Obesity Flashcards
DDx of Obesity
- increase caloric intake
- fluid retention (CHF, renal failure)
- Cushing’s
- hypothyroid
- PCOS
- metabolic syndrome
- drug/medication induced
- genetic obesity
Definition of Obesity
BMI > 30
increase in subQ fat tissue
What factors have contributed to the increase in obesity trends?
- diet: more processed and fast food
- larger portions
- convenience: fast food, packaged food
- less physical activity
- more electronics
How does BMI > 40 affect life expectancy?
decreased by 20 years in men and 5 years in women
What are some of the health risks and comorbidities associated with obesity?
- pulmonary problems, heart dz
- nonalcoholic fatty liver dz, GB dz
- stroke
- cataracts
- CA, osteoarthritis, gout
Obesity Screening Methods
- BMI
- waist circumference
- skinfold measurements with calipers
BMI
weight (kg) divided by height (in meters) squared
What are the drawbacks of using BMI as a measure of obesity?
- overestimate fatness in people who are muscular
- underestimate in older adults who have less muscle mass due to aging
What BMI is considered underweight?
below 18.5
What BMI range is normal?
18.5-24.9
What BMI range is considered overweight?
25-29.9
What BMI is considered obese?
> 30
class 1 = 30-34.9, 2 = 35-39.9, 3 > 40
When is waist circumference measured? At what circumference is cardiovascular risk increased?
- measure WC for BMI 25-35
- increased CV risk for WC > 40 in men and >35 in women
Do apples or pears have a higher risk of CV dz?
apples b/c they have more adipose tissue above the waist around their visceral organs
What is the initial tx strategy for obesity?
lifestyle modifications: diet, physical activity
What are the indications for weight loss surgery?
- 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
What surgical options are available for wt loss?
- gastric sleeve
- gastric bypass (Roux-en-y)
- gastric adjustable band
What is the gold standard for wt loss surgery?
gastric bypass/Roux-en-y
What is the weight loss mechanism for gastric bypass/Roux-en-y surgery?
- restrictive
- malabsorption
What is the weight loss mechanism for gastric sleeve?
restrictive
What is the weight loss mechanism for adjustable band surgery?
restrictive
Advantages and Disadvantages of Roux-en-y Surgery
- ad: most weight loss
- disad: staple leakage, dumping syndrome, nutritional deficiencies
Advantages and Disadvantages of Gastric Sleeve Surgery
- ad: early satiety, decrease in hunger, less invasive
- disad: not reversible, N/V, staple leakage
Advantages and Disadvantages of Gastric Adjustable Band
- 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
What are some of the common weight loss medications?
- orlistat (Alli)
- phentermine
- bupropion-naltrexone
