Obesity Flashcards
Define classification of weight based on body mass index (BMI)
BMI = Weight (kg) / Height (m)2
• For children/adolescents:
o Normal: <95th percentile
o Obese: ≥95th percentile
Describe recent trends in the prevalence of obesity and the public health impact of these trends
TRENDS:
• Decline in obesity rates among preschool children from low-income families
• >1/3 adults and almost 17% youth obese in US
o Rate for children is 3x one generation ago
• Rate of being overweight not much changed but see greater percentages of higher classes of obesity
• Prevalence does not differ between men and women
• >60 years more likely to be obese than younger adults, especially in women
• Rates vary by education and income
PUBLIC HEALTH IMPACT
• Global health problem: from increase in energy, decrease in activities, change in transportation, urbanization of countries
• Increased risk of chronic diseases
• Increased health care costs
• Loss of income from disability or premature death
Describe the development of obesity with consideration to genetic, environmental, and behavioral factors.
Genetic
o Obesity is a polygenic disorder (>200 genes associated)
o Genetic factors account for about 40% variance of obesity in population
o Adipose tissue accumulation, distribution, and function
Intra-uterine/ perinatal
o Maternal undernutrition in pregnancy
o Maternal smoking
o Malnutrition in infancy
o Low birth weight: higher risk for central obesity
o High birth weight: higher risk for high BMI
Environmental
o Food: access, excess, caloric density, liquid calories
o Activity
o Medications that lead to weight gain:
• Corticosteroids, oral hypoglycemics, insulin, some anti-hypertensives, tricyclic antidepressents, lithium, anti-psychotics, anti-convulsants, SSRIs
Endocrine and metabolic diseases
o Potential but rare cause of obesity
Describe metabolic complications of obesity.
- Type II diabetes
- Insulin resistance → increased risk of HT, increased fat stores, inflammatory chemicals
- Dyslipidemia
- Gout
- Metabolic syndrome
List the criteria for the metabolic syndrome.*
Three or more risk factors present:
o Abdominal obesity: Waist circumference > 40 in men, >35 in females
o Triglycerides: ≥ 150 mg/dL or on meds
o HDL-C: <50 in women; or on meds
o Blood pressure: ≥ 130/≥85 mmHg or on meds
o Fasting glucose ≥ 100 mg/dL or on meds
Describe the goals of treatment for metabolic syndrome.
- Lose weight to BMI <25
- Be physically active
- Follow heart healthy diet (DASH)
- Quit smoking
- Limit alcohol to moderate consumption
- GOALS: reduce risk of heart disease by lowering LDL, HT, and managing/preventing diabetes
Outline the complications of obesity: effects on organ systems and disease development, mechanical affects on the body, surgical complications, and psychosocial consequences.
Respiratory o Obesity hypoventilation syndrome o Sleep apnea CV o Atherosclerotic and arteriosclerotic vascular disease o Coronary heart disease, HT, CHF GI o Gall stones o GERD o Fatty liver → steatosis →steatohepatitis →cirrhosis or hepatocarcinoma Kidney disease Reproductive o Polycystic ovary syndrome o Obstetric complications Cancer o Endometrial, breast, colon and rectum, gall bladder, kidney, esophagus, pancreas, thyroid Mechanical o Arthritis o Increased intra-abdominal pressure → incontinence, hernia, pseudo-tumor cerebri Psychosocial o Inappropriate bias o Correlated with lower earnings, depression, low self-esteem
List approaches that physicians could take to improve the management of obesity in their practice.
- Routine screening at every visit
- Advice/strong message on benefits
- Assess readiness to change
- Establish goals, modest but specific
- Recommend a plan or refer for detailed counseling
- Follow-up at subsequent visits
Define modest weight loss (as a % of total body weight).*
- 10-15%
* Decreases BP, improves glucose and serum lipids
Discuss strategies associated with maintenance of weight loss.
- 60-90 minutes of exercise daily
- Lower dietary fat intakes
- Lack of exceptions to diet plan
- Social support
- Weighing weekly
- Alternating strategies: “watching” vs “losing” weight
Define the level of calorie reduction recommended to produce a 1-2 pound per week weight loss.*
• 500-1,000 kcal/day deficit
Discuss the topics that should be included in nutrition education for weight loss.
• Diet history • Review nutritional quality of diet o Energy density of foods • Identify sources of excess calories • Establish goals for specific change • Create a follow-up plan
Discuss the advantages and disadvantages of commercial weight loss programs.
Advantages: o Structure: makes plan easier to follow o Support and accountability o Nutritionally adequate menus Disadvantages o Limited personalization of the plan o Cost o Too much structure (patients don’t learn how to make choices without program) o Limited research on effectiveness and long-term results
Define the role of exercise in weight loss and maintenance.
- Only modest weight loss with exercise alone
- Most weight loss from decreased caloric intake
- Sustained exercise is critical factor in prevention of weight regain
Identify the amount of exercise recommended for weight management.*
o 150 minutes weekly of moderate exercise to maintain healthy weight
o 300 minutes weekly to maximize weight loss and minimize weight regain
