Obesity

Question 1

DDx of Obesity

Answer 1

• increase caloric intake
• fluid retention (CHF, renal failure)
• Cushing’s
• hypothyroid
• PCOS
• metabolic syndrome
• drug/medication induced
• genetic obesity

Question 2

Definition of Obesity

Answer 2

BMI > 30

increase in subQ fat tissue

Question 3

What factors have contributed to the increase in obesity trends?

Answer 3

• diet: more processed and fast food
• larger portions
• convenience: fast food, packaged food
• less physical activity
• more electronics

Question 4

How does BMI > 40 affect life expectancy?

Answer 4

decreased by 20 years in men and 5 years in women

Question 5

What are some of the health risks and comorbidities associated with obesity?

Answer 5

• pulmonary problems, heart dz
• nonalcoholic fatty liver dz, GB dz
• stroke
• cataracts
• CA, osteoarthritis, gout

Question 6

Obesity Screening Methods

Answer 6

• BMI
• waist circumference
• skinfold measurements with calipers

Question 7

BMI

Answer 7

weight (kg) divided by height (in meters) squared

Question 8

What are the drawbacks of using BMI as a measure of obesity?

Answer 8

• overestimate fatness in people who are muscular

- underestimate in older adults who have less muscle mass due to aging

Question 9

What BMI is considered underweight?

Answer 9

below 18.5

Question 10

What BMI range is normal?

Answer 10

18.5-24.9

Question 11

What BMI range is considered overweight?

Answer 11

25-29.9

Question 12

What BMI is considered obese?

Answer 12

> 30

class 1 = 30-34.9, 2 = 35-39.9, 3 > 40

Question 13

When is waist circumference measured? At what circumference is cardiovascular risk increased?

Answer 13

• measure WC for BMI 25-35

- increased CV risk for WC > 40 in men and >35 in women

Question 14

Do apples or pears have a higher risk of CV dz?

Answer 14

apples b/c they have more adipose tissue above the waist around their visceral organs

Question 15

What is the initial tx strategy for obesity?

Answer 15

lifestyle modifications: diet, physical activity

Question 16

What are the indications for weight loss surgery?

Answer 16

• BMI >40
• age 16-70
• failure of non-surgical wt loss
• psychologically stable, no eating disorders
• motivated pt, support system
• absence of alcohol or substance abuse

Question 17

What surgical options are available for wt loss?

Answer 17

• gastric sleeve
• gastric bypass (Roux-en-y)
• gastric adjustable band

Question 18

What is the gold standard for wt loss surgery?

Answer 18

gastric bypass/Roux-en-y

Question 19

What is the weight loss mechanism for gastric bypass/Roux-en-y surgery?

Answer 19

• restrictive

- malabsorption

Question 20

What is the weight loss mechanism for gastric sleeve?

Answer 20

restrictive

Question 21

What is the weight loss mechanism for adjustable band surgery?

Answer 21

restrictive

Question 22

Advantages and Disadvantages of Roux-en-y Surgery

Answer 22

• ad: most weight loss

- disad: staple leakage, dumping syndrome, nutritional deficiencies

Question 23

Advantages and Disadvantages of Gastric Sleeve Surgery

Answer 23

• ad: early satiety, decrease in hunger, less invasive

- disad: not reversible, N/V, staple leakage

Question 24

Advantages and Disadvantages of Gastric Adjustable Band

Answer 24

• ad: early satiety, reversible, adjustable band, no staples, low risk of nutritional deficiency
• disad: no effect on hunger, lower wt loss, implant, frequent visits to adjust band

Question 25

What are some of the common weight loss medications?

Answer 25

• orlistat (Alli)
• phentermine
• bupropion-naltrexone