glucose
Obesity-related complications can be improved with….
5-10% weight loss
0-5% weight loss can improve….
Hypertension
Hyperglycemia
5-10% weight loss can improve….
T2D prevention
NAFLD = fatty liver
PCOS = ovary disorder
Dyslipidemia
10-15% weight loss can improve…
CVD USI NASH OSA GERD Knee OA
> 15% weight loss can improve….
TD2 remission
CV mortality
HFpEF
Historic Perception of Body weight reduction….
Energy intake > Energy expenditure = gain weight
Energy intake < Energy expenditure = weight loss
Appetite enhancing hormone
Ghrelin (orexigenic)
Appetite suppressing hormones
CCK (Anorexigenic)
Peptide YY
GLP-1
Stomach produces which hormone?
Ghrelin
Intestine produce which hormone?
CCK
GLP-1
PYY
OXM
Pancreas produces which hormone?
Amylin
Insulin
PP
Glucagon
Adipose tissues produce which hormone?
Leptin
Adiponectin
Gherlin (Orexigenic) What it does
Activates NPY, AgRP = feel hungy
Block POMC, CART = inhibit feeling full
Anorexigenic Hormones, what they do
Activate POMC,CART = feel full
Block NPY, AgRP = not hungry
Homeostatic eating…..
depends on your Anorexigenic and Orexigenic Hormones
Hedonic eating…..
Eating for pleasure
Executive function…..
Deciding to eat
Body weight is primarily regulated by….
hormonal and neuronal signaling along the gut-brain axis
How does sleep play into obesity?
can effect appetite control
Adaptations to weight loss promote weight regain by….
- Subjective perceptions of appetite increase hunger and desire to eat
- Hormone lvls, increase orexigenic signaling and decrease certain anorexigenic signals
- Metabolism, decrease energy expenditure rates
