Harvey's Garden

Obesity and metabolic syndrome

1 min read

Epidemiology

Etiology

Pathophysiology

Clinical features

  • Metabolic: Type 2 DM (insulin resistance), Dyslipidemia (↑ TG, ↓ HDL), Metabolic Syndrome.
  • Cardiovascular: HTN, CAD, CHF, DVT/PE.
  • Respiratory:
    • Obstructive Sleep Apnea (OSA): Daytime somnolence, snoring.
    • Obesity Hypoventilation Syndrome (Pickwickian Syndrome): BMI ≥ 30 + daytime hypercapnia (↑ PaCO2) + hypoxemia due to restricted chest wall mechanics.
  • Gastrointestinal: GERD, NAFLD/NASH (steatosis), Cholelithiasis (↑ cholesterol excretion).
  • Musculoskeletal: Osteoarthritis (esp. knees/hips), Slipped Capital Femoral Epiphysis (SCFE) in adolescents.
  • Reproductive/Endocrine: PCOS (peripheral conversion of androgens to estrone in adipose tissue), infertility.
  • Oncology: Increased risk of Endometrial (due to unopposed estrogen), Breast (postmenopausal), Colon, Renal, and Esophageal (adenocarcinoma) cancers.

Diagnostics

Treatment

  • Lifestyle Modifications (First-line)
    • Diet: 500-750 kcal/day deficit
    • Exercise: ≥150 min/week moderate activity
    • Target: 5-10% weight loss over 6 months
  • Pharmacotherapy (BMI ≥30 or ≥27 with comorbidities)
    • GLP-1 agonists: Semaglutide, Liraglutide (most effective, 10-15% loss)
      • SE: Nausea, pancreatitis risk
    • Orlistat: Lipase inhibitor → ↓ fat absorption
      • SE: Steatorrhea, fat-soluble vitamin deficiency
    • Phentermine/Topiramate: Appetite suppressant
      • SE: Teratogenic (contraception required)
    • Naltrexone/Bupropion
      • SE: ↑ BP, seizure risk
  • Bariatric Surgery (BMI ≥40 or ≥35 with comorbidities)
    • Roux-en-Y gastric bypass: Most effective (25-30% loss)
      • SE: Dumping syndrome, vitamin deficiencies (B12, iron, folate)
    • Sleeve gastrectomy: Restrictive only, lower complications
    • Benefits: Resolves T2DM, HTN, OSA
  • Key Comorbidities
    • T2DM, HTN, OSA, NAFLD, osteoarthritis, ↑ cancer risk

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