Obesity Flashcards
T/F: Overweight at age 4=20% chance in adulthood.
True
BMI Standards for Overweight, Obese (Class I and II), and Morbidly obese
BMI>25= overweight
BMI>30= obese Class 1:30-34.9, Class 2: 35-39.9
BMI>40 Morbidly obese
*Different for CHILDREN!
BMI=Weight (kg)/Height (m) ^2
Children BMI percentile ranges
- BMI between 85-95th%ile = At risk for obesity
- BMI>95th%ile = Obese
Obesity patterns: Android
Truncal Obesity= Increased incidence of morbidity and mortality
Obesity Patterns: Gynecoid
Hip/Gluteal obesity
Other measures than BMI for Obesity
- Waist-to-hip ratio: >1.0 males and >0.85 females
- Abdominal Circumference: >102cm males and >88cm females
What is most basic cause of Obesity?
Calories in vs. calories out= energy intake exceeds energy use.
Some multifactorial causes of obesity:
1) Genetics (Leptin, etc.) with interaction of environment.
2) Environmental (Sleep, smoking cessation, social, dietary factors, etc.)
3) Endocrine
4) Medications
5) Psychological
Prenatal Influences on obesity:
- MOM: Pre-pregnancy BMI and gestational weight gain.
- BABY: LBW, short stature, small head circumference= increased risk for abdominal fatness.
- Breastfeeding vs. formula feeding
- Genetic and Environmental factors
Neuroendocrine Causes of Obesity
Cushings Syndrome, Hypothyroidism, Polycystic Ovary Syndrome, Growth hormone deficiency, “Hypothalamic obesity”
-Signs for women may be Hirsutism
A congenital etiology of obesity
Prader-Willi Syndrome
List some Comorbidities of obesity
Metabolic syndrome, Insulin resistance, DM II, HTN, CV disease, Dyslipidemia, Respiratory problems, Sleep apnea, hernias, reflux, stress incontinence, hemorrhoids, skin problems, psychologic.
Associated comorbidities of Obesity
-Venous problems, Increased risk of cancer, GI problems
Acanthosis nigricans is a sig of elevated _________ levels
Insulin. Early insulin resistance and DM II
1st line Treatment for an adult with Obesity
- Decrease caloric intake by 500-1000 cal.day. Need 1000-1200/day, 1200-1500 (men)
- Increase physical activity (30-60 min most days per week (5x)
- Support group
- Nutritional consult
- Lifestyle modification (goal is 2#/week, 8-10% of baseline weight)
2nd line Treatment for an adult with Obesity (Classes of Medications)
- As an adjunct to diet and exercise.
- BMI >30 or BMI 27-29.9 and comorbid condition.
- MEDICATION classes: Catecholaminergic medications, Drugs that alter digestion, SSRIs, Combinations of “older medications”
Sympathomimetic (Catecholaminergic) medictions for obesity
1) Phentermine (Fastin)- stimulant
2) Sibutramine (Meridia)
Drugs that alter digestion for Obesity
1) Orlistat- Decrease fat absorption (OTC is Alli)
Serotonin Agonists for Obesity
- Loracaserin
- Fluoxetine (Prozac) and Bupropion (Wellbutrin)
Surgical treatment for Obesity and requirements.
- Bariatric Surgery: Only morbidly obese (BMI>40) who have tried weight loss methods and failed or patients with BMI>35 and have comorbid condition
- Gastric bypass
- Gastric banding
What should be present with all treatment options in obese patients?
Behavioral therapy- Alter eating and physical activity habits
