GI Conditions
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      2. GI Conditions

      Obesity

      Brief Overview: According to the World Health Organization (WHO), obesity is defined as "excess or abnormal fat accumulation that presents a risk to health". According to UpToDate, “However defined (by WHO, CDC, or other), obesity is a chronic disease that is increasing in prevalence in adults, adolescents, and children and is now considered to be a global epidemic.”

      Prevalence: The overall prevalence of obesity in the United States is estimated to be ~40%.

      Etiology:

      • Iatrogenic causes: medications, hypothalamic surgery
      • Dietary: overeating, high-fat diet, frequency of eating
      • Neuroendocrine: hypothalamic, hypothyroidism, seasonal affective disorder, Cushing’s syndrome, PCOS, hypogonadism, growth hormone deficiency, pseudohypoparathyroidism
      • Social/behavioral: ethnicity, night eating syndrome, binge eating
      • Sedentary lifestyle: postoperatively, aging
      • Genetic

      Risk Factors:

      • Abdominal adiposity
      • Low socioeconomic status
      • Poor dietary choices/habits
      • Sleep disorders
      • Depression, anxiety, emotional eating
      • Hormonal imbalance
      • Sleep disorders
      • Certain medications
      • Sedentary lifestyle
      • Family history

      Commonly Associated Conditions:

      • Cardiovascular conditions: HTN, heart failure, atherosclerotic disease, chronic or recurrent atrial fibrillation (A-fib), pulmonary artery hypertension
      • Endocrine conditions : insulin resistance or Type 2 Diabetes, metabolic syndrome, PCOS, male hypogonadism
      • Obstructive Sleep Apnea (OSA)
      • Metabolic-associated steatotic liver disease

      Common Medications:

      • GLP-1 based medications: tirzepatide, semaglutide, liraglutide
      • Alternatives to GLP-1 based medications: Phentermine-topiramate, naltrexone-bupropion, phentermine, orlistat

      Common Labs, Imaging, and Tests:

      • Blood tests: fasting glucose, HgbA1c, TSH, liver enzymes, fasting lipid panel
      • BMI measurement, waist circumference
      • Sleep study (to screen/diagnose OSA if suspected)

      Common Symptoms:

      • Knee/hip/back pain
      • Breathlessness, wheezing
      • Limitations in mobility and ADLs (bathing, dressing, etc.)
      • Poor sleep, snoring
      • Skin changes
      • Fatigue

      Common Treatments:

      • Lifestyle intervention: physical activity, dietary modification
      • Medication intervention may be appropriate for some patients
      • Behavior modification/therapy
      • Surgical intervention may be appropriate for some patients

      Physical Findings:

      • Physical exam may be normal with exception of elevated BMI
      • Goiter
      • Elevated blood pressure
      • Proximal muscle weakness
      • Moon facies
      • Purple striae
      • Acne
      • Hirsutism

      Potential Complications and Contraindications:

      • Metabolic: Diabetes, dyslipidemia
      • Cardiovascular: HTN, heart disease, stroke, venous thromboembolism
      • Cancer: endometrial, kidney, gastric cardia, colon, rectum, biliary tract, pancreas, breast, esophageal adenocarcinoma, ovarian, multiple myeloma, hepatocellular carcinoma, meningioma
      • Musculoskeletal: osteoarthritis, gout
      • GI: hepatobiliary disease, GERD, GI cancer
      • Reproductive effects: infertility, abnormal uterine bleeding, endometrial hyperplasia/carcinoma, anovulatory cycles/PCOS, uterine fibroids, endometriosis, sexual dysfunction
      • GU: CKD, kidney stones, urinary incontinence, dialysis and kidney transplantation
      • Psychosocial: stigma, depression, dementia
      • Respiratory : OSA, asthma, obesity hyperventilation syndrome
      • Infection : flu, COVID-19
      • Skin changes: stretch marks, acanthosis nigricans, hirsutism

      General Health and Lifestyle Guidance:

      • Focus on realistic, gradual weight loss goals
      • Talk with your healthcare provider about a safe, appropriate exercise regimen for you
      • Work with your healthcare provider and/or dietician to determine appropriate dietary modifications
      • Get good quality, adequate sleep
      • Reduce intake of sugary beverages, alcohol, processed foods

      Suggested Questions to Ask Patients:

      • What have you tried in the past to manage your weight?
      • Do you notice emotional or stress-related eating patterns?
      • Are there barriers (time, cost, energy) affecting your ability to make lifestyle changes?
      • Are you open to working with a dietitian or considering medication or surgery?
      • How do your current health conditions impact your quality of life?

      Suggested Talking Points:

      • Even small amounts of weight loss can significantly improve your overall health
      • Seek support – healthcare provider, dietician, weight loss program, counseling/therapy, a friend/family member, accountability buddy
      • Sometimes making small changes one at a time can be an impactful way to sustain change over time rather than a complete overhaul of habits/behaviors all at once
      • Celebrate non-scale victories (e.g., more energy, improved labs, better mobility)

      Sources:

      • UpToDate