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NBME 22 Answers

nbme22/Block 4/Question#48

An 8-year-old boy is brought to the physician by ...

Calorie consumption that exceeds energy expenditure

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submitted by aesalmon(40),

I feel dumb for asking but can someone explain this? If his parents are of close to normal BMI and are concerned about his weight why would they be allowing his calorie consumption to exceed his energy expenditure? ( AKA letting the kid eat too much and not exercise enough)

meningitis  That's a modern day mystery. +  
drdoom  The prompt is only asking "what's the likely cause of obesity?" It's not that they're "allowing" him to eat more than exercise. (Few parents can monitor their kids that closely!) The prompt is only asking what's the most likely explanation for his 95th percentile weight and BMI (given that he otherwise appears normal); in the United States, the most likely explanation is eating way more than you expend. +  
niboonsh  aka 'merica #firstworldproblems +  

My approach to this question was more just focusing in the info they are giving. None of the other option makes sense because there is not evidence to talk about them. I was very tempted to pick the "decrease leptin production" but I remembered Dr Goljan saying "Think simple, think cheap, they are not trying to trick you." So, chubby parents = chubby kids.

almondbreeze  thought his words on "think cheap" had to do with treatments - i.e. exercise +  

FA 2019 pg. 327 on leptin + Satietyhormone.Producedbyadiposetissue.Mutationofleptingene- congenitalobesity.Sleep deprivation or starvation - I leptin production. Leptin keeps you thin. Acts on ventromedial area of hypothalamus (satiety center) to I appetite.

I picked leptin too. However, the q asks for the 'most likely explanation' for his obesity.

+/- almondbreeze(3),

I think the key to understanding this question is that the boy has above average height. Leptin stimulates the release of GH (https://www.ncbi.nlm.nih.gov/pubmed/12122085) Children with Cushing syndrome have short stature https://www.ncbi.nlm.nih.gov/pubmed/16675933) insulin inhibits GH secretion https://www.ncbi.nlm.nih.gov/pmc/articles/PMC425166/) I think that both a high caloric diet in fats and glucose can make you fat so you can eliminate those answer choices.