ABOM Oral Medicine flashcards

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BMI classification thresholds

BMI 18.5–24.9 is normal weight; 25–29.9 overweight; 30–34.9 class I obesity; 35–39.9 class II; ≥40 class III. BMI is calculated as weight in kilograms divided by height in meters squared.

Waist circumference risk thresholds

Increased cardiometabolic risk is present at waist circumference >102 cm (40 in) in men and >88 cm (35 in) in women. Asian populations use lower thresholds of >90 cm in men and >80 cm in women.

Obesity as chronic disease

Obesity is recognized as a chronic, relapsing, progressive disease. Diagnosis requires BMI ≥30 kg/m² or BMI ≥27 kg/m² with at least one weight-related comorbidity such as diabetes or hypertension.

Weight loss of 5–10%

A 5–10% reduction in body weight improves glycemic control, blood pressure, and lipid profiles. Losses ≥10% may improve obstructive sleep apnea and steatohepatitis; ≥15% may induce remission of type 2 diabetes.

Edmonton Obesity Staging System

EOSS stages 0–4 classify obesity by health status and functional impact rather than BMI alone. Stage 0 has no risk factors; stage 4 has severe end-organ damage or disability.

Secondary obesity causes

Secondary causes to consider include hypothyroidism, Cushing syndrome, hypothalamic injury, and medications such as glucocorticoids, antipsychotics, some antidepressants, insulin, and sulfonylureas. Screening is guided by history and examination.

Initial obesity evaluation

Initial assessment includes BMI, waist circumference, blood pressure, fasting glucose or HbA1c, lipid panel, liver enzymes, and screening for sleep apnea symptoms. This identifies comorbidities that guide treatment intensity.

Energy deficit calculation

One kilogram of body fat approximates 7,700 kcal. A daily deficit of 500–750 kcal typically produces weight loss of about 0.5–0.75 kg per week, assuming adherence and no metabolic adaptation.

Treatment selection by BMI

Lifestyle therapy alone is appropriate for BMI 25–29.9. Pharmacotherapy is added at BMI ≥30 or ≥27 with comorbidity. Bariatric surgery is considered at BMI ≥40 or ≥35 with comorbidity.

Anti-obesity medication classes

Approved agents include phentermine/topiramate ER, naltrexone/bupropion ER, orlistat, liraglutide 3.0 mg, semaglutide 2.4 mg, and tirzepatide. Expected weight loss ranges from about 5% to 15% depending on the agent.

Medication contraindications in obesity

Anti-obesity pharmacotherapy is avoided in pregnancy and within 6 months of a cardiovascular event for sympathomimetics. Uncontrolled hypertension and active eating disorders are additional contraindications for certain agents.

Bariatric surgery procedures

Common procedures are sleeve gastrectomy, Roux-en-Y gastric bypass, adjustable gastric band, and biliopancreatic diversion with duodenal switch. Expected excess weight loss is roughly 40–50% for band, 50–60% for sleeve, and 60–70% for bypass.

Post-bariatric micronutrient monitoring

After bariatric surgery, monitor vitamin B12, iron, calcium/vitamin D, folate, and thiamine. Lifelong micronutrient supplementation is typically required, especially after gastric bypass.

Dumping syndrome

Early dumping occurs 10–30 minutes after eating due to rapid gastric emptying, causing nausea, flushing, and diarrhea. Late dumping occurs 1–3 hours later from reactive hypoglycemia. Management includes small, low-sugar, high-protein meals.

Physical activity recommendation

Adults with obesity should aim for at least 150 minutes per week of moderate-intensity aerobic activity plus 2–3 resistance training sessions weekly. This helps preserve lean mass during weight loss.

Weight regain

Weight regain after lifestyle or pharmacologic intervention is common and expected. Long-term follow-up and treatment intensification are part of chronic obesity disease management rather than signs of failure.

Obesity-related comorbidities

Obesity increases risk for type 2 diabetes, hypertension, dyslipidemia, obstructive sleep apnea, MASLD, osteoarthritis, GERD, certain cancers, and depression. Screening and concurrent treatment of these conditions are essential.

Class I obesity

Class I obesity is defined as a BMI of 30.0–34.9 kg/m². It carries increased risk for cardiometabolic disease and is the threshold at which pharmacotherapy may be considered without comorbidities.

Class II obesity

Class II obesity is defined as a BMI of 35.0–39.9 kg/m². It is associated with higher comorbidity burden and may qualify for bariatric surgery when weight-related comorbidities are present.

Class III obesity

Class III obesity is defined as a BMI ≥40 kg/m². It is associated with the highest risk of comorbidities and is an indication for bariatric surgery evaluation regardless of comorbidity status.

Overweight classification

Overweight is defined as a BMI of 25.0–29.9 kg/m². At this level, lifestyle intervention is first-line, and pharmacotherapy may be considered if weight-related comorbidities are present.

MASLD and obesity

Metabolic dysfunction-associated steatotic liver disease (MASLD) is strongly associated with obesity and insulin resistance. Weight loss of 5–10% can reduce liver fat and improve steatohepatitis.

Obstructive sleep apnea screening

Obstructive sleep apnea is common in obesity and should be screened with symptoms such as snoring, witnessed apneas, and daytime sleepiness. Weight loss of ≥10% may improve apnea severity.

Type 2 diabetes remission

Weight loss of ≥15% may induce remission of type 2 diabetes in some patients, particularly those with shorter disease duration. Remission is defined by normoglycemia off glucose-lowering medications.

Phentermine/topiramate ER

Phentermine/topiramate extended-release is an anti-obesity medication that can produce about 8–10% weight loss. It is contraindicated in pregnancy, uncontrolled hypertension, and within 6 months of a cardiovascular event.

Naltrexone/bupropion ER

Naltrexone/bupropion extended-release is an anti-obesity medication producing about 5–6% weight loss. It is contraindicated in uncontrolled hypertension, seizure disorders, and chronic opioid use.

Orlistat

Orlistat is a lipase inhibitor that reduces dietary fat absorption and produces about 3–5% weight loss. It can cause steatorrhea and fat-soluble vitamin malabsorption; supplementation may be needed.

GLP-1 receptor agonists for obesity

Liraglutide 3.0 mg and semaglutide 2.4 mg are GLP-1 receptor agonists approved for obesity, producing about 5–15% weight loss. Gastrointestinal side effects are common and titration is gradual.

Tirzepatide

Tirzepatide is a dual GIP/GLP-1 receptor agonist approved for obesity that can produce up to about 15–20% weight loss in trials. Gastrointestinal effects are common and dose titration is required.

Sleeve gastrectomy

Sleeve gastrectomy removes about 75–80% of the stomach, creating a tubular stomach. It produces roughly 50–60% excess weight loss and requires micronutrient monitoring, though less than gastric bypass.

Roux-en-Y gastric bypass

Roux-en-Y gastric bypass creates a small gastric pouch connected to the jejunum, bypassing most of the stomach and duodenum. It produces about 60–70% excess weight loss and requires lifelong micronutrient supplementation.

Adjustable gastric band

Adjustable gastric banding places a restrictive band around the upper stomach. It produces about 40–50% excess weight loss but requires frequent adjustments and has high long-term complication and removal rates.