Anatomy and patho

• Weight bias refers to negative attitudes and views about obesity and about people with obesity
• Obesity definition

  • complex and chronic disease resulting in abnormal increase in proportion of fat cells in body
  • occurs in visceral and subcutaneous tissues
  • imbalance between energy intake and expendure
• Obesity is not a condition resulting from a lack of willpower and self control. It is a persuasive, progressive and serious condition that is strongly associated with comorbidity (many diseases)
• Obesity classification

  • BMI
  • Waist circumference (over 40 inches for male and 35 inches for female)
  • Waist to hip ratio (optimal: less than 0.8)
• Waist to hip ratio is calculated by dividing waist circumference with hip circumference. This describes the distribution of subcutaneous and visceral adipose tissue
• Visceral (abdominal) obesity with truncal obesity are at higher risk for cardiovascular disease and metabolic syndrome
• BMI is considered an indicator but not a definitive determinant of health risk as it does not take into consideration muscle mass, bone density and distribution of fat.
• An ideal weight or BMI is not a realistic goal for many patients with obesity and sets unachievable targets. Losing 5-10% of excess body weight can already make a huge difference
• Genetics play an important role in determining body fat distribution patterns. Gynoid (pear shape) has a better prognosis but is more difficult to treat. Android (apple shape) has more visceral fat which is linked to metabolic syndrome
• Edmonton obesity staging system (EOSS) measures how healthy the patient is through the medical, mental and functional spheres of the patient
• Causes of obesity:

  • decreased activity
  • endocrine disease
  • hereditary factor
  • unhealthy foods
• Obesity is highly genetic, around 70-80% of our BMI is determined by genes. There is a strong link between FTO (fat mass and obesity associated gene) as well as interaction between hypothalamus and hormones
• Environmental factors affecting obesity

  • greater access to food (prepackages, fast food, soft drinks, bigger servings)
  • lack of physical activity
  • socioeconomic status (less quality of food)
• Psychosocial factors

  • childhood habits
  • food as comfort or reward
  • food is a central focus of most social events
• Obesity consequenes

  • increased mortality rate
  • decreased quality of life
  • impacts every organ system and increases risk for many diseases
• Metabolic syndrome is a collection of risk factors that increase an individual’s chance of developing cardiovascular disease and diabetes
• Metabolic syndrome criteria, need 3 for diagnosis

  • waist circumference: over 88 (f), over 102 (m)
  • triglyceride level: over 1.7 mmol
  • HDL cholesterol level: under 1.3 (f), under 1 (m)
  • BP: over 130 systolic or 85 diastolic
  • fasting glucose level: over 5.6 mmol
• Main underlying risk factors for metabolic syndrome

  • visceral fat
  • insulin resistance
• Medical problems develop if metabolic syndrome is not addressed but no other symptoms other than being overweight or obese