final - obesity Flashcards
(23 cards)
What is obesity?
- “Obesity is defined as a chronic, progressive, relapsing, and treatable multi-factorial, neurobehavioral disease, wherein an increase in body fat promotes adipose tissue dysfunction and abnormal fat mass physical forces, resulting in adverse metabolic, biomechanical, and psychosocial health consequences.”
- Obesity Algorithm 2023, ObesityMedicine.org
- Percent of adults aged 20 and over with obesity: 41.9%
Economic Burden of Obesity: Projected Obesity-Related Health Care Costs
- The U.S. could save $611.7 billion in health care costs by 2030 if the BMI of the average adult were reduced just 5%.
- Robert Wood Johnson Foundation. http://healthyamericans.org/assets/files/TFAH2013FasInFatReportFinal%209.9.pdf
What is ABCD? of obesity
ABCD- (Adiposity Based Chronic Disease)
- -Highlights that this disease is more than just BMI(>30kg/m2) it is multifactorial
- -BMI alone not a good indicator: doesn’t distinguish fat vs muscle, fat distribution
- -Does not integrate ethnic or sociocultural context
- -Combination with weight circumference identifies abnormality in adipose tissue distribution and is relevant to cardiometabolic complications.
Example: A bodybuilder with a high BMI may have little body fat, while an individual with normal BMI may still have visceral fat and metabolic risk (a condition called “normal-weight obesity”).
🧪 What Does ABCD Consider Instead?
1. Adipose Tissue Distribution
Where the fat is matters more than how much:
Visceral fat (around organs) → high cardiometabolic risk
Subcutaneous fat (under the skin) → less harmful
- Waist Circumference (WC)
Better reflects central (abdominal) obesity
WC + BMI helps detect metabolic risk better than BMI alone
- Metabolic Complications
ABCD highlights the role of adiposity in diseases like:
Type 2 Diabetes
Hypertension
Atherosclerosis
Non-alcoholic fatty liver disease (NAFLD)
- Sociocultural and Ethnic Context
Different populations have different fat distribution patterns and disease thresholds
Example: South Asians develop diabetes and heart disease at lower BMI levels than Caucasians
✅ Clinical Relevance of ABCD
Encourages individualized diagnosis and management
Promotes early intervention based on fat function and location, not just BMI
Helps clinicians recognize obesity-related complications even when BMI is “normal”
gynoid vs android obesity
android = apple products (apple shaped)
- fat around VISCERAL ORGANS
- worse CVD risk
- metabolic syndrome pts with High triglycerides, Low HDL, insulin resistance, Glucose intolerance
- Pro-inflammatory and pro-thrombotic state
gynoid = PEAR shape
- obseity but fat is located mostly around HIPS, THIGH, BUTT
- no metabolic syndrome
- decreased CVD risk
cycle with depression and anxiety
Why is obesity considered a chronic condition?
- Research shows there are strong genetic and environmental factors that contribute to the development and maintenance of obesity.
- Genetic factor- Genetic make up that makes an individuals makes more susceptible to obesity.
- Environmental factors - Habits that increase their risks associated with this condition.
- dietary habits
- physical activity levels
- socioeconomic status
- Like other chronic conditions, such as diabetes or hypertension, obesity requires long-term, ongoing management and a multidisciplinary approach.
Psychosocial Burden of Chronic Disease
- Weight Stigma/Weight Bias
- Depression
- Anxiety
- Eating disorders
- Poor body image
- Suicidality
Weight Stigma/Weight Bias
- Weight Stigma- social stereotypes and misconceptions about obesity (lazy, sloppy, non-compliant, unintelligent, unsuccessful and lacking self-discipline and self control.
- Weight Bias- refers to instances wherein individuals receive negative or unreasonable judgments about their person based on their body size or weight, with prejudice being a potential outcome
🧠 Weight Stigma vs. Weight Bias
🔸 Weight Stigma = Stereotypes
Definition: Negative beliefs about people with larger bodies.
Example: Thinking someone is lazy or unmotivated just because they are overweight.
“People with obesity must not care about their health.”
🔸 Weight Bias = Behavior
Definition: Actions or judgments based on weight.
Can be verbal, emotional, or professional.
Example: A doctor assumes a patient’s knee pain is only due to their weight and skips proper evaluation.
“You just need to lose weight” — without ordering imaging or exploring other causes.
📌 Quick Summary:
Term What it is Example
Stigma Stereotype/belief “Overweight people are lazy”
Bias Action/judgment Doctor dismisses symptoms due to weight
Eating Disorders Associated with Obesity
- 87% of individuals with binge eating disorder, and 33% of individuals with bulimia nervosa, had also had obesity at some point in their lives
What competencies are needed to treat this population?
- Knowledge of nutrition and dietetics
- Understanding of physical activity and exercise
- Behavioral and psychological counseling skills
- Awareness of comorbidities and complications
- Effective communication and interpersonal skills are essential for building rapport with patients, understanding their concerns, and providing clear and supportive guidance throughout the weight management process
- Knowledge of pharmacological and surgical interventions
- Cultural competency and sensitivity
- Collaborative and team-based approach
5A’s approach for discussing obesity
evidence based meal plans vs fad diets
Pharmacotherapy Criteria - which pts needs drugs
Bariatric Surgery Criteria - which pts can get surgery
GLP-1
⚖️ Pharmacotherapy Criteria for Obesity
🩺 When to Start Medications:
BMI Initiation Criteria
≥ 30 kg/m² No comorbidities needed
≥ 27 kg/m² With at least one comorbidity (e.g., HTN, DM, dyslipidemia)
💉 GLP-1 Receptor Agonists (Glucagon-Like Peptide-1)
✅ Common GLP-1 Drugs for Obesity
Drug Frequency
Semaglutide (Wegovy) Weekly (injectable)
Semaglutide (Rybelsus) Oral (daily)
Liraglutide (Saxenda) Daily injection
Ozempic (not FDA-approved for obesity) Weekly
Dulaglutide (Trulicity) Weekly
Exenatide (Bydureon) Weekly
🎯 Mechanism of Action
Mimics GLP-1 hormone
↓ Appetite
↓ Gastric emptying
↑ Insulin secretion (glucose-dependent)
May affect reward centers in the brain
📈 Benefits
10–25 lbs weight loss (varies by dose & adherence)
Also lowers A1C, BP, and improves lipid profiles
Reduces cardiovascular risk in patients with T2DM
⚠️ Side Effects
Nausea
Diarrhea
Vomiting
Constipation
Abdominal Pain
Headache
Fatigue
🚫 Contraindications
History of medullary thyroid carcinoma (MTC)
MEN-2 (Multiple Endocrine Neoplasia type 2)
Personal or family history of these conditions
❗️ Caution
No established exit strategy
Weight often regains after stopping medication
🗣 “Participants regained two-thirds of weight after stopping semaglutide.”
💊 Other FDA-Approved Obesity Medications
Drug Mechanism Use Key Side Effects
Orlistat (Xenical, Alli) Lipase inhibitor (↓ fat absorption) OTC and Rx GI: oily stools, urgency, flatulence
Phentermine Stimulant; appetite suppressant (sympathomimetic) Short-term use only Tachycardia, insomnia, ↑ BP
Phentermine/Topiramate (Qsymia) Appetite suppressant + anticonvulsant Long-term Teratogenic, cognitive side effects
Bupropion/Naltrexone (Contrave) Dopamine/norepinephrine + opioid antagonist Craving control Nausea, neuropsychiatric effects
Setmelanotide (Imcivree) Melanocortin-4 receptor agonist Genetic obesity syndromes only Injection-site rxn, skin darkening
📌 Clinical Tips
Combine medication with behavioral therapy and lifestyle modification
Always screen for secondary causes of obesity (e.g., hypothyroidism, Cushing’s)
Monitor:
Weight
Waist circumference
Metabolic labs (glucose, lipids, A1C)
🧠 Key Takeaway
Pharmacologic therapy is best for patients with BMI ≥27 + comorbidity or ≥30
GLP-1s (like Wegovy/Semaglutide) are the most effective option currently available
Long-term use may be required, similar to chronic disease management
Restrictive Procedures
- Adjustable Gastric Banding
- Vertical Sleeve Gastrectomy
- Intragastric balloon
adjustable gastric banding
Vertical Sleeve Gastrectomy (VSG)
- Alone or 1st step of BD-DS
- Remove 75% of stomach
- Restrictive with hormonal changes:
- Increased satiety and decreases gut produced “hunger hormone” GHRELIN
Intragastric Balloon
- Minimally invasive
- Space occupying
- Remove in 6 month
Malabsorptive Procedures
Roux-en-Y Gastric Bypass:
- Creates small gastric pouch + reroutes small intestine
- Restrictive + malabsorptive
- Also induces favorable hormonal changes
- More effective for glycemic control, but ↑ risk of nutrient deficiencies
Single-Anastomosis Duodenal Switch (Loop DS)
- Combines sleeve gastrectomy + intestinal bypass (larger amount of small intestine bypassed = larger risk of nutritional deficiencies)
- Powerful weight loss + metabolic effect
- Reserved for severe obesity/metabolic disease
- High nutritional monitoring burden
- Micronutrient deficiencies: B12, iron, calcium, folate
surgical outcomes chart
