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
Discuss behavior modification techniques for weight loss.
Self-monitoring o Food intake o Exercise o Weight Stimulus control o Modify the physical/cognitive environment o Reduce cues for overeating/inactivity Substitution o Activity instead of eating o Low kcal instead of high kcal foods Assertiveness training to express feelings and follow through with plans Cognitive changes o Recognize success, not focus on failures Social support Goal setting (SMART goals) Reward for achievement
Describe the elements and benefits of a team approach to weight loss.
- Doctor provides strong message
- Dietitian provides individualized nutrition therapy
- Exercise expert provides advice
- Health care team provides follow-up
- Overall: most efficient way to provide variety of expertise, better care to patient
Define BMI levels established by the National Institutes of Health for appropriate use of bariatric surgery as part of obesity management.*
- BMI >40
* BMI ≥35 and associated severe health complications and have not responded to other treatment methods
Describe the types of surgery currently used for obesity and potential side effects of the surgeries.
Restrictive-malabsorptive/ Roux-en-Y: restricts food intake and decreases absorption
o Side effects:
• Dumping syndrome: rapid passage of food from pouch into small intestine, cramping, diarrhea, sympathetic discharge
• Nutritional deficiencies: protein, B12, thiamine, folate, calcium, iron, fat soluble vitamins
Restrictive: food intake is reduced
o Adjustable gastric band—low risk deficiencies, band can slip, erosions
o Gastric sleeve—remove part of stomach
o Laparoscopic Gastric Plication—sewing folds in stomach to reduce volume
o Side effects: micronutrient deficiencies
Describe BMI levels established by the Food and Drug Administration for appropriate use of drugs as part of obesity management.*
- BMI ≥30
* BMI >27 along with other risk factors (ex. HT, diabetes, dyslipidemia)
List types and mechanism of action of obesity drugs currently approved for use in the US.
Phentermine
o Sympathetic amine, tolerance develops
o Short term (up to 12 weeks)
Orlistat o Binds lipase in gut → blocks fat absorption o Good if diet is high in fat o Approved by FDA for 1 year of use o OTC formulation is available (Alli)
Belviq
o Increases serotonin receptors, promotes decreases appetite and fullness
Qsymia
o Combines appetite suppressant (phentermine) and anti-seizure medication (topiramate)
Other short-term appetite suppressants: Diethylpropion, Phendimetrazine, Lorcaserin
Off-label/ not FDA approved: o Bupropion –depression med o Topiramate- seizure med o Zonisamide- seizure med o Metformin- diabetes med
