CSOWM CERTIFICATION EXAM
QUESTIONS WITH VERIFIED SOLUTIONS
2026/2027
Instructions: This exam contains multiple-choice questions covering the core
content domains tested on the CDR CSOWM examination. Topics include
pathophysiology, assessment, nutrition and exercise interventions, behavioral
health, pharmacotherapy, and bariatric surgery.
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
(hunger hormone), decreased PYY and GLP-1 (satiety hormones), and
reduced resting and non-resting energy expenditure .
, 4. Which adipokine is associated with insulin resistance and chronic
inflammation in obesity?
A. Adiponectin
B. Tumor necrosis factor-alpha (TNF-α)
C. Leptin only
D. Interleukin-10
Correct Answer: B — Tumor necrosis factor-alpha (TNF-α)
Rationale: TNF-α is a pro-inflammatory cytokine secreted by adipose
tissue that contributes to insulin resistance and chronic low-grade
inflammation in obesity. Adiponectin is generally anti-inflammatory and
its levels are decreased in obesity .
5. According to the 2023 AAP Clinical Practice Guideline, at what BMI
percentile should intensive health behavior and lifestyle treatment be
considered for children aged 6 and older?
A. ≥ 85th percentile
B. ≥ 95th percentile
QUESTIONS WITH VERIFIED SOLUTIONS
2026/2027
Instructions: This exam contains multiple-choice questions covering the core
content domains tested on the CDR CSOWM examination. Topics include
pathophysiology, assessment, nutrition and exercise interventions, behavioral
health, pharmacotherapy, and bariatric surgery.
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
(hunger hormone), decreased PYY and GLP-1 (satiety hormones), and
reduced resting and non-resting energy expenditure .
, 4. Which adipokine is associated with insulin resistance and chronic
inflammation in obesity?
A. Adiponectin
B. Tumor necrosis factor-alpha (TNF-α)
C. Leptin only
D. Interleukin-10
Correct Answer: B — Tumor necrosis factor-alpha (TNF-α)
Rationale: TNF-α is a pro-inflammatory cytokine secreted by adipose
tissue that contributes to insulin resistance and chronic low-grade
inflammation in obesity. Adiponectin is generally anti-inflammatory and
its levels are decreased in obesity .
5. According to the 2023 AAP Clinical Practice Guideline, at what BMI
percentile should intensive health behavior and lifestyle treatment be
considered for children aged 6 and older?
A. ≥ 85th percentile
B. ≥ 95th percentile
