CSOWM ASSESSMENT DOMAIN EXAM
QUESTIONS WITH VERIFIED SOLUTIONS
2026/2027
Instructions: This exam contains multiple-choice questions covering the
Assessment domain of the CSOWM examination. Topics include
pathophysiology of obesity, anthropometric measurements, laboratory
assessment, behavioral health screening, and psychosocial factors.
1. A 48-year-old patient with a BMI of 32 kg/m² asks about the
underlying biology of obesity. Which statement BEST describes the role
of leptin in established obesity?
A. Leptin levels are typically low in obesity, driving increased hunger
B. Most patients with obesity have leptin resistance, so high leptin fails
to suppress appetite
C. Leptin is secreted by the stomach and stimulates ghrelin release
D. Leptin deficiency is the primary cause of obesity in over 50% of
adults
,Correct Answer: B — Most patients with obesity have leptin resistance,
so high leptin fails to suppress appetite
Rationale: Leptin is produced by adipocytes in proportion to fat mass,
so most adults with obesity have high circulating leptin yet remain
hungry, indicating central leptin resistance at the hypothalamus. True
congenital leptin deficiency is rare .
2. Which gut hormone is MOST associated with the post-meal satiety
signal that GLP-1 receptor agonists pharmacologically extend?
A. Ghrelin
B. Glucagon-like peptide-1 (GLP-1)
C. Cortisol
D. Adiponectin
Correct Answer: B — Glucagon-like peptide-1 (GLP-1)
Rationale: GLP-1 is an incretin secreted by intestinal L-cells after meals;
it slows gastric emptying, enhances glucose-dependent insulin
, secretion, and signals satiety. Semaglutide and liraglutide are
pharmacologic GLP-1 receptor agonists that prolong this satiety signal .
3. A patient who lost 12% of body weight 6 months ago has regained 4
kg despite adherence to her plan. Which physiologic mechanism BEST
explains weight regain after intentional weight loss?
A. A permanent increase in basal metabolic rate after weight loss
B. Compensatory increase in hunger hormones (ghrelin) and decrease
in satiety hormones (PYY, GLP-1) plus reduced resting and non-resting
energy expenditure
C. Increased leptin sensitivity after weight loss
D. Decreased cortisol production
Correct Answer: B — Compensatory increase in hunger hormones
(ghrelin) and decrease in satiety hormones (PYY, GLP-1) plus reduced
resting and non-resting energy expenditure
Rationale: Weight regain after intentional weight loss is driven by
compensatory metabolic adaptations including increased ghrelin
QUESTIONS WITH VERIFIED SOLUTIONS
2026/2027
Instructions: This exam contains multiple-choice questions covering the
Assessment domain of the CSOWM examination. Topics include
pathophysiology of obesity, anthropometric measurements, laboratory
assessment, behavioral health screening, and psychosocial factors.
1. A 48-year-old patient with a BMI of 32 kg/m² asks about the
underlying biology of obesity. Which statement BEST describes the role
of leptin in established obesity?
A. Leptin levels are typically low in obesity, driving increased hunger
B. Most patients with obesity have leptin resistance, so high leptin fails
to suppress appetite
C. Leptin is secreted by the stomach and stimulates ghrelin release
D. Leptin deficiency is the primary cause of obesity in over 50% of
adults
,Correct Answer: B — Most patients with obesity have leptin resistance,
so high leptin fails to suppress appetite
Rationale: Leptin is produced by adipocytes in proportion to fat mass,
so most adults with obesity have high circulating leptin yet remain
hungry, indicating central leptin resistance at the hypothalamus. True
congenital leptin deficiency is rare .
2. Which gut hormone is MOST associated with the post-meal satiety
signal that GLP-1 receptor agonists pharmacologically extend?
A. Ghrelin
B. Glucagon-like peptide-1 (GLP-1)
C. Cortisol
D. Adiponectin
Correct Answer: B — Glucagon-like peptide-1 (GLP-1)
Rationale: GLP-1 is an incretin secreted by intestinal L-cells after meals;
it slows gastric emptying, enhances glucose-dependent insulin
, secretion, and signals satiety. Semaglutide and liraglutide are
pharmacologic GLP-1 receptor agonists that prolong this satiety signal .
3. A patient who lost 12% of body weight 6 months ago has regained 4
kg despite adherence to her plan. Which physiologic mechanism BEST
explains weight regain after intentional weight loss?
A. A permanent increase in basal metabolic rate after weight loss
B. Compensatory increase in hunger hormones (ghrelin) and decrease
in satiety hormones (PYY, GLP-1) plus reduced resting and non-resting
energy expenditure
C. Increased leptin sensitivity after weight loss
D. Decreased cortisol production
Correct Answer: B — Compensatory increase in hunger hormones
(ghrelin) and decrease in satiety hormones (PYY, GLP-1) plus reduced
resting and non-resting energy expenditure
Rationale: Weight regain after intentional weight loss is driven by
compensatory metabolic adaptations including increased ghrelin
