Obesity

Question 1

Principle characteristic of obesity is what?

Answer 1

excess adipose tissue

Question 2

BMI Classification?

Answer 2

BMI 25 -29.9 =overweight
BMI 30-34.9 obesity class 1
BMI 35-39.9 obesity class 2
BMI >40 class 3 or Morbid Obesity

Question 3

BMI calculation

Answer 3

BMI= weight (kg)/height(m)2

Question 4

At what percentile are US Children and Adolescent at risk for overweight?
Obese?

Answer 4

85th - 95th percentile at risk overweight

> 95th percentile for age Obesity

Question 5

LIMITATIONS of BMI

3

Answer 5

Fat mass versus lean mass
Distribution of fat
Ethnic differences

Question 6

The most accurate way to assess body composition is what? 2

Less accurate but lower cost? 2

Answer 6

Dexa scan , CT(high cost)

bioimpedance , water displacement

Question 7

What is the worst fat?

Answer 7

visceral, abdominal fat

Question 8

There are genes responsible but what is often the case at a molecular level?

Answer 8

leptin resistance (never full)

Question 9

Autosomal Dominant diseases that contribute to obesity?

2

Answer 9

1. PCOS

2. Prader-Willi syndrome(most common)

Question 10

Autosomal Recessive diseases that contribute to obesity?

2

Answer 10

1. Bradet-Biedl syndrome (polydactyly)

2. Cushing syndrome

Question 11

X-linked diseases that contribute to obesity?

1

Answer 11

Wilson-Turner

Question 12

MEDICAL COMPLICATIONS of OBESITY

Answer 12

Pulmonary disease-OSA, Restrictive lung disease.
Nonalcoholic fatty liver
OG/GYN –infertility.
Osteoarthritis.
Idiopathic intracranial HTN
CVA
Coronary artery disease.
      CHF , dyslipidemia, HTN.
Diabetes
Cancer- breast ,colon, pancreas ,uterus ,cervix
              esophagus, kidney, prostate
DVT , phlebitis, venous stasis

Question 13

DISEASES MADE WORSE WITH WEIGHT LOSS

3

Answer 13

Paradoxical effect on CHF if you already had it

Body mass loss leading to sarcopenia.

5 fold increase successful suicide rate following gastric bypass surgery.

Question 14

RESISTIN –increased level in what pts? 2

Resistin increases what substances in the body? 3

Answer 14

obesity , DM.

pro inflammatory cytokines : 1. interleukin,

2. TNF ,
3. intracellular adhesion molecule-1.

Question 15

Weight gain is directly related to these CV risk factors:

5

Answer 15

1. dyslipidemia 2. HTN 3. elevated insulin 4. elevated fibrinogen 5. OSA

Question 16

DIRECT EFFECT of INSULIN RESISTANCE on MYOCARDIUM

4

Answer 16

1. Epicardial fat deposition.
2. Increased intra-myocardial triglyceride deposition.
3. Lipotoxicity.
4. Cardiomyocyte apoptosis producing cardiac dysfunction.

Question 17

OBESITY CAUSES HTN.
How?
5

Answer 17

1. Enhanced sodium retention.
2. Vascular smooth muscle hypertrophy
3. Stimulation of renin-angiotensin-aldosterone pathway.
4. Increased activation of sympathetic NS increased vasoconstriction
5. Decreased NO mediated vasodilatation.

Question 18

OBESITY CAUSES LVH.
How?
4

Answer 18

1. Due to the need for high cardiac output.
2. Increases risk for SCD
3. Increases risk for CHF
4. Dx on ECG when sum of S inV1 and R in V5 >35mm

Question 19

OBESITY and CHF:

Possible causes?

Each increase in BMI of 1 unit increases risk of CHF in men and women? (percent)

Explain the paradox of CHF and weight.

Answer 19

Frequent complication of severe obesity.

Severe hypoxemia of OSA is one of several possible causes.

Each increase in BMI of 1 unit increases risk of CHF 5% man, 7% woman.

Paradox of established CHF Once the HF established , higher BMI has improved outcome.

Question 20

OBESITY and STROKE.
For each increase of 1 unit BMI.
hemorrhagic stroke increases ?
ischemic stroke increases ?

Answer 20

6%.

4%.

Question 21

OBESITY and PULMONARY DYSFUNCTION.

Pathology?
Causes an increase in?
Decrease in? 2

Arterial blood gases affected how?

Common side effect?

Increased risk for?

Answer 21

A restrictive ventilatory defect.

Increased RR and
decreased tidal volume and TLC.

Hypoxic arterial blood gases in moderate/severe obesity.

Dyspnea is common (with and without exercise ).

Increased risk for asthma.

Question 22

ALZHEIMER’S DISEASE and BMI.

In what population?

Answer 22

Obesity at high ages increases risk for AD in women.
For every 1 unit increase BMI at age 70 AD risk increases by 36%.
These associations were not found in men.

Question 23

OBESITY and OSA.

Occurs in what % of sevrely obese?

Answer 23

Occurs in in ~50% of severely obese.

OSA presents in up to 90% of obese patients seeking bariatric surgery.

Potentially life-threatening.

Question 24

RISK FACTORS for OSA.

4

Answer 24

1. Upper body obesity.
2. More common in males.
3. Associated with snorring (tiredness in the morning is more specific than snoring)
4. Large neck girth in those who snore is highly predictive of OSA (neck circumference >17inches in men ,16 inches in women).

Question 25

CV COMPLICATIONS of OSA. | 4

Answer 25

1. Acute coronary syndrome increase risk of plaque rupture increase risk of thrombosis 2. Increased risk of stroke. 3. HTN 4, Increased platelets aggregation.

Question 26

OBESITY and NON-ALCOHOLIC FATTY LIVER | this is a precursor to what?

Answer 26

Precursor to liver failure | Transient increase in transaminases with weight loss, especially rapid weight loss.

Question 27

Wealth of epidemiological data connecting obesity and various malignancies. What kinds? 6

Answer 27

1. Post menopausal breast cancer. 2. Colon , 3. pancreas , 4. endometrium, 5. kidney, 6. esophagus.

Question 28

Requirements for bariatric surgery | 2

Answer 28

BMI 35 or more with risk factors | BMI of 40 or more no matter what