approach to childhood obesity

1. Presenter- Dr. PranotiToshniwal
Moderator- Dr. Madhura .N.

2.  Prevalence
 Definition
 Approach

3.  In 2016, an estimated 41 million children
under the age of 5 years were overweight or
obese.
 India has around 14.4 million obese children
as of 2017.
 The world prevalence of obesity has
increased by 300% over the last 40 years.

4.  BMI = Weight in kgs.
Height in metres^2
 Children >2 years, BMI of ≥95th centile, are obese.
Those with BMI between 85 to 95 are overweight.
 WHO guidelines 2018-
a) overweight is BMI >1 SD above theWHO Growth Reference
median; and
b) obesity is BMI > 2 SD above theWHO Growth Reference
median.

6. Mainly-
 Environmental causes.
 Genetic causes.
 Endocrine causes.

7.  Increased availability of high carbohydrate
beverages, drinks, fruit juices.
 Increased availability of “cheap calories”
 Increased use of vehicles, reduced walking.
 Pressure on academic performance.
 Chronic partial sleeping.

8.  Determines the individual susceptibility.
 FTO gene- adiposity in childhood.
 MC4R deficiency- early onset obesity.
 Eg. Of a genetic disease associated with obesity
is Prader-Willi.

9.  Short term control and the regulation of hunger
and satiety is by the neuro-endocrine feedback
system .
 Involves -
1. Adipose tissue
2. Gastrointestinal system.
3. Central nervous system.

10. PATHOLOGY

12.  Endocrine causes –
Cushing syndrome , GH deficiency,
Hypothyroidism, Pseudohypothyroidism.
 Genetic causes-
Bardet-Biedl syndrome, Prader-Wili syndrome,
Turner syndrome.

13. History –
 Developmental delay ?
 Family history ?
 Dietary history ?
 Known co-morbidities?
 History of hyperphagia?
 History of drugs ?

14. Physical examination –
 Vitals ( HTN ? ) , anthropometry
 Presence of markers – hirsutism, moon face,
acanthosis nigricans, short stature,
hypogonadism ?
 Tanner staging,
 Syndromic features?

16.  With normal growth, development and no
syndromic or endocrine features, no workup
is generally necessary,
 In the presence of growth failure and BMI
>3SD
TSH, cortisal levels should be done at the first
sitting.

19.  Counselling.
 Family based treatment.
 Dietary advice.
 Meals to be based on vegetables, fruits, whole
grain and poultry.
 Encouraging activity.

24.  Morbid obesity may require drugs or even
bariatric surgery.
 Surgery is only recommended when near
complete or complete skeletal maturity is
achieved and BMI is ≥40 .

25.  ORLISTAT
1. FDA approved for children >12 years
2. Weight loss is not very significant.
3. Due to side effects, generally not tolerated.
4. Steatorrhoea – most unpleasant side effect.

26.  METFORMIN
1. FDA approved forType 2 DM >10 years,
2. Reduces insulin intolerance,
3. Weight loss is not very significant,
4. May cause GI upset,
5. Can be used for PCOS in adolescent girls.

27.  TOPIRAMATE
1. Not FDA approved,
2. May control cravings,
3. Used for Seizure control in children
4. Not recommended.

28.  PHENTERMINE
1. FDA approved for weight loss > 16 years
2. Weight loss is moderate,
3. May cause anxiety, tremors and HTN.

29.  Octreotide for hypothalamic obesity
 Leptin in cases of leptin deficiency
 Obese children with growth failure may
benefit withGH therapy.

30.  Careful monitoring
 Family counselling regarding diet, regular and
timely eating habits.
 Promote physical activity at schools.
 Reduce use of sweetened beverages, sodas,
concentrated juices (target population is kids in
commercials).

31. THANKYOU