Obesity Flashcards
Define the terms ‘overweight’ and ‘obesity’.
Overweight and obesity are degrees of excess weight associated with increases in morbidity and mortality. BMI cut-off points are used to diagnose both conditions: * Normal: <25 * Overweight: 25-29.9 * Mild obesity: 30-34.9 * Moderate obesity: 35-39.9 * Severe or morbid obesity: ≥40
BMI is calculated by dividing a person’s weight in kilograms by height in meters squared.
Does fat distribution affect the assessment of risk in patients with overweight or obesity?
Yes, central adiposity (android pattern) is associated with greater risk of metabolic health issues compared to lower-body obesity (gynecoid pattern). Abdominal fat is a predictor of diabetes, hypertension, dyslipidemia, and coronary artery disease.
Intraabdominal or visceral fat is most closely linked to these health risks.
Explain the role of waist circumference in risk stratification.
Waist circumference helps assess risk based on fat distribution. Men >40 inches and women >35 inches have increased risk. It is particularly useful for those with a BMI of 25-30 kg/m2.
Individuals with increased waist circumference should focus on preventing further weight gain.
How is waist circumference measured?
Waist circumference is measured with a tape at the level of the iliac crest, parallel to the floor, at the end of a relaxed expiration.
What adverse health consequences are associated with obesity?
Obesity is associated with: * Diabetes * Hypertension * Hyperlipidemia * Coronary artery disease * Degenerative arthritis * Gallbladder disease * Certain cancers * Urinary incontinence * Gastroesophageal reflux * Infertility * Sleep apnea * Congestive heart failure
Risks increase with body weight, age, and family history.
Summarize the economic consequences of obesity.
The annual U.S. health care costs associated with obesity exceeded $275 billion in 2016, mainly due to treating obesity-related comorbidities.
What are the psychological complications of obesity?
Common complications include: * Situational depression * Anxiety * Discrimination * Poor self-image * Social isolation
Treatment of both obesity and psychological conditions may improve quality of life.
How common is obesity?
Obesity prevalence in the U.S. was 39.8% in adults and 18.5% in youth (2015-2016). Higher prevalence among non-Hispanic black and Hispanic adults compared to non-Hispanic white and Asian adults.
What caused the dramatic rise in the prevalence of obesity in the 1980s and 1990s?
The rise is primarily attributed to an environment promoting increased food intake and reduced physical activity, despite body weight being physiologically regulated.
Describe the current model for obesity as a chronic disease.
Obesity is viewed as a chronic, progressive metabolic disease requiring a positive energy balance. It involves complex interactions of energy intake, expenditure, and hormonal responses.
Do abnormal genes cause obesity?
Genetics account for 30% to 60% of weight variance. Severe early-onset obesity can result from specific gene mutations, while common obesity involves multiple genes with small effects.
What is leptin?
Leptin is a hormone secreted by adipose tissue in proportion to fat mass, regulating food intake and energy expenditure via hypothalamic receptors.
Does leptin deficiency cause human obesity?
Leptin deficiency can cause severe obesity in rare cases. Typically, obese individuals have high leptin levels but may be resistant to its effects.
Explain how the melanocortin system is involved in weight regulation.
Alpha-MSH, from the POMC gene, inhibits food intake via MC4-R receptors in the hypothalamus, while AGRP stimulates intake. MC4-R agonists have not proven effective for significant weight loss in humans.
What is ghrelin?
Ghrelin is a hormone that regulates appetite, increasing before meals and decreasing after. It is associated with hunger and may be a target for weight loss drugs.
Does a decrease in energy expenditure play a role in the development of obesity?
Yes, obesity arises from an imbalance between caloric intake and expenditure. However, low metabolic rates are not proven to predispose individuals to obesity.
What are the components of energy expenditure?
The components include: * Basal metabolic rate (BMR) * Thermic effect of food (5%-10%) * Physical activity energy expenditure (PAEE)
PAEE varies greatly, accounting for 10%-80% of total energy expenditure.
Explain the concept of energy balance.
In weight stability, total daily energy expenditure equals total daily energy intake. Individuals with obesity consume more calories over time to maintain their state.
Are there other factors involved in the increase in the prevalence of obesity?
Yes, factors include: * Reduced sleep time * Medication use * Population aging * Environmental toxins
Shortened sleep is linked to obesity and metabolic changes.
What options are available for treating the patient with obesity?
Treatment options include: * Diet * Exercise * Pharmacotherapy * Surgery * Behavioral approaches
Treatment should be tailored based on BMI and associated health problems.
What is the goal of a weight loss program?
The goal is to set realistic expectations for weight loss, typically aiming for 5%-10% of initial weight rather than ideal body weight.
What is the goal of a weight loss program?
Determine realistic weight loss expectations and set goals, typically aiming for a 5% to 10% reduction in initial weight
Most patients desire to achieve ideal body weight but may be disappointed with smaller weight losses
Is a 5% to 10% weight reduction helpful?
Yes, it is associated with improvements in health measures like lower blood pressure and reduced risk of diabetes
A weight loss of 11–12 lb for someone who initially weighed 220 lb is a realistic goal
What is the Stages of Change theory?
A theory that outlines six stages a person passes through before changing long-standing behaviors: (1) precontemplative, (2) contemplative, (3) planning, (4) action, (5) maintenance, (6) relapse
This helps clinicians tailor counseling to the patient’s current stage
