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Basics

Description

  • Obesity refers to excess adipose tissue. Weight status is characterized by calculating the body mass index [BMI = body weight (kg)/body height (m2)] and classified as underweight, normal weight, overweight, obese, or morbidly obese:
    • A BMI ≥30 kg/m2a is consistent with obesity.
  • Obesity is associated with negative health outcomes:
    • The increased risk of morbidity and mortality is most closely related to abdominal obesity.
  • System(s) affected: Endocrine/Metabolic; Cardiac; Respiratory; Gastrointestinal; Musculoskeletal; Mental Health
  • Synonym(s): Overweight; Adiposity

Geriatric Considerations
BMI associated with the lowest risk of mortality increases as age increases.

Epidemiology

  • Predominant age: Incidence rises in the early 20s
  • Predominant sex: Female > Male
Prevalence
  • Mean prevalence of obesity is 32.2% in the US.
  • Overweight: 40% of men and 25% of women
  • Obese: 20% of men and 25% of women
Pediatric Considerations
  • Obesity during adolescence and young adulthood predicts obesity in adulthood.
  • The incidence of obesity among the pediatric population has risen.
  • Risk factors include insufficient physical activity, consumption of sweetened beverages, and excess television viewing.

Risk Factors

  • Parental obesity
  • Sedentary lifestyle
  • High-calorie diet
  • Food insecurity
  • Low socioeconomic status
  • >2 hours/d of television viewing
Genetics
  • Rare genetic syndromes, such as Prader-Willi and Bardet-Biedl
  • Studies are insufficiently powered regarding specific genetic predictors of obesity.

General Prevention

  • Encourage 1 hour of daily exercise, limited television viewing, and moderation in portion size.
  • Avoid calorie-dense and nutrient-poor foods such as sweetened beverages and processed foods.
  • Most patients underestimate daily calorie consumption.

Etiology

  • Obesity is caused by an imbalance among food intake, absorption, and energy expenditure.
  • Underlying causes may be psychiatric disturbances, hypothyroidism, hypothalamic disorders, insulinoma, and Cushing syndrome.
  • Medications: Corticosteroids, neuroleptics (particularly the “atypical” antipsychotics), and antidepressants

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