Obesity and Metabolic Syndrome

Question 1

What are the factors used to determine obesity in children?

Answer 1

Age and Gender.
Obesity > 85th percentile for age and gender
Obese > 95th percentile for age and gender

Question 2

Definition of metabolic syndrome

Answer 2

Combination of 3 of the following

1. Fasting glucose > 110 mg/dL
2. Waist circumference > 40 “ men and > 35 “ women
3. HDL < 50 women, < 40 men
4. Triglycerides > 150
5. BP > 130/85

WHO includes microalbuminuria

Question 3

Definition of prediabetes

Answer 3

A1C 5.7-6.4 %
Impaired fasting glc (100-125)
impaired glucose tolerance after 75 g load (140-199)

Question 4

What is the main intervention for metabolic syndrome?

Answer 4

weight loss, weight loss, weight loss
- not metformin, not a statin, not a particular diet

A recommendation

Question 5

What are lifestyle change recommendations you should make for weight loss

Answer 5

1. Reduce calorie intake by > 500 kcal/day
2. Aerobic physical activity > 150 min/week
3. resistance training > 2 times per week

Question 6

How many K cal = 1 lb weight loss?

Answer 6

3500 kcal = 1 pound weight loss

500 kcal/day

Question 7

How should you counsel pts on appropriate exercise?

Answer 7

• 5-7 times/week (45-60 for weight loss)
• 150 min/week of moderate aerobic activity
• 55-69% predicted max HR
• resistance training: 5 major muscle groups twice weekly

Question 8

What is the most effective form of weight loss?

Answer 8

Bariatric surgery

Reduces all cause mortality - primarily cardiac

Question 9

Indications for bariatric surgery

Answer 9

BMI > 40 or > 35 with obesity-related comorbidities

Question 10

Complications of bariatric surgery:

• most common cause of death after bariatric surgery
• most common complication
• most common deficiency

Answer 10

• PE
• gallstones
• iron deficiency anemia

Question 11

What do you need to monitor after Roux en Y?

Answer 11

Every 3 mo for 1st year: CBC, BMP
Every 6 mo for 1st year: 
- LFTs
- iron studies
- Vit B12, folic acid, thiamine
- Calcium, vit D, parathyroid hormone
- lipids

Question 12

Which medications should be avoided in bariatric surgery patients?

Answer 12

• NSAIDs –> risk anastomotic ulcers

- enteric coated or XR medications

Question 13

When should asymptomatic adults be screened for diabetes according to USPSTF?
How often should you rescreen?

Answer 13

• Asymptomatic adults age 40-70 years who are overweight

- rescreen every 3 years

Question 14

Who does the ADA recommend be screened for Diabetes?

Answer 14

• screen at age 45, and every 3 years after that if normal

- screen if BMI > 25 (BMI > 23 if asian) and 1 additional risk factor (typical risk factors for DM)

Question 15

When should you screen children for diabetes? How often should they be screened?

Answer 15

Age 10 or puberty if

• BMI or weight > 85th %ile
• 2 of the following risk factors: family hx, high risk ethnic/racial group, signs or symptoms of insulin resistance (acanthosis nigricans, HTN, HLD, PCOS)

Screen every 2 years in this group