Obesity

Question 1

T/F: Overweight at age 4=20% chance in adulthood.

Answer 1

True

Question 2

BMI Standards for Overweight, Obese (Class I and II), and Morbidly obese

Answer 2

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

Question 3

Children BMI percentile ranges

Answer 3

• BMI between 85-95th%ile = At risk for obesity

- BMI>95th%ile = Obese

Question 4

Obesity patterns: Android

Answer 4

Truncal Obesity= Increased incidence of morbidity and mortality

Question 5

Obesity Patterns: Gynecoid

Answer 5

Hip/Gluteal obesity

Question 6

Other measures than BMI for Obesity

Answer 6

• Waist-to-hip ratio: >1.0 males and >0.85 females

- Abdominal Circumference: >102cm males and >88cm females

Question 7

What is most basic cause of Obesity?

Answer 7

Calories in vs. calories out= energy intake exceeds energy use.

Question 8

Some multifactorial causes of obesity:

Answer 8

1) Genetics (Leptin, etc.) with interaction of environment.
2) Environmental (Sleep, smoking cessation, social, dietary factors, etc.)
3) Endocrine
4) Medications
5) Psychological

Question 9

Prenatal Influences on obesity:

Answer 9

• 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

Question 10

Neuroendocrine Causes of Obesity

Answer 10

Cushings Syndrome, Hypothyroidism, Polycystic Ovary Syndrome, Growth hormone deficiency, “Hypothalamic obesity”
-Signs for women may be Hirsutism

Question 11

A congenital etiology of obesity

Answer 11

Prader-Willi Syndrome

Question 12

List some Comorbidities of obesity

Answer 12

Metabolic syndrome, Insulin resistance, DM II, HTN, CV disease, Dyslipidemia, Respiratory problems, Sleep apnea, hernias, reflux, stress incontinence, hemorrhoids, skin problems, psychologic.

Question 13

Associated comorbidities of Obesity

Answer 13

-Venous problems, Increased risk of cancer, GI problems

Question 14

Acanthosis nigricans is a sig of elevated _________ levels

Answer 14

Insulin. Early insulin resistance and DM II

Question 15

1st line Treatment for an adult with Obesity

Answer 15

• 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)

Question 16

2nd line Treatment for an adult with Obesity (Classes of Medications)

Answer 16

• 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”

Question 17

Sympathomimetic (Catecholaminergic) medictions for obesity

Answer 17

1) Phentermine (Fastin)- stimulant

2) Sibutramine (Meridia)

Question 18

Drugs that alter digestion for Obesity

Answer 18

1) Orlistat- Decrease fat absorption (OTC is Alli)

Question 19

Serotonin Agonists for Obesity

Answer 19

• Loracaserin

- Fluoxetine (Prozac) and Bupropion (Wellbutrin)

Question 20

Surgical treatment for Obesity and requirements.

Answer 20

• 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

Question 21

What should be present with all treatment options in obese patients?

Answer 21

Behavioral therapy- Alter eating and physical activity habits