Obesity

Question 1

Children older than 2 years are severely obese if they have what?

Answer 1

body mass index at least 20% higher than the 95th percentil for their sex and age

or

BMI of 35 or higher

Question 2

What percentage of US adults are obese?

Answer 2

36%

Question 3

What percentage of adult men and women are overweight?

Answer 3

40% of men, 30% of women

Question 4

What percentage of american youth are severely obese?

Answer 4

4-6%

Question 5

The stomach produces ____ to tell us we’re hungry.

Answer 5

ghrelin

Question 6

Why do weight loss programs usually fail in relation to ghrelin?

Answer 6

the grhelin level doesn’t go down until a couple years after the weight loss, so when you diet you’re constantly being told you’re hungry

Question 7

What’s the main satiety hormone?

Answer 7

leptin

Question 8

What hormone both augments glucose production and promotes satiety when we eat?

Answer 8

GLP-1

Question 9

What are the two different kids of fat?

Answer 9

white adipose - stores calories

brown fat - burns calories and generates heat in the process for newborns - found in skeletal muscle

Question 10

So what do we usually talk about? visceral or subcutaneous adiposity?

Answer 10

visceral diposity

Question 11

Which is more insulin resistant - visceral or subcutenous?

Answer 11

visceral

Question 12

What are some of the reasons obestiy contributes to HTN?

Answer 12

activation of SNS
sodium and volume retention
Renal dysfunction
insulin and leptin resistance
activation of RAS
endothelial dysfunction
Inflammation and oxidative stress

Question 13

What cancers are particularly elevated in obestiy

Answer 13

endometrial
esophageal
kidney
colon
breast

Question 14

Mortality goes up by what percent with every increase of 5 BMI units.

Answer 14

30%

Question 15

At what BMI should you start having the conversation with a patient?

Answer 15

25 and over - even when they’re just overweight

Question 16

True or false: a 3% sustained weight loss isn’t very significant. you have to lost at least 10%

Answer 16

false

even that will result in lower TG, A1C and risk of DM2

Question 17

WHat is a realistic weight goal?

Answer 17

1-2 pounds per week for the first 6 months with an initial goal of 10% from baseline

the issue is that people’s goals are usually unrealistic

Question 18

WHat is the typical weight loss range for the weight loss meds?

Answer 18

3% for orlistat and 9% for phenteramine+topiramate

Question 19

True or false: these medications help people lose weight and improve cardio-metabolic risk factors, reducing CV mobidity and mortality

Answer 19

false - improve things, but don’t reduce morbidity and mortality

Question 20

When do you consider surgical options for weight loss?

Answer 20

BMI over 40

BMI over 35 with comorbidities

Question 21

What is the most common surgery done for this?

Answer 21

vertical sleeve gastrectomy

Question 22

What are the surgical complications here?

Answer 22

dumping syndrome
leaks at incision site with incisional hernia and pneumonia
decreased C2+ absorption, gallstronse, hyperoxaluria, rhabomyolysis, B12 deficiency

Question 23

What is the percent mortality from weight loss surgery?

Answer 23

.2%

Question 24

What was the typical weight loss seen 3 years post surgery with a RYBG or LAGB?

Answer 24

RYBG with 31%

LAGB with 16%