A.10 Obesity

Question 1

A.10 Obesity

define

Answer 1

A metabolic/nutritional condition defined by an excessive accumulation of body fat.
A patient with a body mass index (BMI) of 30 or higher is classified as obese.
Children in the 95th percentile or above for weight and BMI are also considered obese.

Morbid obesity is diagnosed when a patient meets at least one of the following criteria:
- Weighs at least 45 kg over their ideal body weight
- Has a BMI of 40 or higher
- Has a BMI of 35 or higher accompanied by obesity-related health conditions (e.g., hypertension, diabetes)

Underweight < 18.5
Normal or Healthy Weight 18.5 - 24.9
Overweight 25 - 29.9
Class I Obesity3 0 - 34.9
Class II Obesity 35 - 39.9
Class III Obesity (Morbid) ≥ 40

Question 2

A.10 Obesity

Etiology

Answer 2

Obesity is multifactorial, involving both genetic predisposition and environmental factors. Ultimately, it arises from a longstanding imbalance between energy intake and energy expenditure.

Other Contributing Factors:

• Comorbidities: Conditions such as hypothyroidism, Cushing’s syndrome, and hyperinsulinism.
• Medications: Use of drugs like insulin, corticosteroids, and antipsychotics.
• Psychiatric Conditions: Various mental health issues can also play a role.

Question 3

A.10 Obesity

TX

Answer 3

Even a weight loss of 5-10% can enhance health and lower the risk of cardiovascular complications.

First-Line: Lifestyle Modifications
- Dietary Changes: Emphasize calorie restriction and healthy food choices.

• Physical Activity: Aim for a minimum of 30 minutes of moderate exercise per day (2.5 hours per week), which can increase insulin sensitivity, lower blood pressure, and aid in weight loss.

Medical Therapy:
- Manage conditions such as hypertension, diabetes (DM), and dyslipidemia using appropriate medications (e.g., ACE inhibitors).

Bariatric Surgery:
- For patients with a BMI of 40 or higher who have not succeeded with diet and lifestyle changes.

• Sleeve Gastrectomy: First-line option.
• Roux-en-Y Gastric Bypass: Alternative option.

Question 4

A.10 Obesity

Complications

Answer 4

1. Metabolic Syndrome:
2. Cardiovascular Disease
3. Type 2 Diabetes
4. Non-Alcoholic Steatohepatitis
5. Gastroesophageal Reflux Disease (GERD)
6. Obstructive Sleep Apnea
7. Certain Cancers: Primarily colorectal and breast.

Question 5

A.10 Obesity

Metabolic Syndrome

Answer 5

1. Metabolic Syndrome:
   Diagnosis requires the presence of at least 3 of the following conditions:

• Insulin Resistance: Fasting glucose ≥ 5.6 mmol/L (100 mg/dL)
• Elevated Blood Pressure: ≥ 130/85 mmHg
• Elevated Triglycerides: ≥ 150 mg/dL
• Low HDL-C: In men < 40 mg/dL; in women < 50 mg/dL
• Waist Circumference: ≥ 102 cm in men; ≥ 88 cm in women