OBESITY

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?

Hidradenitis suppurativa Signup and view all the answers

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

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

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

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

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

Glucagon-like peptide 1 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?

Bardet-Biedl syndrome Signup and view all the answers

Which hormone mainly acts to suppress food intake?

Leptin Signup and view all the answers

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

Genetic deficiency in POMC or leptin receptor Signup and view all the answers

What does a low level of leptin primarily indicate?

Powerful stimulus to food intake Signup and view all the answers

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

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

Which hormone is secreted from the large intestine?

Oxyntomodulin Signup and view all the answers

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

Suppresses food intake Signup and view all the answers

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

Insulin Signup and view all the answers

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

Autosomal dominant disorder Signup and view all the answers

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

Excessive weight gain Signup and view all the answers

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

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

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

Cholecystokinin (CCK) Signup and view all the answers

What is a characteristic symptom of Bardet-Biedl Syndrome?

Retinal dystrophy Signup and view all the answers

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

Leptin Signup and view all the answers

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

Intense drive to eat and impaired satiety Signup and view all the answers

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

24-hour urine free cortisol measurement Signup and view all the answers

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

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

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

Hidradenitis suppurativa Signup and view all the answers

What dietary recommendation is emphasized to help combat obesity?

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

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

Once every year Signup and view all the answers

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

≥10 Signup and view all the answers

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

Beck Depression Inventory Signup and view all the answers

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

Arthritis Signup and view all the answers

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

Once every year Signup and view all the answers

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

Asia Pacific criteria Signup and view all the answers

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

≥80 cm Signup and view all the answers

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

Polycystic ovary syndrome Signup and view all the answers

What is included in the Rotterdam criteria for diagnosing PCOS?

History of menstrual irregularity Signup and view all the answers

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

≥1.0 Signup and view all the answers

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

At the initial visit for those aged ≤70 Signup and view all the answers

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

≥90 cm Signup and view all the answers

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

75-g oral glucose tolerance test Signup and view all the answers

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

Once a year Signup and view all the answers

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

Patient Health Questionnaire-9 Signup and view all the answers

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

At every visit Signup and view all the answers

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

Fasting lipid profile Signup and view all the answers

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

≥10 Signup and view all the answers

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

≥90 cm Signup and view all the answers

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

≥0.85 Signup and view all the answers

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

≤70 years old Signup and view all the answers

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

Hyperandrogenism 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?

More appropriate for the local population Signup and view all the answers

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

2 out of 3 Signup and view all the answers

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

Body mass index over 25 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?

Yes, both should be used Signup and view all the answers

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

18.5–24.9 Signup and view all the answers

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

≥25 Signup and view all the answers

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

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

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

24.9 Signup and view all the answers

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

Overweight Signup and view all the answers

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

≥30 Signup and view all the answers

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

Defines obesity at a lower BMI cut-off Signup and view all the answers

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

23–24.9 Signup and view all the answers

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

18.5–24.9 Signup and view all the answers

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

<18.5 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.

Studying That Suits You

Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

Description

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.