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House Clinical Pathology > Obesity > Flashcards

Obesity Flashcards

1
Q

Excess energy is stored in _____ cells residing within widely distributed _________. This energy stored as ____ are broken down to ______ for use at other sites.

A

Fat

adipose tissue depots

TGs; free fatty acids

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2
Q

This physiologic event orchestrated through neuro - endocrine system permits humans to survive starvation for as long as _________

A

several months.

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3
Q

Obesity is a state of _______________.

A

excess adipose tissue mass

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4
Q

Obesity

A medical condition in which excess ______ has accumulated to the extent that it may cause adverse effect on health.

A

body fat

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5
Q

Obesity is directly equivalent to increased body weight.

T/F

A

F

Not necessarily equivalent to increased body weight.

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6
Q

Body Mass Index ( ______ index) metric

A

Quetelet

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7
Q

Body Mass Index metric

_________________

A

Weight(Kg)/Height(m)2 Kg/m2

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8
Q

Weight is taken (with or without ?) ______, height (with or without?) ______.

A

Without ; Clothes

Without; shoes

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9
Q

BMI Classification
Underweight
Normal weight
Overweight(pre-obesity) Class I obesity
Class II obesity
Class III obesity

A

Less than 18.5
18.5-24.9
25-29.9
30-34.9
35-39.9
Greater than or equal to 40

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10
Q

BMI

U.S Customary(imperial)

BMI= ______

A

Ib*703/In2

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11
Q

The Surgical literature breaks down class III obesity.
Any
BMI _______ is ____ obesity
BMI _______ is ____ obesity
BMI _______ is _____ obese.

A

35-39.9; severe

40-44.9; morbid

45-50; super

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12
Q

Asian population develop negative health consequences at a (higher or lower?) BMI than Caucasians.

A

Lower

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13
Q

BMI Prime

It is the ratio of the ___________ (currently defined as ___)
Individuals with BMI prime <____are underweight, btw ____ and ____ have optimal weight. Those at ____ or greater are overweight
With BMI prime, at a glance individuals can quantify what percentage they deviate from their upper mass(weight) limit
A person with BMI 34 has BMI prime of 34/25=1.36 and is _____ over his _____

A

actual BMI to upper limit BMI

25

0.74

0.74; 0.99

1.00

36%; upper mass limit

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14
Q

BMI

(Easy or difficult ?) to measure
Useful in _______classification
____ adjustments necessary for racial variation
Useful in surveys

A

Easy

simple anthropometric

No

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15
Q

BMI

Inaccurate in assessment of people with _____________

Does not take _________ into account

Inappropriate in patients with ____ and ____

Underestimation of adiposity in those with ______________

A

heavy muscular mass e.g athletes, weight lifters etc

regional fat distribution

oedema and dehydration

less lean body mass (elderly)

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16
Q

Body fat percentage

An estimate of the fraction of the total body mass that is _____(AKA ___ mass) as opposed to ___ body mass(muscle, bone, organ tissue, blood etc)

A

adipose tissue; fat

lean

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17
Q

Which is more accurate

Body fat percentage or BMI

With reason

A

Body fat percentage is more accurate as a measure of excess body weight than BMI.

BMI lumps up all masses into one figure

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18
Q

Body fat percentage is Used to monitor progress during ______ programme and to assess progress during ______

A

weight loss

body building

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19
Q

The body fat percentage can be estimated by using the ______ equation

A

Deurenberg

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20
Q

Other measures of assessing obesity

Waist circumference is Of great medical importance, indicative of _______

_____ and _____

____ to ___ ratio(___)

A

central obesity

CT scan and MRI

Waist to hip ;WHR

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21
Q

Waist circumference

Male >_____cm
Female >____cm

A

102

88

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22
Q

WHR is A good measure of central adiposity

T/F

A

T

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23
Q

WHR

Measure the;
Waist at its (narrowest or widest?) point width- wise usually just _______________

Hips around the (narrowest or widest?) part of the hip bone

A

Narrowest; above the belly button

Widest

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24
Q

A WHR of ____ for women and ____ for men have been shown to correlate strongly with general heath and fertility.

ABNORMAL; Women >____ Men >____

A

0.7; 0.9

0.9; 1.0

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25
Q

Classification of obesity as per fat distribution

______ (or _____________, males)

________(________, females)

A

Android; abdominal or central

Gynoid; below the waist

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26
Q

Classification of obesity as per fat distribution

Android
-Collection of fat mostly in the ______ -
-______-shaped
-Associated with ———— and _______ disease

A

abdomen

apple

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27
Q

Classification of obesity as per fat distribution

Gynoid
• Collection of fat on _____ and ______
•_____-shaped
-Associated with mechanical problems

A

hips and buttocks

pear

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28
Q

Historical trends

Etymology

obesity is from a latin word ‘______’ meaning ___,____,____

In ____ ’Esus’ is the past participle of ‘____’(to eat),with ‘ ___’(over). ’_____’

First added to the Oxford English dictionary in _____ by ______.

A

obesitas

fat’ ‘stout’ ‘plump’

Greek; edere; ob; Obesus

1611; Randle Cotgrave

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29
Q

Obesity was First recognised as a medical condition by the ______.

A

Greeks

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30
Q

Described by Hippocrates “Corpulence is __________________________________”

A

not only a disease itself, but the harbinger of others

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31
Q

____ surgeon Sushruta (6th century BCE) relates obesity to ____, recommends _____ as a cure

A

Indian; DM

physical work

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32
Q

During the middle ages and the renaissance, the obesity was a sign of ______. Was common among officials.

A

wealth

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33
Q

Industrial revolution-
19th century height and weight ____eased

In the 20th century population reached their genetic potential for height, body weight began to ____ease.

In the 1950’s obesity was linked to _____ and insurance companies _____eased premium on the obese.

A

incr

incr

morbidities; incr

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34
Q

From 1922 to 1999 the requirement for winning the miss America pageant

__% increase in height
__% decrease in weight

A

2

12

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35
Q

Being lean, slim is the ideal presently

T/F

A

T

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36
Q

Who is more predisposed to obesity

Men or women

Children or adults

A

Women

Adults

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37
Q

Obesity is endemic in USA

T/F

A

T

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38
Q

The African Americans are less predisposed to obesity compared to the Caucasians

T/F

A

F

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39
Q

Lowest incidence of obesity is in _________

A

sub-saharan Africa

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40
Q

The pathogenesis of obesity is classically and rightfully seen in terms of the simple paradigm of an imbalance between:
Energy intake
Energy output

T/F

A

F

The mechanism of obesity is far more complex than that

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41
Q

LEPTIN
Discovered in 1994, from Greek word ‘leptos’(___)

A

thin

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42
Q

LEPTIN

A 16kDa protein expressed in _____

Sends afferent signal that relays the ________ to the CNS (_______) i.e ‘______’

A

adipocytes

magnitude of fat stores

hypothalamus; Adipostat

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43
Q

Plasma levels of leptin correlates with adipose tissue mass

T/F

A

T

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44
Q

LEPTIN

Mediates (short or long?) -term appetite control i.e eat (more or less?) when fat storages are low and eat (more or less?) when fat storages are high.

A

Long

More

Less

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45
Q

An anorexic hormone-signals satiety to the Hypothalamus (ventro-medial)also modulates energy expenditure

T/F.

A

T

46
Q

In the ob/ob mouse there is defective ———— resulting in obesity and _______

A

leptin production

insulin resistance.

47
Q

Leptin administration in the ob/ob mouse causes ______ by ______

A

weight loss

reducing appetite

48
Q

Obese humans have low levels of LEPTIN

T/F

A

F

paradoxically, we have high levels presumably because of tissue resistance to it

49
Q

(Minority or Majority?) of obesity may be due to mutation in leptin receptor.

A

Minority

50
Q

Ghrelin
Produced by the _______
Modulates (short or long?) term appetite control i.e eat when the stomach is ——- and stop when the stomach is ____.

A

stomach
Short

empty; full

51
Q

Ghrelin and leptin are antagonistic in their influence on appetite.

T/F

A

T

complementary

52
Q

Bad news for dieters!

Leptins

Dieting _____eases leptin levels

Reducing metabolism (stimulates or suppresses?) appetite

A

decr; stimulates

53
Q

Bad news for dieters

Ghrelin
Levels in dieters are (lower or higher?) after weight loss
The body steps (up or down?) ghrelin production in response to
weight loss.

A

Higher

Up

54
Q

The higher the weight loss, the (lower or higher?) the ghrelin levels.

A

Higher

55
Q

Neuropeptide Y
Produced in the ______ of the ____

Is a potent (stimulator or suppressor?) of appetite Its production is (enhanced or inhibited?) by leptin.

A

Arcuate nucleus; Hypothalamus

stimulator

Inhibited

56
Q

Proopiomelanocortin

Synthesised by ____ (_____ cells of the _____)
A large polypeptide

A

corticotrophs; Basophil; anterior pituitary

57
Q

Proopiomelanocortin

Precursor of both ______ hormone and __________________

A

adrenocorticotrophic

α-Melanocyte Stimulating hormone(MSH)

58
Q

MSH acts on the _______ receptor (____) in the _____ which ___eases energy expenditure and ____eases food intake

A

melanocortin-4 ; MC-4

hypothalamus

incr

decr

59
Q

Agouti protein(Agouti related peptide AgRP)
Expressed in ______

_______ the actions of ____ by ________

A

hair follicle

Antagonises; MSH

blocking MC-4 receptor

60
Q

_________ relationship has been shown btw increasing BMI and BNP conc.
No conclusive data yet for NT-ProBNP. However it is thought that the same relationship will hold.

A

An inverse

61
Q

POMC and _____ stimulate ____ and inhibit _____

A

CART

satiety

feeding

62
Q

NPY and AgRP stimulate _____ and inhibit ____

A

feeding

satiety

63
Q

Leptin ______ NPY/AgRP group while _______ the POMC/CART group.

A

inhibits

stimulating

64
Q

Total calorie consumption is related to obesity

T/F

A

T

65
Q

Most extra calories are from _____ rather than ____

A

CHO

fat

66
Q

Resting or Basal Metabolic Rate(BMR)
Is the Energy cost of _______ and ———

A

metabolising and storing food

67
Q

Adaptive thermogenesis in Brown Adipose tissue(BAT) –through the action of ________________

A

UCP-1 uncouple mitochondria resp.

68
Q

BMR accounts for about ____% of daily energy expenditure whereas active physical activity contributes _____%.

Thermic effect contributes ____%.

A

60-65

25-30

10

69
Q

Obesity results from an imbalance btw _______ and ———-

A

energy intake and expenditure.

70
Q

____ % of the world’s population get insufficient exercise

A

60

71
Q

Genetics

_______ in various genes controlling appetite and metabolism predispose to obesity when sufficient calorie is present

A

Polymorphism

72
Q

Genetics, obesity

Inheritance is Mendelian

T/F

A

F

not

73
Q

Genes Vs Environment

genes influence susceptibility to obesity

T/F

A

T

74
Q

The OB gene is absent in humans

T/F

A

F

Present and is expressed in fat

75
Q

Early onset morbid obesity in humans have association with mutation in either _______ or ______ eg hypogonadotropic hypogonadism which is reversed by __________

A

leptin or leptin receptor

leptin replacement

76
Q

Mutation in the gene encoding POMC-through failure to synthesise ______, a key neuropeptide that _____ appetite in the hypothalamus.

A

α-MSH

inhibits

77
Q

————— mutation by preventing synthesis of α-MSH from its precursor POMC

A

Proenzyme convertase 1(PC-1)

78
Q

α-MSH binds to _______ receptor, a key ______ receptor that ______ eating.

A

type 4 melanocortin

hypothalamic

inhibits

79
Q

Heterozygous mutation in this gene encoding POMC causes obesity in as much as ___% of all cases.

A

50

80
Q

Which obesity related gene isn’t found in rodents but found in humans

A

PC-1

81
Q

Which obesity related gene isn’t found in humans but found in rodents

A

Tub
Fat
AgRP

82
Q

Medical and psychiatric illnesses that can cause obesity

______ syndrome, ______,____ hormone

Eating disorders; _____ disorder, _______ syndrome, ______

Drugs; ______, _____, certain anti- convulsants (_____), _______ and some forms of ________

A

Cushings; hypothyroidism; growth

Binge eating ; Night eating ; Bulimia nervosa

antidepressants; steroids

phenytoin and valproate

pizitifen; hormonal contraceptions

83
Q

Medical conditions that predispose a person to obesity

Insulinoma
Patients gain weight as a result of ____ to avoid ______ symptoms

Craniopharyngiomas and other disorders involving the _______
Tumours, trauma or inflammation cause ________ affecting centres that control hunger, satiety and energy expenditure.

A

overeating; hypoglycemia

Hypothalamus

hypothalamic dysfunction

84
Q

Social determinants

Social class and income inequalities

Societal perceptions; ‘ ________ three square meals a day’

Number of children; women ___% risk per child. Men ___% risk per child

Malnutrition in early life
In a 2006 study ;insufficient sleep and ____easing rate of smoking.

A

Big man big Belly’

7; 4

decr

85
Q

Clinical features of obesity

Adverse effect on health

Morbidly obese individuals(200% ideal body weight have as much as ___ fold increase in mortality

Mortality rises as obesity increases especially with increasing _____ and ____

Increases the risk of many __ and _______ conditions.

These co-morbidities are commonly shown in the metabolic syndrome a combination of; ____,_____ , dyslipidemia (high cholesterol and TGs)

A

12

abdominal and intra-abdominal fat

physical and mental

Type II DM, high BP

86
Q

Metabolic syndrome

Involves picking 1 from : ____,____,____

And picking 2 from : ___,___,____,_____

A

Type 2 diabetes
Insulin resistance

Hypertension
Obesity
Dyspilidaemia
Microalbunuria

87
Q

Hyper-insulinaemia and type II DM

____eases with weight gain and _____ with weight loss
Insulin resistance is more strongly linked to ________ obesity

May be due to insulin itself by _____________

A

Incr

diminishes

intra- abdominal

inducing receptor down regulation.

88
Q

Hyper-insulinaemia and type II DM are pervasive features of obesity

T/F

A

T

89
Q

Obesity and DM cont…

Various circulating peptides produced by adipocytes eg the cytokines(____) and ‘adipokines’ _____ and _____have altered expression in obese adipocytes.

These are capable of modifying ____ action.

A

IL-6

adiponectin and resistin

insulin

90
Q

In obesity, Free fatty acids are known to be increased and capable of impairing ____ action

A

insulin

91
Q

Most obese individuals develop DM.

T/F

A

F

They do not

92
Q

As many as 80% of patients with type II DM are obese.

T/F

A

T

93
Q

Even modest weight loss improves insulin sensitivity.

T/F

A

T

94
Q

CV mortality may be seen in BMI as low as _______

A

25

95
Q

The ______ study revealed that obesity was an independent risk factor for 26 year incidence of CV disease.

A

Framingham

96
Q

Abdominal obesity is associated with _____ lipid profile ;with ____eased LDL cholesterol, VLDL and TG and ____eased HDL cholesterol. This causes coronary Heart dx and IHD

A

artherogenic

incr

decr

97
Q

Obesity and Pulmonary

Reduced ________
Increase ________
____eased total Lung capacity and functional residual capacity
Obstructive ______
______________ syndrome
Increased complication during general anaesthesia
Weight loss improves condition.

A

chest wall compliance

work of breathing
Decr
sleep apnoea
Obesity hypoventilation

98
Q

GIT

_______ billiary secretion of cholesterol,

____saturation of bile causing ______

NAFLD(Steatosis, Steatohepatitis and Cirrhosis) GERD
Pancreatitis
Abdominal ___

A

Enhanced

super-

cholesterol gallstones

hernias

99
Q

fasting causes super-saturation of bile, resulting in gallstone formation

T/F

A

T

100
Q

I

Higher in obesity in males; Ca oesophagus, Colon, Rectum, Pancreas, Liver and Prostate
Higher in obesity in females; _____ , Breasts, Endometrium, Cervix and Ovaries
Non-Hodgkins lymphomas and multiple myeloma

A

Gall bladder

101
Q

Obesity accounts for ____% of cancer deaths in men and ___% in women.

A

14

25

102
Q

Reproductive Disorders-men

Male _______ is associated with increased adipose tissue

Decrease plasma ______ and _________

Increase _____ level derived from conversion of _______ in adipose tissue

A

hypogonadism

testosterone

Sex Hormone Binding Globulin(SHBG)

oestrogen; adrenal androgens

103
Q

Obesity and reproductive disorders in men

_________

_________ may be decreased in morbidly obese men

A

Gynecomastia

Free testosterone

104
Q

masculinisation, libido, potency and spermatogenesis are preserved in most obese men

T/F

A

T

105
Q

Reproductive disorder-women

_______ abnormalities (oligomenorrhea) particularly in women with _____ obesity

Increased _____ production
Decreased ______
____eased peripheral conversion of androgen to oestrogen
PCOS (anovulation and ovarian hyperandrogenism)

A

Menstrual

upper; androgen

Sex hormone binding globulin ; Incr

106
Q

____% of women with PCOS are obese

A

40

107
Q

In obese women with PCOS, weight loss or treatment with insulin sensitizing drugs often restores normal menses
Infertility

T/F

A

T

108
Q

Obesity, Psychiatric

Depression(especially in ____)
Social ——— /weight based ______

_______ impact

A

women

stigmatisation

discrimination

Economic

109
Q

Additional facts and figures

On the average, obesity reduces life expectancy by ______ years

BMI of 30 to 35 reduces life expectancy by _______ years
BMI >40 reduces life expectancy by _____ years

A

6 to 7

2 to 4

10

110
Q

Pharmacologic Therapy

Centrally acting drugs: they are _______

Peripherally acting drugs: they -
_______________

A

appetite suppressants

reduce fat absorption

111
Q

Class 3 obesity is also known as _____ obesity

A

Morbid obesity

112
Q

______ cells of the ________ and ______ produce ghrelin

A

Epsilon

Pancreas

Stomach

House Clinical Pathology (45 decks)

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