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BD 2 > obesity > Flashcards

obesity Flashcards

1
Q

obesity rates in children and adults

A

35% of adults are obese

17% of children are obease

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2
Q

How many women are obease?

How many men are obease?

A

69% of adults are overweight or obese

  1. 5% of men are obease
  2. 8% of **women **are obease
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3
Q

Are minorities more obease or less obease then non-minorties?

A

For men obesity does not vary significantly among racial/ethnic groups.

36% white, 38.8% black, 35.3% hispanic

For **women **obesity varies siginificantly among racial/ethnic groups.

32% white, 58.5% black, 40.7 % Hispanic

black women are almost 2x as likely to be obease then white

*23% of middle age black women (age 40-59) have stage 3

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4
Q

Underweight BMI

A

BMI < 18.5

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5
Q

Overweight BMI

A

BMI=25-29.9

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6
Q

Normal BMI

A

BMI=18.5-24.9

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7
Q

Obese BMI

A

BMI=30

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8
Q

Stage 1 Obeasity BMI

A

BMI=30-34.9

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9
Q

Stage 2 Obeasity

A

BMI=35-39.9

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10
Q

Stage 3 obesity

A

BMI>40

Super obease BMI>50

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11
Q

Childhood obesity

A

Determined by age percentile

  • Overweight defined as body mass index 85th to 95th percentile for age and gender
  • Obesity is defined as body mass index 95th percentile or greater for age and gender
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12
Q

BMI formula

A

BMI=mass(kg)/height(m)^2

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13
Q

Factors contributing to obesity

A
  • Dietary habits (cheap, energy dense, highly palatable)
  • Activity level (sedentary)
  • Genetics- (FTO, MC4R mutation)
  • Gut Bacteria
  • Maternal Environment
  • Socioeconomic status
  • Friends
  • Environment
  • Medications (steroids, SSRIs, anti-psychotics)
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14
Q

Orexigenic

A

appetite stimulant

NPY-neurotransmitter in the autonomic nervous system

  • elevating NPY-ergic activity increases food intakeAgRP- signaling neuropeptide produced in the brain
  • appetite-stimulating effects of AgRP are inhibited by the hormone leptin and activated by the hormone Ghreli

Ghrelin-released by the pituitary gland, activates AgRP

cortisol - secreted by the adrenyl gland

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15
Q

Anorexigenic

A

appetite supressent

POMC, CART, alpha-MSH, CCK, Pancreatic Peptide (PP), Peptide tyrosine-tyrosine (PYY), GLP-1

  • Leptin - produced by fat cells
  • Insulin - secreted when blood glucose levels are high
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16
Q

How many years does being overweight and obease retract from one’s life expectancy?

A

diminished life expectancy in the obese

overweight

o decreases life by 3yrs

obese

o decreases life by 6-7yrs

  • Life expectancy decreases as obeasity becomes more extreme (stage 1 better then superobease)
17
Q

What are the pyschosocial effects of being obease?

A
  • Less education
  • Less likely to be married
  • Lower household income
  • Higher rates of poverty
  • Depression, impaired self-esteem
  • Prejudices- “sloppy, lazy, lack self-discipline”
  • 1.4-2.4 x number of sick days (Swedish Obesity Study 2002)
  • 1.5-2.8 x more likely to be on disability
    • *SOCIAL STIGMATIZATION is the root cause *of the psychosocial effects of obeasity
18
Q

What types of cancerare associated with obeasity?

A

Cancer

  • breast, uterus, cervix
  • colon, esophagus, pancreas
  • kidney, prostate
19
Q

What are some common medical problems associated with obesity?

A
  • Adipose tissue is an endocrine organ
    • many problems assicated with obesity are endocrin
  • hypoventilation syndrome
  • stroke
  • diabetes
  • osteoarthritus
  • cirrhosis
  • Coronary heart disease
  • gout
    • osteoporosis is not assicated with obesity
20
Q

What are the 3 treatment options for obesity?

A
  1. Behavior/Lifestyle modification
  2. Pharmacotherapy
  3. Bariatric surgery
    • risk for obesity relapse is high, must be managed over the long term
    • obesity counciling by Drs increases chance pts will achieve weightloss
21
Q

How much weight loss of needed to improve health outcomes?

A

pts who loose 5-10% of body mass reduce their risk of morbidity associated with overweight/obesity.

22
Q

What are some common pharmacotherapy drugs used in treating obesity?

A

o ADHD drug derivatives

  • Belviqàlocaserinà selective 5HT2c agonist
  • Phentermin (stimulant)
  • Xenicalà Orlistat (Alli)

Contraveà Naltrexone SR/Bupropion SR modulate dopamine association with food (still in clinical trials)

  • Dopamine blocking drugs

Drugs used to achieve clinically signicant weightloss ( 5-10% of weight) to improve health outcomes

23
Q

What percentage of eligibe pts use pharmacotherapy and surgery?

A

Pharmacotherapy

  • 2-3% of pts eliglbe use drug therapy

Surgery

  • 1% of eligible obease pts opt for surgery

Why such low utilizaiton of resources?

  • Time (obesity counciling takes allot of time)
  • Utility (most physicans are apathetic towards obesity tx)
  • Reimbursement is low for medical obesity counciling
  • Surgery is generally covered
  • Cultural barriers (overweight is not a problem in som cultures)
  • Comfort level (pts dont like talking about their weight)
24
Q

What are some behaviors associated with weightloss?

A
  • Record food intake daily
  • Weight: check at least once per week
  • Low-calorie, low-fat diet
  • Total energy intake1300-1400 kcal/d
  • Eat breakfast daily
  • Regular physical activity (60 minutes per day)
  • meal replacement (weight wachers, slimfast) used 1x per day assocated with 3kg-5kg weightloss
25
Q

What are the criteria for weightloss surgery?

A
  • BMI >40 or BMI >35 with comorbidities (i.e diabetes)
  • Failed medical weight loss for 6 months
  • Absence of uncontrolled psychiatric disorder or substance abuse
26
Q

What are the 3 types of weightloss surgery?

A

**Gastric banding **

  • least effective surgery
  • reversible
  • indicated for pts with BMI 30-35

**Gastric bypass **

  • Alterations in ghrelin/leptin
  • results in 50-60% weight loss
  • .1% mortality risk (similar to galbladder, appendectomy)
  • risk of nutritional defficencies

**Gastric sleeve **

  • results in 30-50% of excess body weight loss
  • indicated for pts with superobesity (BMI>50)
  • reduced nutrient deficency side effects

BD 2 (10 decks)

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