• Credits
  • Section Writer: Dr. Om J Lakhani
  • Section Editor: Dr. Om J Lakhani

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• Q. Give the cutoff for obesity in Adults?
  • Normal weight - BMI 18.5 to 24.9 kg/m2
  • Overweight - BMI ≥25 to 29.9 kg/m2
  • Obesity - BMI of ≥ 30 kg/m2
  • Severe obesity - BMI ≥ 40 kg/m2 (or ≥35 kg/m in the presence of comorbidities)
• Q. What is the cutoff for Asians?
  • Overweight- 23-24.9 kg/m2
  • Obesity - >25 kg/m2
  • Typically use 2.5 kg/m2 lower than Western data above
• Q. Enlist the Broad Etiologies of obesity.
  • Lifestyle factors
  • Diet factors
  • Drugs
  • Genetic caused
  • Infection
  • Endocrine causes
  • Perinatal and postnatal life changes
• **Age and obesity **
• Q. Enlist how various life stages are associated with obesity.
  • Antenatal factors are associated with obesity
  • SGA and rapid catch-up growth and obesity
  • Formula feeding and obesity
  • Childhood/ adolescent obesity
  • Pregnancy weight gain
  • Menopause
  • Weight gain in males after the 30s
• Q. What are the antenatal risk factors for obesity?
  • Excess maternal weight gain
  • Excess prepregnancy weight in the mother
  • Diabetes in pregnancy
  • Smoking during pregnancy
  • Exposure to Endocrine disruptors
• Q. What are the risk factors at birth?
  • SGA – higher risk of obesity
  • Breastfeeding – protects from obesity
• Q.  Is birth weight associated with obesity in later life?
  • Poor correlation with higher weight
  • More risk with SGA
• Q. Is obesity In childhood/adolescence associated with obesity in later life?
  • Yes
• Q. When do most women gain excess weight?
  • After puberty
• Q. Does pregnancy and pregnancy weight produce obesity in women?
  • Normal weight gain in pregnancy – lost post pregnancy
  • Excess weight gain in pregnancy  Retained
• Q. What is the normal weight gain in pregnancy?
  • 11.5- 16 kg
• Q. Do OC pills cause weight gain?
  • It is conventionally thought, however, data does not back it
• Q. Is weight gain seen in menopause?
  • Early post-menopausal period is associated with weight gain and fat redistribution
• Q. Does estrogen therapy prevent weight gain after menopause?
  • No
  • It only prevents fat redistribution
• Q. When do men become obese?
  • Obesity starts in the late 20s and 30s
  • Continues to 60s
  • Then declines
• **Lifestyle measures and obesity **
• Q. Enlist the lifestyle measures associated with obesity.
  • Sedentary lifestyle
  • Sleep deprivation
  • Smoking cessation
• Q. Which sedentary behavior is most strongly associated with obesity?
  • TV watching
  • Every 2 hours spent watching TV is associated with a 23% increase risk of obesity and a 14% increase risk of diabetes
• Q. What is the relation between sleep and obesity?
  • Sleep restriction (and not sleep lengthening) is associated with obesity
  • Sleep restriction is also associated with reduced leptin and increased Ghrelin leading to increased food intake
• Q. How much weight gain is seen after smoking cessation?
  • 1-2 kg in the first 2 weeks
  • 2-3 kg in the next 4-5 months
• **Dietary and obesity **
• Q. Enlist the relationship between diet and obesity.
  • The calorie content of the meal
  • Composition of meals
  • Frequency of meals
  • Timing of meals
  • Nighttime eating syndrome
  • Binge eating
  • Restrained eating
• Q. What is restrained eating?
  • Many people have conscious control over their food intake
  • This is called restrained eating
  • This reduces obesity risk
• Q. What is night eating syndrome?
  • It is the intake of more than 25-50% of calories of the day between the last meal and breakfast
  • This typically leads to obesity
• Q. What is Binge eating?
  • It is a psychiatric disturbance
  • There is excess eating in single sessions especially at evening/nighttime
• **Drugs and obesity **
• Q. Which antipsychotics cause weight gain?
  • Clozapine and olanzapine are notorious for weight gain
  • Followed by Risperidone
• Q. What is the relation between TCA and weight gain?
  • TCA causes weight gain
• Q. What is the relation between SSRI and weight gain?
  • It is complex
  • Paroxetine – weight gain
  • Sertraline and Fluoxetine – short-term causes weight loss, long term may cause neutral/ mild weight gain
• Q. Which antidepressant produces weight loss?
  • Buproprion
• Q. Which antiepileptics cause weight gain and which cause weight loss?
  • Weight gain Carbamazepine and valproate
  • Weight loss- Topiramate, Zonisamide
• Q. What type of insulin therapy produces more weight gain?
  • Intensive insulin therapy  more weight gain compared to conventional insulin therapy
• Q. Which antihypertensive causes weight gain?
  • Beta-blockers
• Q. Name some other important drugs which cause weight gain?
  • Cyproheptadine
  • Glucocorticoids
• Neuroendocrine causes of obesity
• Q. Enlist the endocrine causes of obesity.
  • Hypothalamic obesity
  • Cushing’s syndrome
  • PCOS
  • Hypogonadism
  • Pseudohypoparathyroidism
  • GH deficiency
• Q. What is the cause of obesity in Cushing’s syndrome?
  • Increase glucocorticoids  increase 11 beta HSD1 in visceral tissue → increase lipogenesis → increase obesity
• Q. Is hypothyroidism associated with obesity?
  • Mild weight gain is common in hypothyroidism
  • However, it is in the tune of 1-2 kg
• Q. Does treatment of Subclinical hypothyroidism produce weight gain?
  • No
• **Other etiologies **
• Q. What is seasonal affective disorder?
  • People living far north develop depression during winter because of lack of sunlight exposure
  • This is a seasonal affective disorder
  • This can be corrected by exposure to light
  • This may be related to obesity
  • Can be treated with SSRI
• Q. Which viral infection has been linked with obesity?
  • Adenovirus infection
• Q. What is the EOSS score?
  • This is the Edmonton Obesity staging system
• Q. Why is there a need for an EOSS score when we have BMI?
  • This is because BMI correlates poorly with some of the health outcomes
  • EOSS score takes more factors into consideration beyond BMI
  • For the same BMI- different patients may have different EOSS scores and hence different outcomes
• Q. Give the outline for the EOSS staging system.
  • 
  • 
• Q. Give the EOSS staging in simple terms.
  • 0 - No comorbidities or distress due to obesity
  • 1- Mild preclinical morbidities due to obesity
    • Borderline hypertension
    • Aches and pain
    • Impaired fasting glucose
  • 2- Established comorbidities
    • Hypertension
    • Diabetes
    • OSA
  • 3. • End organ damage
    • Myocardial infarction
    • Stroke
  • 4. Severe obesity-related issues
• Q. How does one define an EOSS score?
  • So you say Class I, Stage 0 Obesity - which means a class I based on BMI and stage 0 based on EOSS score
• Q. What treatment would you propose at what stage of obesity?
  • Stage 0 and 1 - lifestyle measures (LSM)
  • Stage 2- LSM and Pharmacological therapy
  • Stage 3-4 - LSM, Pharmacotherapy, and surgery

#update - 22-Jan-2023

• Q. Please tell us the India centric classification for Obesity ?
  • 
• Q. What does the current AACE consensus say about the South Asians in terms of obesity classification ?
  • 
• Q. How does this compare with the rest of the world ?
  • 
• Q. According to Indian consensus statement , when should pharmacotherapy for obesity be started ?
  • 1.The pharmacotherapy should be initiated for BMI above 27 kg/m2 without co-morbidity, or a BMI above 25 kg/ m2 with co-morbidity.
  • 2.The cut-offs for WC for initiating pharmacotherapy was unanimously agreed upon as a WC measurement 10 cms more than the upper limit of gender specific normal value for adult Asian Indians.