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Questions and Answers

Which statement accurately describes the cause of obesity in infants related to hyperphagia?

  • Severe obesity is caused by an intense drive to eat and impaired satiety. (correct)
  • Infants' obesity is often due to excessive sleeping patterns.
  • Obesity in infants is primarily due to genetic factors.
  • Infants' obesity is mostly attributed to lack of physical activity.

    • What method is primarily used to diagnose Cushing syndrome?

  • Blood glucose testing for insulin levels.
  • Blood pressure measurements during stress tests.
  • CT scan to assess adrenal gland structure.
  • Cortisol production rates measured through a 24-hour urine collection. (correct)

    • What role do macrophages play in the inflammation of adipose tissue associated with obesity?

  • They are only present in non-obese adipose tissue.
  • They increase inflammation in both obese and non-obese individuals equally.
  • They are exclusively responsible for fat storage.
  • They appear in greater numbers in obese adipose tissue and are linked to higher inflammatory markers. (correct)

    • Which condition is characterized by recurrent boils and is strongly associated with obesity?

    <p>Hidradenitis suppurativa</p> Signup and view all the answers

    What dietary recommendation should be followed to promote healthier eating habits?

    <p>Eating a variety of whole grains, fruits, and vegetables with reduced sodium intake.</p> Signup and view all the answers

    What is the waist-to-hip ratio (WHR) threshold associated with adverse health outcomes in women?

    <blockquote> <p>0.9</p> </blockquote> Signup and view all the answers

    Which hormone is secreted from enteroendocrine cells of the small intestine?

    <p>Glucagon-like peptide 1</p> Signup and view all the answers

    What condition is characterized by obesity, developmental delay, and polydactyly and has overlapping features with other genetic obesity syndromes?

    <p>Bardet-Biedl syndrome</p> Signup and view all the answers

    Which hormone mainly acts to suppress food intake?

    <p>Leptin</p> Signup and view all the answers

    Setmelanotide, a MC4R agonist, has shown effectiveness in treating which condition?

    <p>Genetic deficiency in POMC or leptin receptor</p> Signup and view all the answers

    What does a low level of leptin primarily indicate?

    <p>Powerful stimulus to food intake</p> Signup and view all the answers

    What is the waist-to-hip ratio indicating adverse health outcomes for men?

    <blockquote> <p>1.0</p> </blockquote> Signup and view all the answers

    Which hormone is secreted from the large intestine?

    <p>Oxyntomodulin</p> Signup and view all the answers

    What is the primary physiological effect of leptin on food intake?

    <p>Suppresses food intake</p> Signup and view all the answers

    Which of the following hormones is NOT secreted from enteroendocrine cells of the small intestine?

    <p>Insulin</p> Signup and view all the answers

    What characterizes Prader-Willi Syndrome (PWS) in terms of genetic inheritance?

    <p>Autosomal dominant disorder</p> Signup and view all the answers

    Children with homozygous loss-of-function leptin mutations are likely to experience what?

    <p>Excessive weight gain</p> Signup and view all the answers

    What waist-to-hip ratio (WHR) is associated with adverse health outcomes in men?

    <blockquote> <p>1.0</p> </blockquote> Signup and view all the answers

    Which hormone is primarily produced in response to fat intake and regulates satiety?

    <p>Cholecystokinin (CCK)</p> Signup and view all the answers

    What is a characteristic symptom of Bardet-Biedl Syndrome?

    <p>Retinal dystrophy</p> Signup and view all the answers

    Which hormone primarily acts to decrease food intake and counteracts starvation signals?

    <p>Leptin</p> Signup and view all the answers

    What key factor contributes to obesity in infants characterized by rapid weight gain and hyperphagia?

    <p>Intense drive to eat and impaired satiety</p> Signup and view all the answers

    What is the primary method utilized to assess cortisol production in diagnosing Cushing syndrome?

    <p>24-hour urine free cortisol measurement</p> Signup and view all the answers

    Which statement best describes the inflammation associated with obesity in adipose tissue?

    <p>It is linked to the presence of more macrophages in obese tissues.</p> Signup and view all the answers

    What condition is associated with recurrent boils and characterized by chronic drainage related to sweat gland activity?

    <p>Hidradenitis suppurativa</p> Signup and view all the answers

    What dietary recommendation is emphasized to help combat obesity?

    <p>Maintain a diet rich in whole grains, fruits, vegetables, and fiber.</p> Signup and view all the answers

    What is the recommended frequency for screening for dyslipidemia in adult Filipinos with obesity?

    <p>Once every year</p> Signup and view all the answers

    What is the minimum PHQ-9 score that indicates a need for psychiatric referral among adults with obesity?

    <p>≥10</p> Signup and view all the answers

    Which of the following questionnaires is NOT used for screening obstructive sleep apnea among adult Filipinos with obesity?

    <p>Beck Depression Inventory</p> Signup and view all the answers

    Which condition among adult Filipinos with obesity is recommended to be screened at every visit?

    <p>Arthritis</p> Signup and view all the answers

    How often should adult Filipinos with obesity be screened for non-alcoholic fatty liver disease using liver ultrasound?

    <p>Once every year</p> Signup and view all the answers

    Which criteria should be used for diagnosing obesity among adult Filipinos?

    <p>Asia Pacific criteria</p> Signup and view all the answers

    What is the waist circumference cut-off for diagnosing obesity in female adults?

    <p>≥80 cm</p> Signup and view all the answers

    Which condition should be screened for among reproductive-aged Filipino women with obesity?

    <p>Polycystic ovary syndrome</p> Signup and view all the answers

    What is included in the Rotterdam criteria for diagnosing PCOS?

    <p>History of menstrual irregularity</p> Signup and view all the answers

    What waist-to-hip ratio (WHR) cut-off indicates obesity in males?

    <p>≥1.0</p> Signup and view all the answers

    When should TSH screening for hypothyroidism be conducted among adults with obesity?

    <p>At the initial visit for those aged ≤70</p> Signup and view all the answers

    What is the cut-off for waist circumference to diagnose obesity in males?

    <p>≥90 cm</p> Signup and view all the answers

    Which test is recommended to screen for dysglycemia among adult Filipinos with obesity?

    <p>75-g oral glucose tolerance test</p> Signup and view all the answers

    What is the recommended frequency for screening for obstructive sleep apnea among adult Filipinos with obesity?

    <p>Once a year</p> Signup and view all the answers

    Which of the following questionnaires is recommended for use in screening for depression among adult Filipinos with obesity?

    <p>Patient Health Questionnaire-9</p> Signup and view all the answers

    When should screening for hypertension occur among adult Filipinos with obesity?

    <p>At every visit</p> Signup and view all the answers

    What is the suggested method for screening dyslipidemia among adult Filipinos with obesity?

    <p>Fasting lipid profile</p> Signup and view all the answers

    What is the appropriate score on the PHQ-9 that indicates the need for psychiatric referral?

    <p>≥10</p> Signup and view all the answers

    What is the recommended waist circumference cut-off for diagnosing obesity in adult males?

    <p>≥90 cm</p> Signup and view all the answers

    Which waist to hip ratio cut-off indicates obesity in female adults?

    <p>≥0.85</p> Signup and view all the answers

    Which age group is suggested for TSH screening for hypothyroidism among adults with obesity?

    <p>≤70 years old</p> Signup and view all the answers

    What is a criterion necessary for diagnosing PCOS based on the Rotterdam criteria?

    <p>Hyperandrogenism</p> Signup and view all the answers

    What is the primary reason for using the Asia Pacific cut-off for BMI over the WHO values among adult Filipinos?

    <p>More appropriate for the local population</p> Signup and view all the answers

    What is the minimum number of criteria required to diagnose PCOS?

    <p>2 out of 3</p> Signup and view all the answers

    Which of the following is NOT included as an indication in the Rotterdam criteria for PCOS diagnosis?

    <p>Body mass index over 25</p> Signup and view all the answers

    Should waist circumference or waist to hip ratio be used in conjunction with BMI for obesity diagnosis among adult Filipinos?

    <p>Yes, both should be used</p> Signup and view all the answers

    What is the BMI classification for normal weight according to the WHO guidelines?

    <p>18.5–24.9</p> Signup and view all the answers

    Which BMI range determines the obesity classification according to the Asia-Pacific guidelines?

    <p>≥25</p> Signup and view all the answers

    How does the Asia-Pacific definition of overweight differ from the WHO definition?

    <p>Asia-Pacific defines overweight as 23–24.9.</p> Signup and view all the answers

    What is the upper BMI limit for the normal classification according to Asia-Pacific guidelines?

    <p>24.9</p> Signup and view all the answers

    In which classification would a person with a BMI of 29 be categorized according to WHO standards?

    <p>Overweight</p> Signup and view all the answers

    What is the BMI threshold for obesity according to WHO guidelines?

    <p>≥30</p> Signup and view all the answers

    How does the Asia-Pacific obesity classification differ from the WHO classification?

    <p>Defines obesity at a lower BMI cut-off</p> Signup and view all the answers

    Which BMI range is classified as overweight according to Asia-Pacific guidelines?

    <p>23–24.9</p> Signup and view all the answers

    In the WHO classification, what is the BMI range that indicates normal weight?

    <p>18.5–24.9</p> Signup and view all the answers

    What is the BMI classification for individuals deemed underweight according to both WHO and Asia-Pacific guidelines?

    <p>&lt;18.5</p> Signup and view all the answers

    Study Notes

    Adverse Health Outcomes and WHR

    • Women with a waist-to-hip ratio (WHR) greater than 0.9 are at an increased risk for adverse health outcomes.
    • Men with a WHR greater than 1.0 face similar health risks.

    Leptin and Its Role

    • Low leptin levels act as a strong trigger for food intake; they largely explain rebound overeating and weight gain after dieting.
    • Leptin primarily functions to suppress food intake.

    Peripheral Hormones

    • Key peripheral hormones include cholecystokinin (CCK) from the stomach, glucagon-like peptide 1 (GLP-1), gastric inhibitory polypeptide (GIP) from enteroendocrine cells of the small intestine, and peptide YY (PYY).
    • CCK and GLP-1 are specifically secreted by enteroendocrine cells.

    Hormones from Large Intestine

    • The large intestine secretes peptide YY (PYY) and oxyntomodulin (OXM).

    Genetic Obesity Syndromes

    • Setmelanotide is an MC4R agonist used effectively in clinical trials for children with genetic deficiencies in POMC or the leptin receptor.
    • Prader-Willi Syndrome (PWS) is the most common genetic cause of obesity, characterized by deletion of an imprinted region on paternal chromosome 15, with an estimated prevalence of 1 in 25,000.
    • Bardet-Biedl Syndrome is a rare autosomal recessive condition marked by obesity, developmental delays, polydactyly, retinal dystrophy, hypogonadism, and kidney abnormalities, resulting from mutations in over 20 genes affecting primary cilia signaling.

    Childhood Obesity

    • Children with homozygous loss-of-function leptin mutations tend to experience rapid weight gain within the first months of life, leading to severe obesity due to intense hunger (hyperphagia) and impaired satiety.

    Cushing Syndrome Diagnosis

    • Cushing syndrome can be diagnosed by measuring cortisol production rates through 24-hour urine free cortisol collections or assessing serum cortisol suppression after dexamethasone administration.

    Inflammation in Adipose Tissue

    • Obesity is associated with an inflammatory response in adipose tissue, characterized by an increased presence of macrophages and elevated inflammatory markers in circulation.

    Hidradenitis Suppurativa

    • Hidradenitis suppurativa is a disabling skin condition closely linked to obesity, characterized by recurrent boils and draining sinus tracts in areas with apocrine sweat glands.

    Dietary Recommendations

    • Recommended dietary practices include a diet rich in whole grains, fruits, vegetables, and dietary fiber, alongside a reduction in sodium intake.

    Adverse Health Outcomes and Body Measurements

    • Women face adverse health outcomes with a Waist-to-Hip Ratio (WHR) greater than 0.9.
    • Men are at risk for adverse health outcomes with a WHR exceeding 1.0.

    Hormonal Regulation and Impacts

    • Low leptin levels indicate a strong stimulus for food intake, contributing to rebound overeating and weight regain post-dieting.
    • Peripheral hormones involved in appetite regulation include:
      • Cholecystokinin (CCK) produced in the stomach.
      • Glucagon-like peptide 1 (GLP-1).
      • Gastric inhibitory polypeptide (GIP).
      • Peptide YY (PYY) from enteroendocrine cells of the small intestine.

    Hormones from Gastrointestinal Tract

    • Enteroendocrine cells of the small intestine secrete GLP-1 and CCK.
    • The large intestine produces hormones like Peptide YY (PYY) and Oxyntomodulin (OXM).

    Leptin's Function

    • Leptin primarily functions to suppress food intake.

    Medical Treatments and Conditions

    • Setmelanotide, a melanocortin-4 receptor (MC4R) agonist, is effective in phase 2/3 clinical trials for children with genetic deficiencies in POMC or leptin receptors.
    • Prader-Willi Syndrome (PWS) is the most common syndromic cause of obesity, affecting roughly 1 in 25,000 individuals, caused by deletion on paternal chromosome 15.
    • Bardet-Biedl syndrome is a rare autosomal recessive disorder characterized by obesity, developmental delay, polydactyly, and other features, often resulting from mutations disrupting primary cilia signaling.

    Genetic Factors in Obesity

    • Children with homozygous loss-of-function mutations in leptin may experience rapid weight gain in infancy, leading to severe obesity due to hyperphagia and poor satiety signals.

    Diagnosing and Factors in Cushing Syndrome

    • Cushing syndrome is diagnosed through measuring cortisol production rates (24-hour urine free cortisol) or serum cortisol suppression via dexamethasone.

    Inflammation and Obesity

    • Increased macrophage presence in obese adipose tissue correlates with higher levels of inflammatory markers in the circulation of obese individuals.
    • Hidradenitis suppurativa is a disabling skin condition associated with obesity, characterized by recurrent boils and draining sinus tracts in areas with apocrine sweat glands.

    Dietary Recommendations

    • Guidelines emphasize a diet rich in whole grains, fruits, vegetables, and dietary fiber, while advising a reduction in sodium intake.

    BMI Assessment for Filipinos

    • Asia Pacific BMI criteria are preferred over WHO global values for diagnosing overweight and obesity in adult Filipinos.

    Supplementary Measurements

    • Waist circumference and waist-to-hip ratio are recommended alongside BMI for diagnosing obesity.
    • Waist circumference cut-offs for obesity are:
      • Males: ≥90 cm
      • Females: ≥80 cm
    • Waist-to-hip ratio cut-offs for obesity are:
      • Males: ≥1.0
      • Females: ≥0.85

    Screening Recommendations

    • Hypothyroidism screening using TSH is suggested for adults aged ≤70 years with obesity at initial visit.
    • Screening for polycystic ovary syndrome (PCOS) is recommended for reproductive-aged women with obesity using Rotterdam criteria.

    Rotterdam Criteria for PCOS

    • Indications include:
      • Menstrual irregularity
      • Clinical or biochemical hyperandrogenism (e.g., acne, hirsutism, male-pattern hair loss)
      • Ultrasonography findings of polycystic ovaries
    • Diagnosis of PCOS requires meeting 2 out of 3 criteria.

    Dysglycemia and Lipid Profile Screening

    • Annual screening for dysglycemia using a 75-g oral glucose tolerance test is suggested for adults with obesity.
    • Fasting lipid profile screening for dyslipidemia is recommended for individuals with obesity.
    • Hypertension screening is also advised for adults with obesity.

    Liver and Sleep Disorders Screening

    • Non-alcoholic fatty liver disease should be screened using liver ultrasound in adults with obesity.
    • Obstructive sleep apnea screening using the STOP-BANG score is recommended once a year.
    • Additional questionnaires for sleep apnea include:
      • Epworth Sleepiness Scale
      • Berlin Questionnaire

    Mental Health and Other Evaluations

    • Depression screening is advised for adults with obesity using the Patient Health Questionnaire-9 tool every 6 months.
    • Referral for psychiatric evaluation is recommended if PHQ9 score is ≥10.
    • Arthritis screening should be conducted at every medical visit for adults with obesity.
    • Screening for obesogenic medications is also necessary for individuals with obesity.

    BMI Assessment for Filipinos

    • Asia Pacific BMI criteria are preferred over WHO global values for diagnosing overweight and obesity in adult Filipinos.

    Supplementary Measurements

    • Waist circumference and waist-to-hip ratio are recommended alongside BMI for diagnosing obesity.
    • Waist circumference cut-offs for obesity are:
      • Males: ≥90 cm
      • Females: ≥80 cm
    • Waist-to-hip ratio cut-offs for obesity are:
      • Males: ≥1.0
      • Females: ≥0.85

    Screening Recommendations

    • Hypothyroidism screening using TSH is suggested for adults aged ≤70 years with obesity at initial visit.
    • Screening for polycystic ovary syndrome (PCOS) is recommended for reproductive-aged women with obesity using Rotterdam criteria.

    Rotterdam Criteria for PCOS

    • Indications include:
      • Menstrual irregularity
      • Clinical or biochemical hyperandrogenism (e.g., acne, hirsutism, male-pattern hair loss)
      • Ultrasonography findings of polycystic ovaries
    • Diagnosis of PCOS requires meeting 2 out of 3 criteria.

    Dysglycemia and Lipid Profile Screening

    • Annual screening for dysglycemia using a 75-g oral glucose tolerance test is suggested for adults with obesity.
    • Fasting lipid profile screening for dyslipidemia is recommended for individuals with obesity.
    • Hypertension screening is also advised for adults with obesity.

    Liver and Sleep Disorders Screening

    • Non-alcoholic fatty liver disease should be screened using liver ultrasound in adults with obesity.
    • Obstructive sleep apnea screening using the STOP-BANG score is recommended once a year.
    • Additional questionnaires for sleep apnea include:
      • Epworth Sleepiness Scale
      • Berlin Questionnaire

    Mental Health and Other Evaluations

    • Depression screening is advised for adults with obesity using the Patient Health Questionnaire-9 tool every 6 months.
    • Referral for psychiatric evaluation is recommended if PHQ9 score is ≥10.
    • Arthritis screening should be conducted at every medical visit for adults with obesity.
    • Screening for obesogenic medications is also necessary for individuals with obesity.
    • Rapid weight gain in infants can lead to severe obesity characterized by hyperphagia and impaired satiety, promoting food-seeking behavior.
    • Hidradenitis suppurativa is a disabling skin condition linked to obesity, causing recurrent boils and chronic draining sinus tracts in apocrine sweat gland areas.

    Diagnosis of Cushing Syndrome

    • Cushing syndrome is diagnosed via 24-hour urine free cortisol measurement or checking the suppression of serum cortisol with dexamethasone.

    Inflammation in Adipose Tissue

    • Obese adipose tissue exhibits increased macrophage infiltration, leading to elevated inflammatory markers in circulation, linking obesity to systemic inflammation.

    Dietary Recommendations for Obesity Management

    • Emphasize a diet rich in whole grains, fruits, vegetables, and dietary fiber while reducing sodium intake.

    Waist-to-Hip Ratio (WHR) and Health Outcomes

    • A WHR greater than 0.9 in women and greater than 1.0 in men is associated with adverse health outcomes.

    Leptin and Its Role

    • Low leptin levels indicate a powerful stimulus for food intake, contributing to weight regain after dieting.
    • Leptin primarily acts to suppress food intake.

    Hormones Involved in Appetite Regulation

    • Peripheral hormones include:
      • Cholecystokinin (CCK) from the stomach
      • Glucagon-like peptide 1 (GLP-1)
      • Gastric inhibitory polypeptide (GIP) and peptide YY (PYY) from enteroendocrine cells.

    Hormones from Gastrointestinal Tract

    • Small intestine secretes GLP-1 and CCK.
    • Large intestine produces Peptide YY and Oxyntomodulin (OXM).
    • Prader-Willi Syndrome (PWS): Most common genetic obesity syndrome with an estimated prevalence of 1 in 25,000, caused by a paternal chromosome 15 deletion.
    • Bardet-Biedl Syndrome: Rare autosomal recessive condition leading to obesity, developmental delay, and multisystem issues due to mutations affecting primary cilia signaling.
    • Annual screening for dysglycemia via a 75g oral glucose tolerance test is advised.
    • Fasting lipid profile and hypertension checks are recommended among obese adults.
    • Liver ultrasound suggested for screening non-alcoholic fatty liver disease.
    • Assessment for obstructive sleep apnea via the STOP-BANG questionnaire annually.
    • Additional questionnaires for obstructive sleep apnea include the Epworth Sleepiness Scale and Berlin Questionnaire.

    Mental Health and Obesity

    • Depression screening using the Patient Health Questionnaire-9 is warranted every six months; a score of 10 or more indicates the need for psychiatric referral.

    Additional Health Assessments

    • Annual screening for arthritis and review for obesogenic medications are recommended for adults with obesity.
    • Asia Pacific BMI cutoffs should be used for diagnosing obesity instead of WHO values.

    Waist Measurement Guidelines

    • Waist circumference cutoffs for obesity are ≥90 cm for males and ≥80 cm for females.
    • Waist-to-hip ratio cutoffs are ≥1.0 for males and ≥0.85 for females.

    Hypothyroidism and Polycystic Ovary Syndrome (PCOS) Screening

    • TSH screening suggested for obesity-related hypothyroidism in adults under 70.
    • Polycystic ovary syndrome screening using Rotterdam criteria is recommended for reproductive-aged women with obesity.

    Rotterdam Criteria for PCOS Diagnosis

    • Diagnosis requires at least two of the following:
      • Menstrual irregularity.
      • Clinical/biochemical hyperandrogenism (acne, hirsutism, male-pattern hair loss).
      • Ultrasonography evidence of polycystic ovaries.
    • Rapid weight gain in infants can lead to severe obesity characterized by hyperphagia and impaired satiety, resulting in persistent food-seeking behavior.
    • Hidradenitis suppurativa is a debilitating skin condition linked to obesity, causing recurrent boils and draining sinus tracts in areas with apocrine sweat glands.

    Diagnosis of Cushing Syndrome

    • Diagnosis methods include measuring cortisol production via 24-hour urine free cortisol or suppression of serum cortisol using dexamethasone.

    Inflammation in Adipose Tissue

    • Higher macrophage presence and increased inflammatory markers are found in the adipose tissues of obese individuals compared to nonobese individuals.

    Dietary Recommendations for Obesity Management

    • Recommended diet includes whole grains, fruits, vegetables, dietary fiber, and reduced sodium intake.

    Health Risk Indicators

    • Waist-to-hip ratio (WHR) associated with adverse health outcomes:
      • Women: WHR >0.9
      • Men: WHR >1.0
    • Waist circumference cut-offs for obesity:
      • Men: ≥90 cm
      • Women: ≥80 cm
    • Waist-to-hip ratio cut-offs for obesity:
      • Men: ≥1.0
      • Women: ≥0.85

    Hormonal Influences on Appetite

    • Low leptin levels are a powerful stimulus for food intake, contributing to rebound overeating and weight regain after starvation or dieting.
    • Peripheral hormones impacting satiety include:
      • Cholecystokinin (CCK)
      • Glucagon-like peptide 1 (GLP-1)
      • Gastric inhibitory polypeptide (GIP)
      • Peptide YY (PYY).
    • Prader-Willi Syndrome (PWS) is the most common syndromic cause of obesity, arising from a deletion on chromosome 15, with a prevalence of ~1 in 25,000.
    • Bardet-Biedl syndrome is rare and characterized by obesity, developmental delay, polydactyly, and other symptoms due to mutations affecting ciliary signaling.

    Screening and Recommendations for Adults with Obesity

    • Annual screening for dysglycemia using a 75 g oral glucose tolerance test.
    • Fasting lipid profile and hypertension screening are recommended.
    • Liver ultrasound screening for non-alcoholic fatty liver disease/nonalcoholic steatohepatitis is recommended.
    • Obstructive sleep apnea (OSA) screening using STOP-BANG score is recommended annually; other tools include the Epworth sleepiness scale and Berlin questionnaire.
    • Depression screening recommended using the Patient Health Questionnaire-9 (PHQ-9) tool every 6 months; scores ≥10 suggest psychiatric referrals.
    • Arthritis screening at every visit is advised.

    Screening for Additional Conditions

    • Obesogenic medications should be monitored.
    • Hypothyroidism screening using TSH is suggested for adults ≤70 years old at the initial visit.
    • Polycystic Ovary Syndrome (PCOS) screening in reproductive-aged women using the Rotterdam criteria requires two out of three indicators:
      • Menstrual irregularity
      • Hyperandrogenism (clinical or biochemical)
      • Polycystic ovaries on ultrasound.

    Classification Systems for Obesity

    • Recommend using Asia-Pacific criteria for BMI diagnosis of overweight and obesity over WHO's values.
    • Assessment should include waist circumference and waist-to-hip ratio alongside BMI to diagnose obesity.

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    Test your knowledge on women's and men's health regarding waist-to-hip ratios and their implications. Learn about hormones like leptin and peripheral hormones like CCK and GLP-1 that play critical roles in nutrition and metabolism.

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