Adult Obesity & Metabolic Syndrome Flashcards Preview

DEMS: Unit IIb > Adult Obesity & Metabolic Syndrome > Flashcards

Flashcards in Adult Obesity & Metabolic Syndrome Deck (12)
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1

BMI definition of obesity

  • Normal → 18.5 - 25 kg/m2
  • Overweight → 25 - 29.9 kg/m2
  • Obese → ≥ 30 kg/m2
  • Morbid Obesity → ≥ 40 kg/m2; in US qualifies for bariatric surgery

2

BMI formula

Formula = wt (kg)/ height2 (m2)

3

Waist circumference definition of obesity

  • High medical risk is defined as a waist circumference in
    • Men > 40 inches / 102 cm
    • Women > 35 inches / 88 cm
  • Measure waist at top of iliac crests

4

Possible causes of obesity

  • Bottom Line: Calories in > Calories out.
    • Major conveniences ==> decreased physical activity
    • Food is better tasting, more dangerous, bigger portions, widely available
  • Genetic interactions with environment
    • Pima Indians in Mexico vs. AZ.
      • Same Genes but way higher DM in AZ
  • Psychiatric disease
  • Sedentary lifestyle and barriers to activity
  • Medications that cause weight gain

5

Health problems associated w/obseity

  • Obstructive sleep apnea → 40% prev
  • Type 2 diabetes
  • Hypertension
  • Hyperlipidemia
  • Cardiovascular disease
  • Non-alcoholic fatty liver disease
  • Erectile dysfunction and infertility
  • Certain forms of cancer (e.g., breast, colon)
  • Depression
  • Low back pain
  • Osteoarthritis

6

General definition of metabolic syndrome

  • specific body phenotype of abdominal obesity
  • associated with a group of metabolic disorders that are risk factors for cardiovascular disease, including coronary artery disease, stroke, and congestive heart failure.

 

7

Criteria for Metabolic syndrome in men

  • Abd obesity = > 40 in / 102 cm
  • Triglycerides = ≥ 150 mg/dL OR  on ↑ TG drug
  • HDL = < 40 mg/dL OR on drug for ↓ HDL
  • BP = ≥ 130 systolic OR ≥ 85 diastolic OR on Anti HT drug
  • Fasting glucose = ≥ 100 mg/dL OR on hypoglycemic drug

8

Criteria for Metabolic syndrome in women

  • Abd obesity = > 35 in / 88 cm
  • Triglycerides = ≥ 150 mg/dL or  on ↑ TG drug
  • HDL = < 50 mg/dL or on  drug for ↓ HDL
  • BP = ≥ 130 systolic OR ≥ 85 diastolic OR on Anti HT drug
  • Fasting glucose = ≥ 100 mg/dL OR on hypoglycemic drug

9

Medical History taking in the obese patient

  • Chronological history of body weight changes
  • Previous weight loss attempts
  • Obesity related medical complic.    
  • Medications that cause weight gain
  • Current diet and physical activity patterns
  • Goals of treatment
  • Readiness and motivation for treatment including screening for depression
  • Goals for weight loss

10

Social/Family hx taking in the obese patient

  • Social Hx: Smoking and other
  • Family Hx: obesity and co-morbidities

11

Physical exam in the obese patient

  • Height, weight, BMI, Waist circum.
  • BP with appropriate cuff size
  • Skin changes → acanthosis?
  • Signs of pulmonary HT/venous insufficiency → edema?
  • Signs of thyroid disease → goiter?
  • Signs of dyslipidemia
  • Signs of diabetes

 

12

Lab/diagnostic tests in the obese patient

  • Thyroid stimulating hormone (TSH)
  • Fasting blood glucose and Hb A1c
  • Fasting lipid panel
  • Liver panel
  • Remainder of tests determined by individual assessment and clinical suspicion (e.g., sleep study)