Obesity, Metabolic Syndrome, and Smoking Cessation (Clin Med)

Leptin

anorexigenic (decreases appetite)

Ghrelin

orexigenic (increases appetite)

What does this refer to

• Diagnosed with BMI of 30 or higher

  • Also test lipid panel, LFTs, thyroid panel, glucose/A1c

• Management: individualized care plan including evaluation of comorbidities and psychosocial circumstances

• Complex interaction of multiple genes, environmental factors, and human behaviors

Obesity

What does this refer to

• BMI ≥30

• Very common in the US

• Increased risk of CVD, diabetes, hypertension, degenerative joint disease, obstructive sleep apnea, some malignancies

• Associated with increased incidence of depression and anxiety

• Result of multiple influences including genetics and environmental factors

• Must rule out possible underlying medical causes

• Management focuses on prevention and multifactorial lifestyle modifications

Obesity

What does this refer to

• Marked increase in last 50 years

  • Now 40% US adults

• More in Hispanic and AA

• More extreme in women

• Lower in higher education levels

• More in middle income

Epidemiology of obsesity

What does this refer to

• Multifactorial

• Imbalance between caloric intake and energy expenditure

• Due to interaction between genes, behavior and environment

• Affected by interplay of multiple hormones

Etiology of Obesity

What does this refer to

• May be able to identify cause based on history: Increased intake, decreased activity

• Secondary obesity is rare, but should be considered in all obese patients

• Symptoms may include:

  • Fatigue

  • Decreased exercise tolerance

  • Dyspnea

  • GERD

  • Skin conditions

    • Acanthosis nigrans

    • Intertrigo

    • Comorbidities

History of obesity

What does this refer to

• Age at onset

• Recent changes in weight, diet, activity

• Previous weight loss attempts

• Childhood weight

• High and low weight extremes

• PMH

• Family history

• Social history

History you should ask about when observing patients with obesity

What does this refer to

Symptoms and signs of obesity

What does this refer to

• Depression

• Diabetes

• Metabolic syndrome

• NAHS

• Insulinoma

• PCO

• Cushing syndrome

• Medication

• Binge-eating disorder

Differential Diagnosis of Obesity

What does this refer to

• Lipid panel

• Liver and thyroid function tests

• Fasting glucose

• HbA1C

• Others based on Hx and PE to r/o secondary causes

  • Cortisol

  • Sleep study

  • FSH, LH

Lab studies for obesity

What does this refer to

• Individualized plan

• Realistic goals:

  • About 2 lbs/week

  • Lose 8-10% of body weight in 3-6 months

• 1st line: conservative

  • Lifestyle changes

    • Healthy diet:

      • Decrease 500-1000 kcal/d

      • Food journal

    • Increased activity

      • Goal of 30-60 min most days of the week

    • Support:

      • Physician assistant

      • Groups

Treatment for obesity

What does this refer to

Pharmacotherapeutics

• Only for BMI>30 or certain comorbid conditions

• Orlistat-pancreatic lipase inhibitor

• Lorcaserin-serotonin 2C receptor agonist

• Phentermine+topiramate-combination stimulant+impulse controller

• Buproprion+Naltrexone-Antidepressant+opiod antagonist

• Liraglutide-GLP-! agonist

2nd line treatment for obesity

What does this refer to

• ________, a group of related illnesses

• May progress to chronic illness if ignored.

• Comprise of too much belly fat, high triglycerides, and high cholesterol, high blood pressure, and high blood sugar.

• Increased risk of heart disease, diabetes, and stroke are higher if at least three of these issues are present

Metabolic Syndrome definition

What does this refer to

• Increased belly fat

• High TG and Lipids

• HTN

• High Glucose

Factors in metabolic syndrome

What does this refer to

• Overweight and obesity

• An inactive lifestyle

• Insulin resistance

• The body can't use insulin properly.

• Insulin resistance can lead to high blood sugar levels.

• Age - your risk goes up as get older

• Genetics - ethnicity and family history

Causes of metabolic syndrome

What does this refer to

Metabolic syndrome in females

What does this refer to

Metabolic syndrome in males

What does this refer to

Presence of 3 or more = diagnostic for metabolic syndrome

What does this refer to

• WHO and CDC recommendation

  • 150 minutes of moderate exercise weekly paired with muscle strengthening activity twice weekly

• Walking, even short episodes of intermittent activity, is a recommended starting point for sedentary patients

• Motivational interviewing is a powerful technique to drive change

Physical activity

What does this refer to

• Brief Tobacco Intervention is most effective initial approach to tobacco cessation

• Ask: Do you smoke, chew, or use any form of tobacco, vape, or e-cigarette?

• Advise: Quitting smoking is the single most important thing you can do to improve your health and we have resources that can help you

  • Never miss a chance

  • Nearly 80% of smokers want to quit

  • Link it to a current health concern or problem

  • Nicotine replacement therapy

  • Medications

    • Varenicline

    • Buproprion

• Refer: Find Certified Tobacco Treatment Specialists in your area

  • 1-800-QUIT-NOW

Tobacco

What does this refer to

• Waistline 40’’ or more

Large waistline for men

What does this refer to

• Waistline 35’’ or more

Large waistline for women

What does this refer to

• Less than 40 mg/dL

Low HLD (good) cholesterol for men

What does this refer to

• Less than 50 mg/dL

Low HLD (good) cholesterol for women