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Chldhood obesity


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Chldhood obesity

  1. 1. Obesity Definition A chronic condition characterised by excess adipose tissue, causally related to serious medical illness
  2. 2. Obesity Diagnostic Tools • Percentile on Growth Charts • Body Mass Index (BMI) • Triceps Skin fold Thickness (TST) • Waist-hip ratio
  3. 3. Diagnosis of Obesity • Weight for height >120% • Age specific growth charts • Skin fold thickness: >85%centile for sex and age • Waist : >40” in males & 35” in females • WHR : >0.8 women & 0.9 in males
  4. 4. Percentage Wt. for Ht. = ------------------------------------- X 100 Weight for Height Actual Weight Expected weight for actual height < 90 % : PEM > 90 % : Normal > 120-130 : Obesity
  5. 5. Body Mass Index or BMI in Adolescents Weight in kilograms is divided by the square of the height in meters • Normal : 19 to 24.9 kg/m2 • Overweight : 25 - 26.9 • Obese : 27 to 29.9 • Severe Obesity : Over 30 (Over the 95th Percentile) • Morbid Obesity : Over 40
  6. 6. Skin fold thickness Skin thickness is an index of body fat SFT Taken at  Triceps (most common site)  Subscapular  Suprailiac  Abdomen  Upper thigh Lange’sHarpenden’s Skin foldSkin fold
  7. 7. Adolescent Growth Chart Measure of Height Weight and BMI in single graph
  8. 8. Types of Obesity • Simple obesity • Pathologic obesity – Dysmorphic syndromes – Endocrine – CNS – Drugs – Leptin deficiency
  9. 9. Prevalence: The National Health and Nutrition Examination Surveys • 75% relative increase in obesity in adolescents is noted since 1970 • 25% of American adolescents are identified as being obese • 50% increase in morbid obesity (a BMI of 30 or more) over the past decade • Indian studies 7-21 % prevalence
  10. 10. Factors Contributing to the Obesity Epidemic • Increase – in intake of regular soda drinks – In intake of fast foods – in portion size of fast foods – highcarb snacks • Decrease – in physical activity • Increase – in physical inactivity (TV, video, computer time)
  11. 11. Why is it important? • WHO has declared obesity as a “global epidemic” • Childhood & adolescent obesity is a risk factor for adult obesity “Tracking” • Life style diseases like NIDDM,Coronary artery disease Hypertension, dyslipidemia, cancers are linked with obesity • Psychosocial problems
  12. 12. Obesity: Complications • Psychological – Disturbed body image – Poor self-image/self-esteem – Poor family relations: scapegoat and source of embarrassment – Poor peer relations and social isolation – Exclusion from activities, especially dating – Acting out and depression
  13. 13. Obesity: Complications • Medical – Coronary artery disease – Cerebrovascular disease – Gallstones – Orthopedic problems – Sleep apnoea – Increased cancer risks (colon, rectum, prostate) – Diabetes mellitus
  14. 14. Overweight Screening Procedure Screening includes evaluation for: – Family history – Blood pressure – Total Cholesterol (≥ 200 mg/dl) – Large change in BMI (≥ 2 points in previous year) – Concern about weight – Smoking history
  15. 15. Family History • Positive Family History includes history of: – Cardiovascular Disease – Parental hypercholesterolemia – Hypertension – Diabetes – Parental Obesity
  16. 16. Physical Exam • Eyes – Peripheral view – Fundi • Skin – Acanthosis nigricans – Purple stria – Texture – Hirsutism, acne • Endocrine - Hypopituitarism - Hypercortisolism - Hyperinsulinemia - Hyperandrogenism in females
  17. 17. Lab Work-Up • T4, TSH • Free testosterone (in females) • Fasting insulin and glucose • Lipid profile • 24 hour urine for free cortisol • DHEA-S • Sleep studies • Chest x-ray; EKG
  18. 18. Management Strategies of Obesity Prevent weight gain Promote weight maintenance Manage co morbidities Promote weight loss Rule out treatable medical causes
  19. 19. Underlying Medical Conditions • Hypothyroidism – Initiate treatment with levothyroxin • Cushing’s syndrome – Identify source of excess cortisol – Surgically remove source of excess ACTH or cortisol
  20. 20. Treatment Content  Diet / Nutrition Plan  Physical Activity  Controlling the environment  Self-monitoring  Goal setting and contacting  Parenting skills  Managing high-risk situations  Maintenance and relapse prevention
  21. 21. General Management Principles  Can start with weight stabilization  Eventually a 10% weight reduction  Can decrease by 500 calories/day with low fat/high fiber diet  Set realistic goals  2% decrease in 2500 calories: 5 lb to drop in one year (use skim milk)
  22. 22. Physical Activity  Providing and choice of activities appears to be superior to providing a specific exercise prescription  Recent research suggests that reducing sedentary behaviors may be more effective than promoting physical activity in promoting weight loss
  23. 23. Exercise  Exercise also plays very vital role in the management of obesity.  The more exercise one takes, greater is the daily energy expenditure and more rapidly the obesity reduces.
  24. 24. Energy expenditure in different activities  At rest 1Kcal /min  Walking, gardening 5 Kcal/ min  Cycling, swimming 7 Kcal /min  Squash, jogging, hill climbing 10 Kcal/ min
  25. 25. Benefits of exercise • Obese people with a heavier body to move, spend more energy for same amount of work. • It is valuable as a diversion from sitting indoors and being tempted to eat. • Exercise reduces appetite. • After exercise the resting B.M.R. may increase for some hours.
  26. 26. Controlling the Environment Help reduce cues  (e.g., taking TV out of bedroom) Limit access to high calorie foods Encourage family activities (e.g., family walks)
  27. 27. Parenting Skills  Parents often need practice in general parenting skills to implement many of the behavioral methods including:  Being consistent  Being observant so they can reward behavior change  Effectively using rewards  Modeling desired behavior  Limit setting (saying “no” when necessary)
  28. 28. Parental Problems
  29. 29. Child’s Attitude  What was wrong?  Why were these kids such picky eaters?
  30. 30. Management Options  Behavioural interventions  Mealtime suggestions
  31. 31. Tactics for Toddlers To tempt littleTo tempt little taste budstaste buds && minimizeminimize mealtimemealtime hassles.hassles.
  32. 32. 1. Offer a nibble tray Toddlers like to graze their way throughToddlers like to graze their way through a variety of foods, so why not offer them aa variety of foods, so why not offer them a customized smorgasbord?customized smorgasbord? Use an ice-cube tray, a muffin tin, or a compartmentalized dish, and put bite-size portions of colorful and nutritious foods in each section. Call these finger foods playful names that a two-year-old can appreciate
  33. 33. 2. Spread it Toddlers like spreading, or more accurately, smearing. Show them how to use a table knife to spread cheese, peanut butter, and fruit concentrate onto crackers, toast, or rice cakes.
  34. 34. What and how much they are willing to eat may vary daily. Don't be surprised if "The only thing consistent about children’s feeding is"The only thing consistent about children’s feeding is inconsistency."inconsistency." •your child eats a heaping plateful of food one day and practically nothing the next, •adores spinach on Tuesday and refuses it on Thursday • wants to feed herself at one meal and be totally catered to at another. 3. Count on inconsistency
  35. 35. Toddlers are into toppings. 4. Top it Putting nutritious, familiar favorites on top of new and less-desirable foods is a way to broaden the finicky toddler's menu
  36. 36. Make a smoothie – together. Milk and fruit – along with supplements such as juice, egg powder, wheat germ, yogurt, honey, and peanut butter – can be the basis of very healthy meals. 5. Drink it.. If your youngster would rather drink than eat, don't despair So what if they are consumed through a straw? One note of caution: Avoid any drinks with raw eggs or you'll risk salmonella poisoning.
  37. 37. How much a child will eat often depends on how you cut it. 6. Cut it up Cut sandwiches, pancakes, waffles, etc. into various shapes using cookie cutters.
  38. 38. 7. Package it Our kids enjoy the unexpected and fanciful when it comes to serving dishes – anything from plastic measuring cups to ice- cream cones.
  39. 39. "Doctor, he won't eat his vegetables" 8. Become a veggie vendor So if you aren't the proud parent of a veggie lover, try the following tricks •Plant a garden with your child. •Slip grated or diced vegetables into favorite foods •Use vegetables as finger foods and dip them in a favorite sauce or dip. •Concoct creative camouflages. •Cut the vegetables into interesting shapes (Make veggie art).
  40. 40. 9. Share it If your child is going through a picky- eater stage, invite over a friend who is the same age or slightly older whom you know “likes to eat.” Your child will catch on. Group feeding lets the other kids set the example.
  41. 41. 10. Respect tiny tummies This less-is-more meal plan is not only more successful with picky eaters, it also has the added benefit of stabilizing blood-sugar levels, which in turn minimizes mood swings. Dole out small portions at first and refill the plate when your child asks for more.
  42. 42. 11. Make it accessible Reserve a low shelf in the refrigerator for a variety of your toddler's favorite (nutritious) foods and drinks. This tactic also enables children to eat when they are hungry, an important step in acquiring a healthy attitude about food. Give your child shelf space.
  43. 43. 12. Use sit-still strategies One reason why toddlers don't like to sit still at the family table is that their feet dangle. Try sitting on a stool while eating. Children are likely to sit and eat longer at a child-size table and chair where their feet touch the ground.
  44. 44. 13. Turn meals upside down The distinctions betweenThe distinctions between breakfast, lunch, and dinnerbreakfast, lunch, and dinner have little meaning to ahave little meaning to a child.child. If your youngster insists onIf your youngster insists on eating chapathi in theeating chapathi in the morning or fruit and cerealmorning or fruit and cereal in the evening, go with it –in the evening, go with it – better than her not eating atbetter than her not eating at all.all. This is not to say that you should become a short-order cook, filling lots of special requests, but why not let your toddler set the menu sometimes?
  45. 45. 14. Let them cook Let your child help prepare the food. Use cookie cutters to create edible designs out of foods. Give your assistant such jobs as tearing and washing lettuce, scrubbing potatoes, or stirring batter.
  46. 46. 15. Make every calorie count Offer your child foods that pack lots of nutrition into small doses. Nutrient-dense foods that most children are willing to eat include: •Pasta,Brown rice and other grains, Potatoes,Cheese, Poultry, Eggs, Squash, Fish, Sweet potatoes, Kidney beans,Yogurt, etc.
  47. 47. Behaviour Modification - Adolescents  Aimed at changing behaviour  useful while treating obesity
  48. 48. Flash Card Technique • Increases motivation • involves writing reasons for wanting to lose weight • I will look better • I will feel better • I will be be healthier • I will fit into my favourite pair of jeans
  49. 49. Food Diary Time Food Or Liquid consumed Place Circumstances 7.50 pm 1 pack of chips 1 piece of cake 1 cola bedroom watching TV • Identifies triggers • Useful in understanding eating patterns • Logs exact amount of food or liquid consumed
  50. 50. Setting diets & goals • Identifying and sticking to – a specific diet – food to be consumed – Place – time • Setting reasonable goals like – losing one or two pounds a week likely to be achieved
  51. 51. Food Pyramid Cereals Pulses GLV Fruits Non-Veg Food Milk Sweets, oily & fatty food
  52. 52. Ways of controlling urges • Removal of tempting foods • Use of distractors like engaging in another activity • Using positive self-statements like I can do this, I must control myself, I will be fine, The urge will pass
  53. 53. Use of Reinforcement • Positive reinforcement : Rewarding oneself as goals are met e.g. going for a film with a friend • Negative reinforcement : escape unpleasant stimulus to increase desired behaviour > missing a favourite TV programme if overeaten
  54. 54. Obesity Treatment Strategies NOT recommended  Surgery  Drug Treatment (including herbal treatments)  Quick Weight Loss Diets
  55. 55. Pharmacotherapy  Shown to be effective in the treatment of obesity in some adults  Their use in most youth is limited at this time  Teens should be at least 16 years of age with morbid obesity
  56. 56. Failure of Obesity Treatment • Lack of family involvement and support • lack of flexibility • Lack of emphasis on increasing physical activity • Lack of a maintenance phase
  57. 57. Diets may produce weight loss but do not cure obesity; weight regain is common.
  58. 58. Eat less; eat 2/3 or ½ the calories you have been eating
  59. 59. Target is to eat about 1200-2000 kcal/d, depending on the age of the child
  60. 60. Try to cut out empty calorie foods – fats, soft drinks, and fast foods.
  61. 61. Amounts of low calorie foods can be increased – fruits and vegetables
  62. 62. Avoid other activities while eating (except conversation)
  63. 63. • Meal or food should not be provided as reward.
  64. 64. • Make small portions of food appear as large (small plate, food cut up in small pieces)
  65. 65. Leave eating place as soon as you have eaten
  66. 66. Slow down the rate at which you eat
  67. 67. Chew each mouth full for long.
  68. 68. Reduce inactivity
  69. 69. Take steps to minimize hunger, loneliness, depression, boredom, anger and fatigue which lead to overeating,
  70. 70. Think positively
  71. 71. WHAT can we do to prevent obesity ? Right from childhood into adolescence into adulthood we must encourage •Exercise, •Physical activity •Physical Fitness •Life style modification •Nutritional intervention
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  73. 73. • C.S.N.VittalC.S.N.Vittal