metabolic syndrome/obesity

THE METABOLIC SYNDROME

SYNDROME X

THE QUARTET

INSULIN RESISTANCE SYNDROME

22.9% OF US ADULTS 20 YEARS OF AGE AND OLDER

WORSE AS YOU AGE

INCREASES DRAMATICALLY AS BMI INCREASES

DEFINED BY QUARTET

ABDOMINAL OBESITY( CENTRAL OR VISCERAL)

HTN

DYSLIPIDEMIA

INSULIN RESISTANCE W HYPERGLYCEMIA

ABDOMINAL OBESITY LEADS TO INSULIN RESISTANCE

PROTHROMBOTIC STATE

PROINFLAMMATORY STATE

DUE TO INCREASED> INFLAMMATORY CYTOKINE ACTIVITY

CHRONIC LOW GRADE INFLAMMATION 2/2

COMPLEX INTERPLAY BETWEEN GENETIC AND ENVTL FACTORS

HIGH PG

INSULIN RESISTANCE

STRESS

GENETICS

DIET

AGE

INTERRUPTED SLEEP PATTERNS

EXCESS ALCOHOL CONSUMPTION

BIG ABDOMEN

ACANTHOSIS NIGRICANS

INSIDIOUS ONSET-LOOKS DIRTY

NECK

AXILLAE

AACE 2003

3 OF 5

WAIST CIRCUMFERENCE >40 INCHES MEN + >35 INCHES WOMEN

TRIGLYCERIDES >150 MG/DL

HDL <40 MG/DL MEN

< 50 MG/DL WOMEN

HTN BP >130/85 MMHG

HIGH FASTING GLUCOSE FPG >=110 MG/DL

ATHEROSCLEROSIS ( PLAQUE BUILD UP, REMEMBER ARTERIOSCLEROSIS IS HARDENING OF ARTERIES= ATHERSCLEROSIS + HTN )

DM

MI

NAFLD

PAD

CAD

EXERCISE: MODERATE,INTENSE, AEROBIC

SMOKING CESSATION

WT LOSS: 10 % IN 6 MONTHS

DIET: FRUITS VEG LOFAT DAIRY,

DASH, MEDITERRANEAN, HIGH FIBER

WATER 6-8 GLASSES A DAY

TREAT RISK FACTORS NOT MET SYNDROME

ANTIHYPERTENSIVE -ACE/ARB

HMG-COA

METFORMIN

ASA( LO DOSE ELDERLY)

WEIGHT LOSS MEDS

RD

PSYCHOLOGIST

PHYSICAL THERAPY'

WT LOSS PROGRAM: CURVES FOR WOMEN, WEIGHT WATCHERS

SAME AS NON PHARM

> PREVALENCE W AGE

2.5 FOLD INCREASE IN CVD RISK

5 FOLD INCREASE IN DM RISK

> PREVALENCE OF OBESITY

DEPRESSION = POOR OUTCOMES

MODIFIED EXERCISE AND RESISTANCE EXERCISE

WORLDWIDE EPIDEMIC

AGE >50 OBESE

50% BLACK WOMEN

40 %HISPANIC WOMEN

33%WHITE WOMEN

RELSHIP BETWEEN EDUCATION LEVEL AND OBESITY

SPENDING ON OBESITY RELATED CARE $821 MILLION 2017

BMI LOW SPECIFICITY

DOES NOT ACCOUNT FOR:

BODY FAT %

DISTRIBUTION

MUSCULARITY

PUBERTY OR MENOPAUSE

BODY FRAME SIZE

WAIST CIRCUMFERENCE SHOULD BE MEASURED

WAIST FAT > CVD AND DM

HIP FAT < CVD AND DM

25-29.9 O/W

CLASS 1: 30-<35

CLASS 2: 35-<40

CLASS 3: 40AND >

OTHER :

35-39.5 SEVERE OBESITY

40-44.5 MORBID OBESITY

45-50 SUPER OBESITY

UA

CBC

CMP- BUN, LFTS

URIC ACID-essential risk factor of obesity -nih

CREATININE RATIO

SERUM GLUCOSE

TSH

LIPID PANEL

2 HOUR OGTT W BG LEVELS

ALL STUDIES DEPENDENT ON FINDINGS OF H&P

5 MAIN STEPS:

FOCUSED OBESITY RELATED HISTORY

PE TO DETERMINE TYPE AND DEGREE OF OBESITY

ASST COMORBID CONDITIONS

FITNESS LEVEL HISTORY

ASST OF PT READINESS TO ADOPT LIFESTYLE CHANGES

ALL SYSTEMS EXCEPT HEENT AND NEURO

WT MGT PROGRAM

HEALTHY EATING AND PHYSICAL ACTIVITY

PHARM

SHORT TERM MEDS

PHENTERMINE

SYMPATHOMIMETIC

S/E TACHYCARDIA, PSYCHOSIS HTN

CHRONIC MEDS:

ORLISTAT/XENICAL

BLOCKS FAT ABSORPTION IN STOMACH AND INTESTINES

S/E DIARRHEA,FLATUS W OILY DC , FATTY STOOLS , INCONTINENCE

LORCASERIN/BELVIQ-WITHDRAWN FROM US MARKET 2020 > CA RISK

PHENTERMINE-TOPIRAMATE/QSYMIA

SYMPATHOMIMETIC

DC IF <5% WEIGHT LOSS AFTER 12 WEEKS

NALTREXONE-BUPROPRION( CONTRAVE)

OPIOID ANTAGONIST-ANTI DEPRESANT

S/E DEPRESSION/SUICIDE SCREEN

GLP1 RA

PROMOTES SATIETY

LIRAGLUTIDE/VICTOZA/SAXENDA

0.6-3MG DAILY SQ

TIRZEPATIDE/MOUNJARO/ZEPBOUND

GLP1RA/GIP

2.5MG TITRATE TO 15MG SQ WEEKLY

SEMAGLUTIDE/OZEMPIC/WEGOVY

TITRATE 0.25MG-2.4 MG SQ WEEKLY

SLEEVE

LAP BAND W PORT ADJUSTABLE

ROUE-EN Y BYPASS

INTRAGASTRIC BALLOON

1. ROUTINE SCREENING

2. WEIGHT MGT PROGRAM -CLINIC, CUMMUNITY, WORKSHOP, DIGITAL

3. IBT-INTENSIVE BEHAVIORAL THERAPY + RD

4. PHARMACOTHERAPY-

5. BARIATRIC SURGERY IF ABOVE FAILS

IMPACTS

MORBIDITY

MORTALITY

QOL

INSTITUTIONALISATION RISK

BY 2030 20% OF US POP WILL BE OVER 65

NATURAL INCREASE IN BODY FAT THRU ADULTHOOD UP TO 80S THEN REDUCTION

FAT REDISTRIBUTION FROM PERIPHERAL AND SQ TO CENTRAL LOCATION AND >WAIST CIRC

NATURAL LOSS OF MUSCLE -SARCOPENIA

>FALLRISK