| What is obesity? | Global epidemic (1997), disease (2013) which predisposes to overall reduction of quality of life and premature death.
It is defined as abnormal or excessive fat accumulation that may impair health. |
| How is obesity measured? | Usually using BMI (w/h2) which correlates w/total body fat.
Healthy (18.5-25) overweight (25-30) obese I (30-35) obese II (35-40) obese III (>40)
Although BMI alone is not diagnostic, waist circumference and waist/hip ratio are useful to categorize pt as normal or overweight.
Individuals w/waist circumference >94cm for men and 80cm women is a risk category |
| How is children obesity? | In children use of BMI is confusing (wide variations acc to age and sex), majority of centers use CDC BMI for age growth chart (Obesity BMI>95th percentile for age and overweight between 85-95th percentile |
| List some other procedures used in evaluation of body fat? | • Caliper-derived measurements of skin-fold thickness
• Dual-energy radiographic absorptiometry (DEXA)
• Bioelectrical impedance analysis
• Ultrasonography to determine fat thickness
• Underwater weighing |
| How is epidemiology of obesity? | In lebanon prevalence is 31%, in 2016 6% of girls and 8% of boys age 5-19 are obese
In USA prevalence was 18.5%, affected 13.7 million children and adolescents |
| What are the childhood obesity effects on health and well-being? | Short-term (increased risk of CVD, high cholesterol, HTN, prediabetes, bone and joint problems, sleep apnea, psycosocial issues (low esteem))
Long-term (increased risk of adult obesity, heart disease, T2DM, stroke, cancer, osteoarthritis) |
| How is the pathophysiology of obesity? | It is a complex and multifactorial disease where imbalance between energy intake and expenditure (problems in adipose, genetics, pancreas, gut, meds, inactive cessation of smoke, lifestyle)
We have interaction among hormonal and neural pathways that regulate food intake and body fat mass (major hormone controlling weight is leptin (stimulates POMC which stimulates paraventricular nucleus releases hypothalamic hormones), Ghrelin on the other hand is inhibitory (stimulates NPY and AgRP to inhibit PVN)
So main parts are paraventricular nucleus and arcuate nucleus. |
| What are causes of obesity? | 30% genetic predisposition, but environment is major factor determining expression of obesity.
Secondary causes (hypothyroid, Cushing's, insulinoma, PCOS, hypothalamic obesity, GH deficiency, OCP, meds (phenothiazine, valproate, carbamazepine, antidepressants, cortisol, insulin), eating disorders (binge-eating, bulimia nervosa, night-eating) hypogonadism, pseudohypoparathyroid, obesity of tube feeding. |
| What are health consequences of obesity? | Life expectance in 40 years for obese people is reduced by 7 years in women and 6 years in men
Metabolic comorbidities (cancers, asthma, fatty liver, gallstones, infertility, CVD, T2DM, prediabetes, thrombosis, gout)
Mechanical comorbidities (urinary incontinence, arthrosis, sleep apnea, chronic back pain)
Mental disorders (depression and anxiety) |
| What is metabolic syndrome? | individuals at increased risk of type 2
diabetes and cardiovascular diseases (CVD) due to the
metabolic dysfunction commonly seen in individuals
with insulin resistance |
| What are diagnostic criteria of metabolic syndrome? | 3/5 criteria is diagnostic.
increased waist circumference (specific community), increased TGs (>150mg/dl), reduced HDL (<40mg/dl men and <50mg/dl women), increased BP (sys>130 dia>85), increased fasting glucose (>100mg/dl) |
| How is risk indication of metabolic disease? | It is not an absolute risk indicator (no factors determining absolute risk like age, sex, smoking, LDL-CT levels)
Metabolic syndrome pt risk for CVD X2 over next 5-10 years, and risk for T2DM 5X |
| How is clinical evaluation of obese pt? | Hx (ethnicity, family hx, dietary habits, physical activity, eating patterns and disorders, depression or mood disorders, determinants like genetics or drugs or endocrinopathy, consequences of obesity, motivation for change and previous tx of obesity)
PE (measure weight and height, WC, BP, obesity-related diseases (DM, HTN, dyslipidemia, CVD), acanthosis nigricans for insulin resistance)
Labs (FBG, serum lipid profile, uric acid, thyroid function, liver function, CV assessment, endocrine evaluation, liver investigation for abnormal liver tests, sleep lab for sleep apnea) |
