Obesity, Metabolic Syndrome and Dyslipidaemia for NEET PG Medicine: BMI, Bariatric Surgery, Statins, LDL Targets, Familial Hypercholesterolaemia

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🎯 Exam priority: Medium. Expect: BMI classes, Asian cut-offs, metabolic syndrome components, bariatric surgery criteria and dumping, statin mechanism and adverse effects, LDL goals, ezetimibe and fibrate actions, familial hypercholesterolaemia signs, xanthelasma, lipaemia retinalis, triglycerides and pancreatitis, and secondary causes.

CBME mapping: GM 14.1–14.14. Lipid pharmacology is in Pharmacology; obesity epidemiology and NP-NCD in Community Medicine; atherosclerosis in Pathology; IHD in article 2.

BMI classes, obesity care, lipid drugs and targets. Drawn by TrackNation.

Obesity and Metabolic Syndrome

• BMI = weight (kg) / height (m)². Overweight 25–29.9; class I obesity 30–34.9; class II 35–39.9; class III ≥ 40. Lower cut-offs are suggested for people of Asian descent. Add waist circumference and, where possible, body composition.

• Complications: cardiovascular disease (especially with abdominal fat), diabetes, certain cancers, gallstones, obstructive sleep apnoea, infertility. Binge eating disorder can drive severe obesity.

• Drugs: semaglutide, tirzepatide, liraglutide, phentermine/topiramate, naltrexone/bupropion, orlistat — stopping them often causes weight regain.

• Bariatric surgery: BMI ≥ 35 regardless of comorbidity, or 30–34.9 with metabolic disease. Common operations: sleeve gastrectomy, Roux-en-Y gastric bypass. Dumping syndrome after high-sugar or high-fat meals: light-headedness, sweating, nausea, pain, diarrhoea.

• Metabolic syndrome: ≥ 3 of large waist (abdominal fat), high fasting glucose, hypertension, high triglycerides, low HDL.

Dyslipidaemia

• Secondary causes: diabetes, CKD, cholestatic liver disease (PBC), hypothyroidism, alcohol, drugs (thiazides, beta-blockers, retinoids, antiretrovirals, cyclosporine, tacrolimus); low HDL with smoking, anabolic steroids, HIV, nephrotic syndrome.

• Clues: xanthelasma (yellow plaques on the medial eyelids — also in PBC with normal lipids), arcus, tendon xanthomas; triglycerides > 500 risk acute pancreatitis; very high TG gives eruptive xanthomas and lipaemia retinalis.

• Familial hypercholesterolaemia (LDL-receptor defect): heterozygotes 1 in 200 — tendon xanthomas, arcus, CAD at 30–50 years (~5% of MIs under 60); homozygotes — CAD before 18, need LDL apheresis or liver transplant.

• Goals (MSD): with ASCVD, high-intensity statin to cut LDL > 50% and LDL < 70 mg/dL; very high risk (recent MI, diabetes, CKD ≥ 3) < 55. ICMR diabetes target: LDL < 100 (< 70 with CAD). High TG: lifestyle first (exercise, weight loss, avoid sugar and alcohol).

• Non-fasting lipids are usually sufficient; fast if non-fasting TG > 400.

Traps the Examiner Sets

• Statin muscle symptoms can occur with a normal CK.

• Xanthelasma does not always mean high lipids (PBC).

• Alcohol raises HDL but is not a treatment.

• Bariatric surgery at BMI ≥ 35 even without comorbidity.

• Omega-3 lowers triglycerides but can raise LDL.

Memory Hooks & Shortcuts

Shortcuts to lock in this article's numbers and lists. Each one only re-packages facts proven above.

• 🧠 BMI ladder '25-30-35-40' — BMI classes

• 🧠 Metabolic syndrome '3 of WGBTH': Waist, Glucose, BP, TG, HDL — metabolic syndrome

• 🧠 Statin = 'Stop the Synthesis'; Ezetimibe = 'Exclude from the gut' — lipid drugs

• 🧠 Fibrates Fight Fat in blood (TG) — fibrates

• 🧠 FH: 'Tendons, Arcus, early Attacks' — familial hypercholesterolaemia

Rapid-Revision Cards

• BMI

  kg / m².

• BMI classes

  25–29.9 overweight; 30–34.9 I; 35–39.9 II; ≥ 40 III.

• Asian BMI

  Lower cut-offs suggested.

• Obesity drugs

  Semaglutide, tirzepatide, liraglutide, orlistat…

• Bariatric criteria

  BMI ≥ 35; or 30–34.9 + metabolic disease.

• Dumping

  After sugar/fat: dizziness, sweating, diarrhoea.

• Metabolic syndrome

  ≥ 3 of waist, glucose, BP, TG, low HDL.

• Statin action

  HMG-CoA reductase ↓ → LDL receptors ↑.

• Statin muscle

  Up to 10%; CK may be normal; rhabdo rare.

• Ezetimibe

  Gut cholesterol absorption ↓; LDL ↓ 15–20%.

• PCSK9 inhibitors

  Evolocumab, alirocumab — when goal unmet.

• Fibrates

  LPL ↑; TG ↓ ~50%.

• Omega-3

  TG ↓, LDL may ↑.

• LDL goals (MSD)

  ASCVD < 70; very high risk < 55.

• ICMR DM LDL

  < 100; < 70 with CAD.

• TG and pancreatitis

  > 500 mg/dL.

• Heterozygous FH

  1/200; tendon xanthomas, arcus, CAD 30–50.

• Homozygous FH

  CAD < 18; LDL apheresis.

• Xanthelasma

  Medial eyelids; also PBC.

• Lipaemia retinalis

  Creamy retinal vessels; very high TG.

• Secondary causes

  Hypothyroid, CKD, cholestasis, alcohol, drugs.

• Non-fasting lipids

  Fine; fast if TG > 400.

Sources

Facts in this article were checked against these documents.

• MSD Manual Professional: Obesity; Metabolic Syndrome; Metabolic and Bariatric Surgery; Dyslipidemia — Merck & Co. (MSD Manuals), reviewed 2025–26 (link)

• Standard Treatment Workflow: Diabetes Mellitus Type 2 — Indian Council of Medical Research, DHR, 2022 (link)

• Competency Based Undergraduate Curriculum, General Medicine (GM 14) — National Medical Commission, 2024

Test Yourself: Practice Questions

Thirty questions in NEET PG style, most of them clinical vignettes.

Practice Questions (NEET PG pattern)

Original questions written in the style of the exam: +4 for a correct answer, −1 for a wrong one. Every answer was checked against the sources listed above. NEET PG papers are not published by NBEMS, so these are not past-paper questions.

Q1. A man weighs 96 kg and is 1.70 m tall (BMI ≈ 33). By the standard classification he has

• (a) class II obesity

• (b) overweight

• (c) class III obesity

• (d) class I obesity

Q2. BMI is calculated as

• (a) waist divided by hip

• (b) height divided by weight

• (c) weight times height

• (d) weight (kg) divided by height (m) squared

Q3. For people of Asian descent, BMI cut-offs for overweight and obesity are

• (a) the same

• (b) higher

• (c) lower than for other ethnic groups

• (d) not applicable

Q4. Class III obesity is BMI of

• (a) ≥ 40 kg/m²

• (b) ≥ 35 kg/m²

• (c) ≥ 50 kg/m² only

• (d) ≥ 30 kg/m²

Q5. A pulmonary complication strongly associated with obesity is

• (a) bronchiectasis

• (b) sarcoidosis

• (c) pneumothorax

• (d) obstructive sleep apnoea

Q6. A patient who lost weight on semaglutide stops the drug. The likely outcome is

• (a) hypothyroidism

• (b) permanent weight loss

• (c) no change ever

• (d) weight regain

Q7. A person with BMI 37 and no comorbidities asks about bariatric surgery. Current recommendations say

• (a) not eligible below BMI 40

• (b) eligible only with diabetes

• (c) never before age 60

• (d) eligible — BMI ≥ 35 regardless of comorbidities

Q8. After a Roux-en-Y gastric bypass, a patient gets light-headedness, sweating, nausea and diarrhoea after sweets. This is

• (a) dumping syndrome

• (b) anastomotic leak

• (c) gallstones

• (d) B12 deficiency

Q9. Metabolic syndrome is usually diagnosed when how many of its five features are present?

• (a) 3 or more

• (b) 1

• (c) 2

• (d) all 5

Q10. Which is NOT a component of metabolic syndrome?

• (a) large waist circumference

• (b) low HDL cholesterol

• (c) high triglycerides

• (d) high LDL cholesterol

Q11. Statins lower LDL by

• (a) activating lipoprotein lipase

• (b) binding bile acids

• (c) blocking intestinal absorption

• (d) inhibiting HMG-CoA reductase, which up-regulates LDL receptors

Q12. A patient on atorvastatin has muscle aches with a normal CK. The correct statement is

• (a) statin muscle symptoms can occur without CK elevation

• (b) a normal CK excludes a statin cause

• (c) this is always rhabdomyolysis

• (d) statins never cause muscle symptoms

Q13. A serious but uncommon muscle adverse effect of statins is

• (a) muscular dystrophy

• (b) dermatomyositis always

• (c) myasthenia gravis

• (d) rhabdomyolysis

Q14. Ezetimibe acts by

• (a) inhibiting PCSK9

• (b) activating PPAR-alpha

• (c) inhibiting intestinal absorption of cholesterol

• (d) inhibiting HMG-CoA reductase

Q15. A patient with recent MI on a high-intensity statin still has LDL above goal. The next step is

• (a) add ezetimibe or a PCSK9 inhibitor

• (b) stop the statin

• (c) no change

• (d) add a fibrate only

Q16. For a patient with established ASCVD, the usual LDL goal per MSD is

• (a) < 130 mg/dL

• (b) < 160 mg/dL

• (c) no goal

• (d) < 70 mg/dL with > 50% reduction

Q17. Per ICMR, the LDL target for a diabetic patient without coronary disease is

• (a) < 160 mg/dL

• (b) < 100 mg/dL

• (c) < 55 mg/dL

• (d) < 70 mg/dL

Q18. Fibrates mainly lower

• (a) LDL by 60%

• (b) Lp(a)

• (c) triglycerides (by about 50%) via lipoprotein lipase

• (d) HDL

Q19. Prescription omega-3 fatty acids

• (a) lower triglycerides but may raise LDL

• (b) lower LDL strongly

• (c) are statins

• (d) raise triglycerides

Q20. Acute pancreatitis can be caused by triglyceride levels above

• (a) 200 mg/dL

• (b) 150 mg/dL

• (c) 500 mg/dL

• (d) 250 mg/dL

Q21. A 34-year-old man has tendon xanthomas, corneal arcus and a strong family history of early MI. The likely diagnosis is

• (a) familial chylomicronaemia

• (b) Tangier disease

• (c) metabolic syndrome only

• (d) heterozygous familial hypercholesterolaemia (LDL-receptor defect)

Q22. A child with homozygous familial hypercholesterolaemia may need

• (a) fibrates only

• (b) LDL apheresis or liver transplantation

• (c) no treatment

• (d) omega-3 only

Q23. Yellow plaques on the medial eyelids are

• (a) lipaemia retinalis

• (b) tendon xanthomas

• (c) eruptive xanthomas

• (d) xanthelasma — may also occur in PBC with normal lipids

Q24. A patient with triglycerides of 2400 mg/dL has creamy-white retinal vessels on fundoscopy. This is

• (a) lipaemia retinalis

• (b) diabetic retinopathy

• (c) hypertensive retinopathy

• (d) central retinal vein occlusion

Q25. A secondary cause of hypercholesterolaemia that should be excluded is

• (a) hypothyroidism

• (b) Addison disease

• (c) iron deficiency

• (d) hyperthyroidism

Q26. Drugs that can worsen lipid levels include

• (a) statins

• (b) thiazides, beta-blockers, retinoids, antiretrovirals and cyclosporine

• (c) ezetimibe

• (d) metformin and SGLT2 inhibitors

Q27. For routine lipid screening, most patients

• (a) must fast 24 hours

• (b) need fasting lipids always

• (c) need no lipid test

• (d) can have non-fasting lipids; fast if non-fasting TG > 400

Q28. The first step for a patient with high triglycerides is

• (a) lifestyle change — exercise, weight loss, avoid concentrated sugar and alcohol

• (b) plasma exchange

• (c) statin at maximum dose

• (d) PCSK9 inhibitor

Q29. A patient asks whether drinking alcohol to raise HDL is advisable. The answer is

• (a) no — alcohol raises HDL but is not recommended as therapy

• (b) yes, if HDL < 40

• (c) yes, 2 drinks daily

• (d) only red wine

Q30. Low HDL cholesterol is associated with all EXCEPT

• (a) regular aerobic exercise

• (b) nephrotic syndrome

• (c) anabolic steroids

• (d) cigarette smoking

Active Recall

From memory: give BMI classes and the Asian caveat, bariatric surgery criteria and dumping, metabolic syndrome components, statin mechanism and adverse effects, LDL goals, actions of ezetimibe, PCSK9 inhibitors and fibrates, features of familial hypercholesterolaemia, clues of severe dyslipidaemia and secondary causes.