obesity

[lsu1000]

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What is the most effective immediate way to reduce mortality in an obese hypertensive male?

A. exercise with weight training
B. aerobic exercise
C. weight loss

 

[Doc Ivy]

I'm guessing the answer is aerobic exercise. Physical activity can reduce blood pressure independent of weight loss and vice versa, although the two would have a synergistic effect. Weight loss takes time. So I think exercise would be the most immediate non pharmacologic intervention in HTN

 

[beastmaster]

It's A. Resistance training has a good track record in blood pressure management, and I believe a few years ago even the AHA had a big panel concurring this fact.
Fat by itself is not a serious health risk, so C is out. B would have been a popular choice 20 years ago, but today we know it is not the best method. Plus, resistance training does have an aerobic component.

 

[Doc Ivy]

Cool. Good to know. 👍 But I take issue with your statement about fat not being a serious health risk. Recent results from the Framingham study suggest otherwise. The authors concluded that "A modest weight loss, particularly when sustained, substantially lowers the long-term risk of hypertension in overweight adults."


Moore LL, Visioni AJ, Qureshi MM, Bradlee ML, Ellison RC, D'Agostino R.
Weight Loss in Overweight Adults and the Long-term Risk of Hypertension: The Framingham Study.
Arch Intern Med. 2005 Jun 13;165(11):1298-303.

 

[beastmaster]

But I take issue with your statement about fat not being a serious health risk. Recent results from the Framingham study suggest otherwise. The authors concluded that "A modest weight loss, particularly when sustained, substantially lowers the long-term risk of hypertension in overweight adults."

Wish I had the time to debate this, after all its a profound statement that I made. But if you do a careful and more extensive analysis of the literature you will find that my statement is correct. I think you are being too hasty citing a study so narrow. Look at some epidemiological studies, this year's nutrition studies in AJCN, and stay away from journals with "obesity" in their name. And btw, you misquoted my statement -- I said "fat by itself."

 

[mjl1717]

Wish I had the time to debate this, after all its a profound statement that I made. But if you do a careful and more extensive analysis of the literature you will find that my statement is correct. I think you are being too hasty citing a study so narrow. Look at some epidemiological studies, this year's nutrition studies in AJCN, and stay away from journals with "obesity" in their name. And btw, you misquoted my statement -- I said "fat by itself."

But doesnt being obese make your heart work harder in general!!!
And to be on the longevity team I would think that one would prefer a SLOW beating heart. (Since the only time the heart rest is in between beats???

 

[BlackNDecker]

But doesnt being obese make your heart work harder in general!!!
And to be on the longevity team I would think that one would prefer a SLOW beating heart. (Since the only time the heart rest is in between beats???

The answer to the question seems too easy...weight loss. Is it incorrect to reason that choices A & B do not involve weightloss? I think answers A & B require one to read to much into the question. By losing weight you will reduce fat(improved metabolism), increase glucose utilization(decreased circulating free fatty acids), and decrease HTN(via reduced load on heart and vessels). If an individual is morbidly obese, exercise could result in considerable strain on the heart and vessels...possibly resulting in HF. Isn't that why one is advised to consult a physician before beginning an exercise program?

Resistance training and aerobic exercise are only as effective as the diet consumed.

 

[Ramoray]

what is up with all these questions being posted that are laughable? i mean i havent taken step 1 yet but i can already assure you that you will see nothing like this. If shelf exams and some common sense is any indications you wont see a question like this. Its hardly worth debating, even more worthless responding but maybe ill ssave osomeone from stressing out about questions like this. bad bad questions, i laugh bye

 

[tigershark]

The answer is weight loss. Modest reductions of only 5-10% body weight will often make medication unneccesary....surprising people are confused about this.

 

[Ramoray]

well if you think this quesiton is straight forward you dont think too much. obviously the first 2 choices lead to weight loss so when i read teh question i am thinking of the first 2 as weight loss is implied in the answer and it is the ADDED benefit of the cardio benefits and how that effects you along with the weight loss. so to me i see
1. aerobic workout with weights- weight loss, cardio benefits and muscle mass and tone increase and its benefits
2. aerobic exc-weight loss and cardio benefits
3. weight loss alone

so to me its those three. and that is why its a bad question and youll never see it

 

[Janders]

w. obviously the first 2 choices lead to weight loss so when i read teh question i am thinking of the first 2 as weight loss is implied in the answer and it is the ADDED benefit of the cardio benefits and how that effects you along with the weight loss

It might not be the most Step1ish question ever, but don't assume anything about the answer choices. Only one says weight loss. Weightloss is the best way, short of medication, to try and control hypertension.

One thing I've learned from the NBME practice tests: don't over think things. If the right answer is staring at you, pick it.

 

[beastmaster]

It might not be the most Step1ish question ever, but don't assume anything about the answer choices. Only one says weight loss. Weightloss is the best way, short of medication, to try and control hypertension.

One thing I've learned from the NBME practice tests: don't over think things. If the right answer is staring at you, pick it.

The question asks about the "most effective" way to reduce "mortality." Unless he is on his death bed, this concerns long-term blood pressure management.

choices 2 and 3 will essentially yield the same immediate net result (although the group with dietary modification is more likely to fail at it in the long run):
http://www.ncbi.nlm.nih.gov/entrez/...ed&dopt=Abstract&list_uids=9880120&query_hl=2

Choice 1 is better than choice 2 (as I explained earlier). Choice 3 is ineffective in the long-term (recidivism, people drop diets MUCH more than a simple training regiment).

Therefore correct answer should be 1, regardless of what an "answer key" in some booklet says about this idiotic, incomplete question. An exception could perhaps be made for the very elderly, but the question doesn't specify this.

 

[lsu1000]

Hate to break it to you, but this question was on my step I exam on May 26th.

So although it may be laughable, it was one there and as you can tell from the discussion it was not an easy one.

 

[BlackNDecker]

The question asks about the "most effective" way to reduce "mortality." Unless he is on his death bed, this concerns long-term blood pressure management.

choices 2 and 3 will essentially yield the same immediate net result (although the group with dietary modification is more likely to fail at it in the long run):
http://www.ncbi.nlm.nih.gov/entrez/...ed&dopt=Abstract&list_uids=9880120&query_hl=2

Choice 1 is better than choice 2 (as I explained earlier). Choice 3 is ineffective in the long-term (recidivism, people drop diets MUCH more than a simple training regiment).

Therefore correct answer should be 1, regardless of what an "answer key" in some booklet says about this idiotic, incomplete question. An exception could perhaps be made for the very elderly, but the question doesn't specify this.

No, the question asks what is the most effective IMMEDIATE way to reduce mortality in an obese hypertensive male. Forget failure rate, and throw out any long-term arguement that you have...you gotta answer what is asked.

HTN male:
Exercise = Sympathetic Response....epinephrine >>> Incr. CO, Incr. Arterial P
(Regardless if Aerobic or Anaerobic exercise).

Weight Loss = Less external pressure on vessels >>> Decr. Arterial P

Sadly we do not know what time frame is implied in "IMMEDIATE"...I mean 30 min of aerobic exercise results in significant loss of body water(sweat) >>> this would pull fluid out of the cells and reduce external pressure on vessels. Sweating is much less of a factor, regardless of intensity, with anaerobic exercise....I'm sure some of my fellow "meat heads" will agree with me.

 

[Doc Ivy]

Hate to break it to you, but this question was on my step I exam on May 26th.

So although it may be laughable, it was one there and as you can tell from the discussion it was not an easy one.

This is clearly and interesting and controversial question. What DOES immediate mean? What factors should be taken in to account in mortality, his obesity or his HTN? Anyway, like someone said it was a poorly written question, so don't sweat it lsu1000, if we can't agree on an answer I bet it was experimental.

 

[tigershark]

well if you think this quesiton is straight forward you dont think too much. obviously the first 2 choices lead to weight loss so when i read teh question i am thinking of the first 2 as weight loss is implied in the answer and it is the ADDED benefit of the cardio benefits and how that effects you along with the weight loss. so to me i see
1. aerobic workout with weights- weight loss, cardio benefits and muscle mass and tone increase and its benefits
2. aerobic exc-weight loss and cardio benefits
3. weight loss alone

so to me its those three. and that is why its a bad question and youll never see it

Obviously you have never been to a gym, because the first two choices in no way "obviously" lead to weight loss. This question is a no-brainer.

 

[Ramoray]

Obviously you have never been to a gym, because the first two choices in no way "obviously" lead to weight loss. This question is a no-brainer.

******, obviously i have and obviously you have maybe been to the gym but obviously have wasted thousands of hours of your life if you have not seen any weight loss by going to the gym. If a person is obese and he is going to the gym and lifting weights properly or doing aerobic excercise than regardless of what muscle he puts on, he will drop the fat off. Fat drops off faster than muscle mass can build so if you are lifting weights religiously in a routine, you will lose weight if you are obese. its a fact. If you are fat and you do aerobic excercise, you will lose weight 100 percent of the time. What a *******.. obviously if you are skinny and hit the gym to build muscle mass then your not going to lose weight. but the question is about an obese man. If you are obese, and hitting the gym and you do not lose weight than you have a big problem. Unless you are eating like a horse, but you have to make some assumptions in every question. but im assuming he is on the same diet as he was preworkout, so simple calories in .. calories out.. fat man who eats the same and doesnt work out... begins working out with weights, cardio or anything,, more calories go out= weight loss... *******

 

[xaelia]

Heh. Uhm...okay, enough with the flaming over semantics and non-factual generalizations about gym memberships.

I had this same question that lsu1000 is referring to about weight loss, exercise and pharmacologic interventions. I don't recall the specifics of the other options, and the wording is important, of course, but I believed the best answer was weight loss - other options were stopgap treatment of the symptoms but not getting at the underlying problem of the patient's obesity. Long-term dependence on medication for health maintenance is a good thing to get away from, anyway, in practice....

I also had a similar question where it was a fat, hypertensive smoker etc., and I had to pick one thing to fix on him. I said smoking, but, well, who knows....