Obesity

avatar
Created by
gabie

Cards (41)

  • Obesity is a chronic disease that is increasing in prevalence globally
  • Increase in prevalence of obesity in almost all countries since 1980 and a doubling in prevalence in 70 countries!
  • In Trinidad and Tobago, the overweight or obese category among primary school children was approximately 11% in 1999, and increased to 23% in 2009, a 100% increase
  • Between 1999 and 2009, there was a 400 per cent increase in overweight/obese children in Trinidad and Tobago
  • Overweight and obesity

    • Abnormal or excessive fat accumulation that presents a risk to health
  • Overall 8.5% of children in Trinidad and Tobago were overweight and 2.4% were obese (based on BMI)
  • Factors associated with higher BMI in children in Trinidad and Tobago include higher BMI in the parents, higher reported birthweight, older age of the child's mother, smaller family size, and higher maternal educational attainment
  • 75% of female and 17% of male type 2 diabetic patients visiting primary healthcare clinics in Trinidad had high Waist Circumference
  • Patients with elevated Waist Circumference had significantly higher mean levels of basal insulin and insulin resistance
  • 15% of children aged 7-18 years in Trinidad and Tobago were obese and 17% were overweight, with primary school children having a higher prevalence of obesity (22.9% vs 11.0%) and overweight (20.0% vs 15.6%) than secondary school children
  • The overall prevalence of Acanthosis Nigricans among children in Trinidad and Tobago was 43.4%
  • The prevalence of Normal Weight Obesity (normal BMI but elevated body fat percentage) among young adults in Trinidad and Tobago was 19.9%
  • Screening for overweight and obesity in adults
    All adult patients should be screened by measuring BMI as part of routine physical examination, and waist circumference should be measured in those with BMI 25-35 kg/m2
  • BMI categories for adults
    • Underweight - <18.5 kg/m2
    • Normal weight - ≥18.5 to 24.9 kg/m2
    • Overweight - ≥25.0 to 29.9 kg/m2
    • Obesity - ≥30 kg/m2
    • Class I - 30.0 to 34.9 kg/m2
    • Class II - 35.0 to 39.9 kg/m2
    • Class III - ≥40 kg/m2 (also referred to as severe, extreme, or massive obesity)
  • Waist Circumference Thresholds for Adults
    • Abdominal obesity (waist circumference greater than ≥35 in [88 cm] in women or ≥40 in [102 cm] in men)
    • A waist circumference ≥31 in (80 cm) in Asian females and ≥35 in (90 cm) in Asian males is considered abnormal
  • Measuring Waist Circumference in Adults
    1. Locate the top of the right iliac crest
    2. Place a measuring tape in a horizontal plane around the abdomen at the level of the iliac crest
    3. Before reading the tape measure, ensure that the tape is snug, but does not compress the skin, and is parallel to the floor
    4. The measurement is made at the end of a normal expiration
  • Evaluation of obesity in adults
    • Assessment of the etiology of the weight gain
    • History, examination, FBS, A1C, TSH, liver enzymes, and fasting lipids
    • Subsequent intervention, if necessary, is based upon historical, physical, and/or laboratory results in the setting of shared decision making with the patient
  • Etiologic classification of obesity
    • Social and behavioral factors
    • Genetic (dysmorphic) obesities
    • Other
    • Neuroendocrine obesities
  • Comorbidities of obesity

    • Cardiovascular disease
    • Sleep apnea
    • Nonalcoholic fatty liver disease
    • Symptomatic osteoarthritis
    • Type 2 diabetes
    • Hypertension
    • Dyslipidemia
    • Depression
    • Reduced QOL
    • Death
  • Approach to Obesity Treatment
    • Little or no risk
    • Low risk
    • Moderate risk
    • High risk
  • Dietary therapy for obesity
    • The goal is to reduce the total number of calories consumed
    • Dietary Approaches to Stop Hypertension (DASH) or Mediterranean-style diet are preferred
    • Reductions in refined carbohydrates, processed meats, and foods high in sodium and trans fat; moderation in unprocessed red meats, poultry, eggs, and milk; and high intakes of fruits, nuts, fish, vegetables, vegetable oils, minimally processed whole grains, legumes, and yogurt are preferred
    • Long term adherence is the biggest predictor of success, otherwise most regain weight lost after reversion to usual eating habits
  • Exercise for obesity

    • Increasing energy expenditure through physical activity is a strong predictor of weight loss maintenance
    • Physical activity should be performed for approximately 30 minutes or more, five to seven days a week
  • Drugs that affect weight
    • Produce weight loss
    • Are weight neutral
    • Produce weight gain
  • Candidates for drug therapy for obesity
    Individuals with a BMI ≥30 kg/m2, or a BMI of 27 to 29.9 kg/m2 with comorbidities, who have not met weight loss goals (loss of at least 5 percent of total body weight at three to six months) with a comprehensive lifestyle intervention
  • Pharmacologic Options for Obesity
    • Incretin-based therapy (Tirzepatide or Semaglutide)
    • Other pharmacotherapy options (Combination of Phentermine-Topiramate, Orlistat, Combination of Bupropion-Naltrexone, Phentermine)
  • Dietary supplements, HCG injections, Calcium, and green tea are not recommended for the treatment of obesity as they are not more effective than placebo and have a high incidence of adverse effects
  • Candidates for metabolic (bariatric) surgery include adults with a BMI ≥40 kg/m2 or a BMI ≥35 kg/m2 with obesity-related comorbidities
  • Candidates for drug therapy
    Individuals with a BMI ≥30 kg/m2, or a BMI of 27 to 29.9 kg/m2 with comorbidities, who have not met weight loss goals (loss of at least 5 percent of total body weight at three to six months) with a comprehensive lifestyle intervention
  • Obesity in adults: Drug therapy
  • Pharmacologic Options for Obesity
    • Incretin-based therapy (Tirzepatide or Semaglutide)
    • Combination of Phentermine-Topiramate
    • Orlistat
    • Combination of Bupropion-Naltrexone
    • Phentermine
  • Drug Therapies NOT Recommended for Obesity

    • Dietary supplements (may contain sibutramine, enproporex, fluoxetine, bumetanide, furosemide, phenytoin, rimonabant, cetilistat, amphetamines, BZD, and phenolphthalein)
    • Hcg injections
    • Calcium
    • Green tea
  • Bariatric Surgery Candidates

    Adults with a BMI ≥40 kg/m2, or a BMI of 35- 39.9 kg/m2 with at least one serious comorbidity, who have not met weight loss goals with diet, exercise, and drug therapy
  • Bariatric Procedures

    • Roux-en-Y gastric bypass
    • Sleeve gastrectomy
    • Biliopancreatic Diversion with duodenal switch
  • Classification of obesity in Children (2-20 years of age)
    • Overweight - BMI between the 85th and 95th percentile for age and sex
    • Obesity - BMI ≥95th percentile for age and sex
    • Severe obesity - BMI ≥120 percent of the 95th percentile values or a BMI ≥35
  • Comparison of Obesity Categories for adults and children

    • Underweight (Adults: BMI <18.5, Youth: BMI <5th percentile for age)
    • Normal weight (Adults: BMI 18.5-24.9, Youth: BMI ≥5th to <85th percentile)
    • Overweight (Adults: BMI 25-29.9, Youth: BMI ≥85th to <95th percentile)
    • Obesity (Adults: BMI ≥30, Youth: BMI ≥95th percentile)
    • Severe obesity (Adults: BMI ≥35 (class II obesity), BMI ≥40 (class III obesity), Youth: BMI ≥120 percent of the 95th percentile, or a BMI ≥35 (whichever is lower), BMI ≥140 percent of the 95th percentile, or a BMI ≥40 (whichever is lower))
  • The likelihood of persistence of childhood obesity into adulthood is related to age, parental obesity, and severity of obesity
  • A substantial component of adolescent obesity is established before five years of age
  • Causes of obesity in Children
    • Glycemic index of foods
    • Sugar-containing beverages
    • Larger portion sizes for prepared foods
    • Fast food service
    • Diminishing family presence at meals
    • Decreasing structured physical activity
    • Shortened sleep duration
    • Availability of sidewalks and playgrounds
    • Television viewing
    • Medications (certain psychoactive drugs)
    • Genes
    • Endocrine disorders (<1%)
    • Hypothalamic lesions
    • Metabolic programming (mother's weight, in utero, early childhood)
  • Childhood Obesity Evaluation

    • Screen ALL children for Obesity - MEASURE BMI!!
    • Assess nutrition and physical activity
    • History and Examination for etiologies and complications
    • Labs for lipids, Hba1c/FBS, LFTs
  • Symptoms and their potential significance in Childhood Obesity
    • Delayed development - Genetic syndrome
    • Short stature or reduced height velocity - Genetic syndrome
    • Headaches (especially morning) - Pseudotumor cerebri
    • Nausea/vomiting
    • Blurred or decreased vision
    • Snoring - Sleep apnea, obesity hypoventilation syndrome
    • Daytime sleepiness
    • Nocturnal enuresis
    • Abdominal pain - Gallbladder disease, Nonalcoholic fatty liver disease
    • Hip pain, knee pain, limp - Slipped capital femoral epiphysis (SCFE) or Blount disease (tibia vara)
    • Right upper quadrant abdominal pain - Cholelithiasis or non-alcoholic fatty liver disease
    • Oligomenorrhea or amenorrhea - Polycystic ovary syndrome (PCOS)
    • Urinary frequency, nocturia, polydipsia, polyuria - Type 2 diabetes
    • Binge eating or purging - Eating disorder
    • Insomnia - Depression
    • Anhedonia - Depression