- obesity isn't a simple mendelian trait - single genes are only found in the mouse - there is an autosomal recessive mutation, chromosome 6, the leptin gene (obese people develop resistance to leptin) - multiple genes and it is transgenic - there are so far 176 different himan cases of obesity due to single gene defects

Obesity Flashcards by Emily Hendrickson

Formula for BMI?

BMI= wt (kg)/ht (m)^2

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BMI classification:

BMI: 25- 29.9 overweight
30-34.9 obesity class 1
35-39.9 obesity class 2
>40 class 3 or morbidly obese

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BMI in US children and adolescent?

85th-95th percentile at risk for being overweight
> 95th percentile for age obesity
if both parents are obese: 87% chance child will be obese

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Obesity prevalence 2009-2010

obesity prevalence: age 2-19
all groups: 35.7%
males: 35.8%, females: 35.5%

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Cost of childhood obesity?

national epidemic
costs 3 billion dollars annually
economic calculations will clim higher: consider long term disability, lost earnings

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Cost of obesity and overweight all ages?

direct cost: preventive, dx and tx services
indirect cost: value of lost wages
cost now est at $270 billion a year

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Why are there limitations to BMI?

fat mass versus lean mass
distribution of fat
ethnic differences

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What is the most accurate way to assess body composition? what is a cheaper way?

most accurate: DEXA scan, CT (expensive)

- less accurate but lower cost: bioimpendance, water displacement

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What is worse, an android fat distribution or gynoid?

apple/andriod is worse: excess fat in the abdomen, its more common in men, significant correlation with metabolic syndrome
pear/gynoid: is excess fat on thighs and buttocks, common in women, and no significant correlation with metabolic syndrome

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Distribution of adipose tissue?

upper body: subq, superficial and deep
lower body: visceral - worse, hold all the toxic hormones and enzymes that promotes metabolic syndromes
also ectopic, and IMAT

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Why is there a BMI limitation because of ethnic differentiation?

at any given BMI the % FM of asians 5% higher compared to caucasians
african americans>jamaicans> nigerians

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Prevalence of obesity?

BMI>25 68%
> 30 35%
> 40 6.5%
(people who are overweight are becoming obese)

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Why are we becoming an obese society?

genetics
cultural
societal

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Genetics of obesity?

obesity isn’t a simple mendelian trait
single genes are only found in the mouse
there is an autosomal recessive mutation, chromosome 6, the leptin gene (obese people develop resistance to leptin)
multiple genes and it is transgenic
there are so far 176 different himan cases of obesity due to single gene defects

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What is genetical obesity related to?

- autosomal dominant:
  PCOS
 prader-willi syndrome (most common)
- autosomal recessive:
Bradet-Biedl syndrome (polydactyly) facial features, wide eyes, mental retardation
cushing syndrome
x linked wilson turner

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Other enviro causative agents of obesity?

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convenience foods
portion size
increased flight transportation
adeno 13 virus
societal issues
post viename society: YOLO
sedentary behavior

Medical complications of obesity?

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pumonary disease: OSA, restrictive lung disease
nonalcoholic fatty liver
OB/GYN: infertility
osteoarthritis
idiopathic intracranial HTN
CVA
CAD
CHF, dyslipidemia, HTN
diabetes
cancer: breast, colon, pancreas, uterus, cervix, esophagus, kidney, prostate
DVT, phlebitis, venous stasis

How much of a wt loss is beneficial?

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10% wt loss will beneficially improve the following conditions:
RA, OA, cancer, CAD, DM, DVT, HTN, lung disease, OSA, OBGYN complications, incontinence, pancreatitis

What diseases are made worse with wt loss?

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paradoxical effect on CHF if you already have HF and become obese, HF wont get worse
body mass loss leading to sarcopenia (because bones are carrying so much wt when obese)
5 fold increase successful suicide rate following gastric bypass surgery (don’t feel safe anymore)

Relationship of obesity and mortality

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increased mortality in all age groups (35-89)
lowest mortality rates are for those with BMI 20-22
mortality begins to increase modestly with BMI > 25
BMI > 30, all cause mortality rates increase by 50-100%

Relationship b/t adipocytes and inflammation?

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resistin: increased level in obesity, DM
resistin increases pro inflammatory cytokines: IL, TNF, intracellular adhesion molecule-1
- found that pts that lost wt didn’t need ortho surgery anymore because inflammatory cytokines were decreased because of decreased wt load

CVD risk and obesity? CV risk factors

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wt gain is directly related to these CV risk factors:
dyslipidemia
HTN
elevated insulin
elevated fibrinogen
OSA

insulin resistance has a direct effec on what and why is this?

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direct effect on myocardium
epicardial fat deposition
increased intra-myocardial triglyceride deposition
lipotoxicity
cardiomyocyte apoptosis producing cardiac dysfunction

How does obesity cause HTN?

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enhanced sodium retention
vascular smooth muscle hypertrophy
stimulation of renin-angiotensin aldosterone pathway
increased activation of sympathetic NS increased vasoconstriction
decreased NO mediated vasodilation

How does obesity cause LVH?

- due to need for high cardiac output - increases risk for SCD - increases risk for CHF - dx on ECG when sum of S in V1 and R in V5 > 35 mm

Relationship b/t obesity and CHF?

- 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, and 7% in women - paraox of est. CHF: once HF est, higher BMI has improved outcome

Relationship b/t obesity and stroke?

- for each increase of 1 unit BMI - hemorrhagic stroke increases 6% and ischemic stroke increases by 4%

Relationship b/t obesity and pulmonary dysfunction?

- a restrictive ventilatory defect (diaphragm pushed up against lungs because of fat tissue, so total lung capacity is decreased -> hypoxia) - increased RR and decreased tidal volume and TLC - hypoxic arterial blood gases in moderate/severe obesity - dyspnea is common (w/ and w/o exercise) - increased risk for asthma

Relationship b/t alzheimers and BMI?

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 weren't found in men because they didn't live that long

Obesity and OSA?

- occurs in 50% of severly obese - OSA presents in up to 90% of obese pts seeking bariatric surgery - potentially life threatening

Risk factors for OSA?

- upper body obesity - more common in males - associated with snoring (tiredness in morning more specific than snoring) - large neck girth in those who snore is highly predictiv of OSA (circumference > 17 in in men and 16 inches in women)

CV complications of OSA

- acute coronary syndrome: increase risk of plaque rupture, increase risk of thrombosis - increased risk of stroke - HTN - increased platelets aggregation - increased platelets aggregation

Effect of wt loss and OSA?

p 10% of wt reduction iproves severity of OSA by more than 50%

Obesity and non-alcoholic fatty liver?

- occurs > 66% in obese, > 90% in BMI > 40, precursor to liver failure, transient increase in transaminases with wt loss, especially rapid wt loss (after a couple of months liver enzymes will go back down to normal levels)

What percentage of cancer deaths are attributed to dietary factors?

- 35%

relationship b/t obesity and cancer?

- wealth of epidemiological data connecting obesity and various malignancies: post menopausal breast cancer, colon, pancreas, endometrium, kidney, and esophageal cancer - premenopausal breast cancer: 2 large studies revealed that a 70% increased risk of premenopausal breast canacer vs. normal wt

Obesity Flashcards

(36 cards)