obesity and metabolic syndrome Flashcards
- Define obesity
BMI 30-34.9 (high), 35-39.9 (very high) and >40 (extremely high). Waist circumference >40in in men or >35 in women.
what is the current percentage of obese and overweight people in US
35.7% are obese, 33% are overweight
Which groups is BMI less accurate
Elderly, certain ethnic groups, large muscle mass
What is abdominal adiposity a predictor of
risk for DM, HTN, CAD and dyslipidemia
Why is abdominal obesity bad
Free fatty acids from intra-peritoneal fat is released into blood stream then into the liver where it causes insulin resistance.
When is waist circumference most helpful
in the BMI range of 25-35, where an elevated WC confers and increased risk of DM2, HTN and CAD. At BMI greater than this, WC doesn’t change risk
Which ethnicity has highest risk of CV disease with increased waist circumference
men: hispanics. Women: whites
At what BMI does risk of DM2 increase
BMI>21-23
how does hypertension correlate with BMI
As BMI increases, HTN increases linearly
how does BMI correlate with dyslipidemia
Cholesterol >240mg/dl increases progresively with BMI in men. In women, prevalence is higest at BMI25-27 and does not increase further with increasing BMI
BMI and CAD
Risk of CAD increases at BMI of 23 for men and 22 for women
Stroke and BMI
For each unit change in BMI, there is an 8% increase in hypertensive death and ischemic strok
What is obstructive slep apnea linked with
systemic HTN and increased risk of CAD, stroke, CHF, arrythmia, pulm HTN, DM2.
Which cancers have increased risk in obesity
Post menopausal breast, colon, endometrial, renal cell, esophageal, pancreatic, prostate, cervical
Which BMI has lowest risk of cardiovascular death
23.5-24.9. Risk increases dramatically as BMI increases
- List the possible causes of obesity.
Long term positive energy balance- genetics plays a role in obesity but alterations in environment are the main cause of the recent increase in obesity. Causes include portion sizes, high glycemic index foods, taste, added sugar, sedentary workplaces and schools, automobiles, drive throughs, TV, cost of fruits/veggies, etc
- Define Metabolic Syndrome using the current AHA/NCEP definition.
Consists of at least 3 of 5 risk factors which place patient at risk for developing type 2 diabets and CVD. Hallmarks are: abdominal obesity, elevated triglycerides, low HDL, increased BP, and increased fasting glucose
What are the defining levels for waist circumference, TG, HDL-C. BP and fasting glucose in metabolic syndrome
Waist: men >40, womn >35in. TGL >150mg/dl. HDL men 130/85. Fasting glucose > 100mg/dl
How does risk of CVD correlate with DM2
Risk is elevated even before being diagnosed with Diabetes. That risk increases even more after being diagnosed
describe regulation of food intake
food intake causes release of signals such as cortisol (adrenal glands), leptin (adipose), ghrelin (pancreas), insulin (pancreas), and central signals from the brain. These either promote or inhibit food intake.
Leptin function
Leptin is produced by fat cells, released into the circulation, and it crosses the blood-brain barrier to bind to its receptor in the hypothalamus, which stimulates the expression of neuropeptides and neurotransmitters that inhibit food intake.
- List the steps in the clinical evaluation of the obese patient.
step 1: Office assessment-Evaluate for obesity related diseases, rule out medical causes for obestity, search for triggers such as meds, determine readiness to lose weight, initiate treatment plan, discuss goals and expectations. Step 2: long term treatment plan
What are some medical causes of obesity
Meds: steroids, anti-psychotics, anti depressants, insulin, beta blockers, hormones. Secondary causes: hypothyroidism, cushings syndrome, Prader willi, downs, hypothalamic disorder
how to assess for weight loss readiness
Motivation, stress level (free of major life crises), no psychiatric issues, time availability (15-30 min/day for weight control). If these things are not in place, focus on preventing additional weight gain and explore barriers to weight reduction.
how does a 5% vs 10% weigh loss affect A1C, BP, cholesterol, HDL and triglycerides
At 5% A1C, BP, and total cholesterol decrease. HDL increases and triglycerides do not change. At 10%, triglycerides drop.
- List the health problems that are associated with obesity.
sleep apnea, arthritis, insulin resistance, cancer, social disability, heart disease, fatty liver, PCOS
list routine lab evaluation of patient with obesity
TSH, diabetes screening, A1C, fasting lipid panel, liver associated enzymes, sleep study possibly
