Obesity

Exam Cram

• BMI > 30

Outline

Background 

Obesity refers to excess weight, with reflect to height. 

Causes

1. Primary: lifestyle factors

2. Secondary

   1. 1. 1. Medical steroids

         2. Hypothyroidism

         3. Cushing's syndrome (hypercortisolaemia)

         4. Genetic- Angelman's 

History:

Examination:

Ix

• BMI

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Diagnosis

Sensitivity Specificity

Screening: BMI > 30 95% 75%

Weakness of BMI- cannot differentiate muscle from fat

Severity: BMI

• 20-25 Normal

• 25-30 Obese

• 30-35 Severe Obesity

• 35-40 Morbid obesity

Differentials

• Excess muscle mass, e.g. body builders

• Secondary obesity causes- hypothyroidism, hypercortisolaemia, medication related: insulin, steroids; 

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Management

• Lifestyle 

  • • • • Dietary advice, dietician

        • Exercise regime, physio

• Medical

  • • • • GLP-1 agonists

• Surgical

  • • • • Gastric band

NICE Indications for Liraglutide (GLP-1 agonist)- 1/3 required:

1. BMI > 35

2. Impaired fasting glucose or glucose tolerance

3. High risk of cardiovascular disease

Metabolic Syndrome

Diagnostic criteria: NCEP ATP III, > 2 factors

• Waist circumference > 102cm (M) or > 88cm (F)

• Triglycerides > 150mg/dL

• HDL cholesterol < 40mg/dL (M), < 50mg/dL (F)

• BP > 130/85

• Blood sugar (fasting) > 11.0

Differentials

• Cushing's Syndrome 

Risk factors

• Environment

  • Poor diet- high saturated fat, sugar, salt

  • Lack of exercise

• Genetic component

The fact obesity is a new phenomena and our genetic diversity hasn't changed considerably in the last 200 years but our environment has, suggests an environmental cause. 

Associated conditions

Core

• Obesity

• Hypertension

• NAFLD (Non Alcoholic Fatty Liver Disease) 

• PCOS (Polycystic ovary syndrome) 

• T2DM (Type 2 Diabetes Mellitus) 

Secondary

• Cancers- breast, bowel, endometrial

• Coronary Artery Disease , Stroke , Venous Thrombotic Disease 

• Osteoarthritis & Gout 

• Urinary Stones & Biliary Stone Disease 

• Irritable Bowel Syndrome & GORD  

• Obstructive Sleep Apnea (OSA)

• Peripheral Vascular Disease

• IIH (Idiopathic Intracranial Hypertension) & Alzheimer's Disease 

References

NICE

Page written in 2024.