Lecture 4.1 - Obesity & Metabolic Syndrome

Question 1

Weight bias ranks….

Answer 1

just below race, gender and age as the 4th most common form of discrimination in the US

Question 2

Explicit vs implicit bias

Answer 2

Explicit: bias within conscious awareness intentionally influences outward behavior

Implicit: unconscious attitudes & stereotypes affecting actions and decision, activated w/o awareness or control

Question 3

HCP weight bias impacts care

Answer 3

1. perceived med adherence is lower

2. HCP spend less time w/ pts in clinic

Question 4

Reasons obese pts avoid care

Answer 4

1. 36% uncomfortable with HCP
2. 46% unsolicited advice
3. 36% negative provider attitude

Question 5

Weight bias impacting coverage

Answer 5

1. Only few states include coverage of any anti-obesity medications
2. Many think its for cosmetic reasons

Question 6

Patients who experience stigma have….

Answer 6

2.4X more likely to have MDD, stress over body image

Consume more calories

More likely to avoid exercise and increased BP

Question 7

Weight stigma impacts quality of care…..

Answer 7

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

Question 8

Strategies to mitigate weight bias in HC environment

Answer 8

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

Question 9

Biomarkers used to estimate obesity?

Answer 9

BMI
Waist:circumference
Waist:hip ratio

Question 10

Obesity is….

Answer 10

excessive fat accumulation impair health

Presence and severity measured directly by imaging

Question 11

Underweight BMI

Answer 11

< 18.5

Question 12

Normal Range BMI

Answer 12

18.5-25

Question 13

Overweight BMI

Answer 13

25-30

Question 14

Obese BMI

Answer 14

30+

Question 15

Obese I BMI

Answer 15

30-35

Question 16

Obese II BMI

Answer 16

35-40

Question 17

Obese III BMI

Answer 17

> 40

Question 18

Waist Circumference

Answer 18

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

Question 19

Waist Circumference cut-offs

Answer 19

Men: > 94cm, 37in
Women: > 80cm, 31.5in

Question 20

Obesity Staging Systems

Answer 20

Edmonton Obesity Staging System (EOSS)

better predictor of mortality than BMI alone

Domains: Medical, Mental, Functional

Question 21

Key risk factor for cardiometbolic disease?

Answer 21

Obesity

Question 22

Metabolic Syndrome is…

Answer 22

complex of interrelated risk factors for CVD and T2D, including dysglycemia, raised blood pressure, elevated TGs, low HDL and obesity

Question 23

Clinical Diagnosis of Metabolic Syndrome

Answer 23

3 of the 5 following….

1. Elevated Waist circumference
2. Elevated TH
3. Reduced HDL-C
4. Elevated BP
5. Elevated fasting glucose

Question 24

Obesity-related complications can be improved with….

Answer 24

5-10% weight loss

Question 25

0-5% weight loss can improve....

Answer 25

Hypertension | Hyperglycemia

Question 26

5-10% weight loss can improve....

Answer 26

T2D prevention NAFLD = fatty liver PCOS = ovary disorder Dyslipidemia

Question 27

10-15% weight loss can improve...

Answer 27

``` CVD USI NASH OSA GERD Knee OA ```

Question 28

> 15% weight loss can improve....

Answer 28

TD2 remission CV mortality HFpEF

Question 29

Historic Perception of Body weight reduction....

Answer 29

Energy intake > Energy expenditure = gain weight | Energy intake < Energy expenditure = weight loss

Question 30

Appetite enhancing hormone

Answer 30

Ghrelin (orexigenic)

Question 31

Appetite suppressing hormones

Answer 31

CCK (Anorexigenic) Peptide YY GLP-1

Question 32

Stomach produces which hormone?

Answer 32

Ghrelin

Question 33

Intestine produce which hormone?

Answer 33

CCK GLP-1 PYY OXM

Question 34

Pancreas produces which hormone?

Answer 34

Amylin Insulin PP Glucagon

Question 35

Adipose tissues produce which hormone?

Answer 35

Leptin | Adiponectin

Question 36

Gherlin (Orexigenic) What it does

Answer 36

Activates NPY, AgRP = feel hungy | Block POMC, CART = inhibit feeling full

Question 37

Anorexigenic Hormones, what they do

Answer 37

Activate POMC,CART = feel full | Block NPY, AgRP = not hungry

Question 38

Homeostatic eating.....

Answer 38

depends on your Anorexigenic and Orexigenic Hormones

Question 39

Hedonic eating.....

Answer 39

Eating for pleasure

Question 40

Executive function.....

Answer 40

Deciding to eat

Question 41

Body weight is primarily regulated by....

Answer 41

hormonal and neuronal signaling along the gut-brain axis

Question 42

How does sleep play into obesity?

Answer 42

can effect appetite control

Question 43

Adaptations to weight loss promote weight regain by....

Answer 43

1. Subjective perceptions of appetite increase hunger and desire to eat 2. Hormone lvls, increase orexigenic signaling and decrease certain anorexigenic signals 3. Metabolism, decrease energy expenditure rates