Week 2- Obesity Flashcards
1
Q
how to measure BMI
A
weight (kg) divided by height (m) sqaured
2
Q
what is the 3 BMI classes for obesity
A
Obesity ≥ 30 kg/m2
- Class I 30 - 34.9
- Class II 35 - 39.9
- Class III 40+
3
Q
what is a obese BMI
A
Obesity ≥ 30 kg/m2
4
Q
what are the limitations of BMI
A
- correlates with excess adipose tissue but does not reflect body composition
- does not differentiate between fat mass and fat-free mass
- does not account for body fat distribution
- limited applicability to certain populations including: young adults, athletes, older adults (over 65 years), pregnant females, and certain racial/ethnic groups (Asian, Black and Canadian First Nations, including Inuit)
- e.g. Japan uses > 25 kg/m2 as the cut-off for obesity
5
Q
waist circumference measures?
A
index of central adiposity (abdominal obesity)
6
Q
what is an obese waist circumference in female and male
A
female > 35 inches/ 88cm
male > 40 inches/ 102cm
7
Q
where to measure waist circumference
A
approximate midpoint between the lowest rib and the top of the iliac crest
8
Q
what has a higher LR+; BMI or waist circumference
A
BMI
9
Q
waist to hip ratio
A
- waist measurement (same as waist circumference) divided by hip measurement taken around the widest portion of the buttocks
10
Q
what is waist to hi[ ratio for
A
assess body fat distribution
11
Q
what is an obese waist to hip ratio for males and females
A
male >1
female >0.85
12
Q
dual energy x ray absorptiometry (DXA) strengths and limitations
A
precise
expensive, radiation, limited use BMI >35
13
Q
bioelectric impedance (BIA) strengths and limitations
A
convenient, portable, inexpensive, accurate for lean body mass
accuracy reduced by poor hydration status, under-estimates fat mass in overweight and obese people
14
Q
skinfold thickness strengths and limitations
A
convenient, portable, inexpensive
hard to calibrate, not as accurate or reproducible
15
Q
what is the gold standard for body fat assessment, used to establish accuracy of BMI?
A
Obesity, BF% or BMI (dual energy x- ray absorptiometry, DXA)
16
Q
gold standard for BF%, obesity, BMI
A
DXA
17
Q
what physical exams to assess for obesity
A
- BMI (height + weight)
- degree and distribution of body fat (e.g. waist circumference)
- overall nutritional status
- blood pressure
- other relevant physical exams to assess secondary causes of weight gain
18
Q
what labs for obesity?
A
all patients should be screened for comorbid conditions, including: fasting glucose, hemoglobin A1c (HbA1c), lipid panel, and comprehensive metabolic profile (i.e. electrolytes, kidney function, liver function, calcium, glucose)
19
Q
how many adult Canadians are obese
A
1 in 3
20
Q
medical history to consider in obesity
A
- the age at onset of weight gain
- recent weight changes (watch for rapid weight gain)
- family history of obesity
- occupational history
- eating and exercise behavior
- previous weight loss experience
- psychosocial factors, including assessment for mood and eating disorders
knowing this information will help differentiate between primary and secondary weight gain
21
Q
what is primary weight gain
A
accumulate adipose tissue from imbalance of caloric intake and energy expenditure
22
Q
what age and gender is primary weight gain more common for
A
F > M
24-34 years old
adults after 55 years tend to lose weight
23
Q
primary weight gain formula
A
increase caloric intake, appetite
decreased physical activity level, basal metabolic rate (BMR) and thermic effect of food
24
Q
environmental factors contributing weight gain
A
increased caloric intake (processed), eating patterns (binging), alcohol (liquid calories), insufficient sleep, smoking cessation, sedentary lifestyle, physical disability, obesogenic environment, society (SES), culture, environmental chemicals (endocrine disrupting)
25
abnormalities in brain gut axis in obesity
-satiety decreased (PYY decrease)
- increases gastric emptying and volume
-pscyhological (depression and anxiety)
26
what is secondary weight gain?
accumulation of adipose tissue from genetics, medical conditions (i.e. neuroendocrine disorders) or medication side effects
-->secondary causes can co exist with primary obesity
27
genetic contribution to secondary weight gain
-multiple genes (polygenic)
-->i.e - Prader-Willi syndrome, Laurence-Moon syndrome, Cohen syndrome, and
Biemond syndrome
genes affect leptin/melanocortin pathway
28
genetic influence % of obesity and what on
90% inter-individual variation
total body fat, fat-free mass, body fat distribution, basal
metabolic rate, physical activity, macronutrient intake and eating behavior
29
Cushing's syndrome (endocrine disorder associated with weight gain)
hypercortisolism (high cortisol) alters metabolism causing visceral adiposity and insulin resistance (T2D cormorbid)
30
hyperinsulinemia (endocrine disorder associated with weight gain)
elevated insulin; insulin resistance preceding T2D
31
hypothyroidism (endocrine disorder associated with weight gain)
low serum thyroid hormone
reduced BMR and thermogenesis, water and salt accumulate (<10%)
32
hypogonadism (endocrine disorder associated with weight gain)
male; low testosterone
alter metabolism, increase central adiposity and insulin resistance
33
PCOS (endocrine disorder associated with weight gain)
irregular mensturation, hyperandrogegism, and/or polycystic ovaries --> obesity and insulin resistance
34
obesity related pregnancy complications
- gestational diabetes
- gestational hypertension and pre-
eclampsia
- thromboembolism
- sleep apnea
- mortality
***- augmentation + instrumentation of
labour
***- cesarean deliveries
- postpartum hemorrhage
- postpartum weight retention
35
what is gestational diabetes
any degree of glucose intolerance with onset or first recognition during pregnancy due to either pancreatic dysfunction or placental hormone-induced insulin resistance
36
what BMI is associated with gestational diabetes
BMI >25
37
patient labs/ history for gestational diabetes
CVD, PCOS, hypertension, low HDL, HbA1c >5.7
38
which weeks are testing for gestational diabetes done at
24-28 weeks
39
what is the 2 step test for gestational diabetes
1. oral glucose challenge test for 1 hours
if over a certain value do for 2 hours to diagnose
40
management of gestational diabetes
type 1= diet
type 2= medication
41
risks in gestational diabetes
increased risk of stillbirth, pre-eclampsia, shoulder dystocia, c-section, large for gestational age infants
- 35-60% risk of T2DM in 10-20 yrs
42
what is a risk of obese waist circumference
increased cardio metabolic risk
43
what % is secondary weight gain
like 1%....
44
what is pre-eclampsia
hypertension (140/90) after 20 weeks of gestation (pregnant) WITH proteinuria and/or end-organ dysfunction (renal dysfunction, liver dysfunction, central nervous system disturbances, pulmonary edema, thrombocytopenia)
45
what differentiated pre-eclampsia from gestational hypertension
pre eclampsia is with proteinuria or end organ dyfunction
46
what can cause pre-eclampsia? which BMI > puts at risk?
BMI > 30
autoimmune disease, chronic hypertension, diabetes (type 1 or 2), Hx of pre- eclampsia, muti-fetal gestation, renal disease; age > 35yrs, Black race or low socioeconomic status, fHx pre-eclampsia (mother, sister), BMI >30, nulliparity
47
symptoms of pre-eclampsia
new onset headache (+/- visual disturbance), RUQ or epigastric pain with associated N/V, dyspnea, increase in swelling
48
diagnose pre-eclampsia
BP ≥ 140/90 mmHg, plus proteinuria or one of the following: - thrombocytopenia (low platelets), ↑ AST +/- ALT, ↑ creatinine
49
what to manage in pre-eclampsia
BP and seizure prevention
50
prognosis for preeclampsia
good with early detection and delivery at 37 weeks (or 34 weeks if severe)
cannot go full term; induce labour early
51
slide 32 chart for hypertensive disorders of pregnancy
x
52
what week in pregnancy to diagnose pre-eclampsia
20 weeks of gestation
53
maternal complications if obese
-risk of labour induction
-shoulder dystocia from fetal macrosomia and excess pelvic adiposity
-risk of cesarean deliveries
-postaprtum hemorrhage
-hard to use labour instruments
-anesthesia complications
-in hospital longer
54
birth outcomes for obese moms
-prengnacy loss
-still birth
-congenital abnormalities (i.e. neural tube defects)
-macrosomia (big baby)
-kid can develop obesity, metabolic disorders and neurodevelopment (i.e. autism), asthma
-failure to initiated breastfeeding
55
recommended weight gain in pregnancy and in what trimesters
if low by than 1lb/ week
if BMI >30 then 0.5lb/week
**this is in the 2nd and 3rd trimesters not the 1st (dont want to gain weight in the 1st)
56
total weight gain recommended if BMI>30
5-9kg / 11-20lbs
57
what is menopause? how long must menses be stopped for?
a non-pathologic estrogen-deficient condition involving the permanent cessation of menses for at least 12 months
58
what is menopause associated with
-altered body composition (more visceral fat, because low estrogen tells fat to go to stomach not hips and butt)
-reduced energy expenditure
-moode; depressed
59
medications associated with weight gain
CHART on slide 39
60
red flag findings of rapid weight gain over days to weeks
Difficulty breathing or coughing at night
Inability to sleep lying flat
Recent increase in waist or pant-size
Yellowing of skin or whites of eyes (jaundice) OR tea-coloured urine
Prolonged or excessive bleeding Reduction in urination
Nausea, vomiting, generalized itch Swelling in feet, ankles or legs
Increased thirst or urination
Blurry vision
Pain or stiffness in joints
Chest tightness or pressure brought on by exertion or emotional stress
Snoring or stop breathing at night
Difficulty staying awake during day
--> flow chart of slide 41
i.e. if have ascites, jaundice and coagulopathy it could be chronic liver diesease and you would treat the weight gain as secondary
61
health conditions associated with obesity
Coronary artery disease
Congestive heart failure
Stroke
Emphysema, chronic bronchitis, or obstructive pulmonary disease
Pulmonary embolism Deep vein thrombosis Cancer
Diabetes Hypercholesterolemia Hypertension
Depression
Macular degeneration Cataract removal Glaucoma
Asthma
Gingivitis
GERD
Ulcers
Gallbladder removal Pancreatitis
Kidney disease (+ stones) Osteoarthritis
Knee + hip replacement
Neck, back or joint pain
Frequent headaches
Stress
Fatigue/lack of energy
Feeling depressed/ anxious
Chronic insomnia Indigestion or heartburn Impotence
Skin problems
Bladder + yeast infections
62
proprtion of disease prevalence attributable to obesity
T2D - 61%
uterine cancer 34%
gallbladder disease 30%
osteoarthritis 24%
63
serious comorbid disease prevalence in obese populations
NAFLD 60-90%
hypertension 49-65%
hyperlipidemia 34-41%
64
charts slide 47-50
xx
65
T2D and obesity
hyperglycemia bc of insulin resistance
9% of people with diabetes have obesity...
increased thirst, increased hunger, increased urination, fatigue
acanthosis nigricans, prone to infections, delayed wound healing; may also have peripheral neuropathy (numbness or tingling in hands/feet) or blurred vision
66
T2D diagnosis
hemoglobin A1c (HbA1c) or fasting blood glucose (FBG)
- FBG > 7.0 mmol/L OR HbA1c > 6.5%
67
t2d and obesity
- 80% of patients with T2DM are obese
- 7-20% of obese adults have T2DM
68
obstructive sleep apnea
prevalence; 45% in obese adults
risk factors: obesity, advanced age (40-70yrs), male, supine sleep position, fHx of OSA, retrognathia, commercial motor vehicle driver, postmenopausal women not on HRT
69
diagnose obstructive sleep apnea
polysomnography
- BMI, neck circumference > 40 cm (16 inches), chin position, narrow
oropharyngeal opening
70
sleep apnea questionnaire
STOP Bang!
snore
tired
observed apnea
high blood pressure
bmi
age
neck circumference
male gender
71
NAFLD
prevalence is 80-90% in obese
spectrum of conditions characterized by hepatic steatosis on imaging or histology and the absence of secondary causes
diagnosis: ultrasound, liver biopsy
- hepatomegaly, mildly elevated or normal ALT / AST, AST:ALT <1
prognosis: steatosis is reversible/non-progressive, non-alcoholic streatohepatitis can
progress to cirrhosis (risk of hepatocellular carcinoma 2.4% over 7yrs)
72
weight loss needed for steatosis and non alcoholic steatohepatitis
weight loss 3-5% for steatosis, 7-10% in non-alcoholic steatohepatitis
73
slide 61-63 for flow chart
if super high BMI and 2+ risk factors might want weight loss surgery
lower risk is lifestyle changes and pharmacotherapy
74
baraiatric surgery 4 (band, sleeve, bypass, duodenal switch) --> what followup labs do you want
CMC, lipids, bone densitometry, urine excretion, b12, folic acid, iron, vitamin D, iPTH, vitamin A, copper, zinc, selenium, thiamine, ...
75
Edmonton obesity staging system (EOSS)
ranks mortality risk in overweight individuals based on obesity-related comorbidities and functional status.
-4 stages of disease
-stage 0 and 1 are no clinical and subclinical risk factors
-stage 2 is established disease
76
how much weight loss can show change
- weight loss of 5-10% is sufficient in many patients to achieve clinically relevant improvements in many risk factors (hypertension, dyslipidemia, dysglycemia) in a “dose-dependent” manner
