CHILDHOOD OBESITY LECTURE

1. CHILDHO
OD
OBESIT
Y

2. DEFINITI
ON
• BMI is the most widely used
parameter to define obesity.
• In children >2yrs,obesity is defined as BMI
>/= 95th percentile.
• BMI between 85th-95th percentile falls in
the overweight range.
• Weight for height >120% is
considered obesity.

3. • It is a global public health problem
sparing only dramatically poor regions
with chronic food scarcity.
• Prevalence is 31% in age group of 2-
6yrs, 16% in ages 6-19yrs.
PREVALE
NCE

4. ETIOLO
GY
1.Environmental factors :
Increased consumption of high
carbohydrate beverages,fast food,
increased snacking between
meals, decline in levels of
physical activity, increase in
sedentary activities,

5. high pressure for academic
performance, socioeconomic
status,race,gender, maternal
education level,
parental obesity,
prenatal factors like weight gain during
pregnancy,high birth weight,gestational
diabetes,IUGR with early infant catch up
growth,

6. chronic partial sleep loss
(1.>> hunger and appetite due to
decreased leptin levels and increased
ghrelin levels,
2.decreased glucose tolerance and insulin
sensitivity due to alterations in
glucocorticoids levels,
3.synthesis of orexins,peptides in
lateral hypothalamus increasing
feeding)

7. 2.Genetic
causes :

9. 3.Endocrine causes :
• Monitoring of stored fats,control
over appetite,satiety occurs
through neuroendocrine feedback
loops
• Linking adipose tissue,CNS and GI
tract.

10. FROM THE GIT
Stimulating
appetite Ghrelin
Promoting satiety
Cholecystokinin
Glucagon like
peptide-1 Peptide
YY
FROM THE ADIPOCYTES
Adiponectin (>> levels in fasting,<< in
obesity) Leptin(= satiety,
low levels stimulate food intake,high levels
inhibit hunger)

11. FROM THE BRAIN
Neuropeptide Y
Agouti related
peptide Orexin
stimulate
appetite
Melanocortins
Alpha melanocortin stimulating
hormone
satiet
y

13. Endocrine
causes
• Cushing syndrome (central
obesity,hirsutism,moon
face,hypertension)
• Growth hormone deficiency
(short stature,slow linear
growth)
• Hyperinsulinism
(nesidioblastosis,pancreatic
adenoma,Mauriac syndrome)

14. • Hypothyroidism (short
stature,weight
gain,constipation,cold intolerance)
• Pseudohypoparathyroidism (short
metacarpals,subcutaneous
calcifications,dysmorphic
facies,MR,short
stature,hypocalcemia,hyperphosphate
mia)

15. 4.CONSTITUTIONAL
OBESITY
• No organic cause.
• Due to imbalance between energy intake
and expenditure.
• These children are tall for age ->
differentiating factor from
pathological obesity.
• Normal development,obesity is
proportional.
• Unnecessary investigations to be
avoided.

16. 5.HYPOTHALAMIC
OBESITY
• Following
surgery,radiation,tumors,trauma,infecti
on.
• Rapid onset obesity sets in.
6.DRUGS
• Anti epileptic
drugs,steroids,estrogen,atypical
antipsychotics.

17. COMORBIDIT
IES
1.Type-2 diabetes (>> insulin
resistance) 2.Hypertension
3.Hyperlipidemia
4.Non alcoholic fatty liver
disease,cirrhosis 5.Risk of chronic
inflammation (low levels of
adiponectin - anti-inflammatory
peptide,
high levels of proinflammatory peptides

18. 6.Obstructive sleep apnea
7.Orthopedic complications like
Blount
disease,slipped femoral capital
epiphysis
8.Mental health problems like low
self esteem,depression,eating
disorders
9.Metabolic
syndrome 10.PCOS

19. EVALUATI
ON
• Identified as a part of routine medical
checkup.
• Perform detailed physical examination.
• Charting growth charts for weight,height,BMI.
• Consider possible medical causes for obesity
(poor linear growth,rapid changes in weight
gain).
• Detailed history of family eating and
activity patterns
(description of regular
meal,snacking,physical and sedentary

20. • Family history of adiposity and obesity
related disorders.
• Laboratory testing to identify
comorbid conditions.

25. INTERVENTI
ON
• Nutritional advice + exercise +
cognitive behavioral therapy.
• Meals should be based on
fruits,vegetables,whole grains,lean
meat,fish and poultry.
• Gradual approach to cut down calories.
• Family support is crucial.

26. RECOMMENDED CALORIC
INTAKE DESIGNATED BY
AGE AND GENDER

27. “TRAFFIC LIGHT” DIET
PLAN
• Groups foods into those which can be
consumed without any limitation
(green),
in moderation (yellow), reserved
for infrequent treats (red).
• Can be adapted to any ethnic
group/regional cuisine.

29. • Increasing physical activity contributes
to weight loss,decreases risk for
cardiovascular disease.
• Restriction of screen time to no more than
2hrs/day in children >2yrs old,no television
for children less than 2yrs (AAP).

30. •Pharmacological therapy :
Adjunctive,>> rate of weight
loss

32. • Bariatric surgery :
For adolescents with a BMI >/= 40,
after attaining complete skeletal maturity,
suffering from medical problems associated
with
obesity,
after they have failed 6 months of
multidisciplinary weight management
program
(Roux-en-Y,adjustable gastric band)

33. PREVENTI
ON
• Improved food choices+increased
physical activity+reduced screen time.
• Promotion of breast feeding(exclusive
for 6 months,total BF for 12months).
• Introduction of infant foods at 6 months
with focus on cereals,fruits,vegetables.
• Introduction of lean meat,poultry,fish later in
first year of life.
• Avoiding highly sugared beverages and
foods.

34. • Family approach , scheduled
meals.
• Frequent snacking to be
avoided.
• Limiting screen time for children.
• 60min/day of activity for
children.
• Encourage walking to school.
• Use of mass media.

35. THANK
YOU