approach to a child with obesity

1. CHILHOOD OBESITY
By
Dr.shahid syed
PG.Trainee ATH abbottabad

2. OBESITY DEFINITION
“Excessive storage of energy as FAT relative
to lean body mass.
Energy intake exceeds expenditure

3. EPIDEMIOLOGY
United states: childern and adolescent
Overweight 24%
Obese 16-18%
World wide: 10%
Malta (25.4%)
USA (25.1%)

4. .
Obesity can be measured by using BMI which is an
excellent tool for measuring body fats.
(BMI = weight in kg / Height in meters)
NORMAL:
BMI 5 - 84 percentile
OVER WEIGHT:
BMI 85 - 95 percentile
OBESITY:
BMI 95 - 99 percentile
MORBID OBESITY:
BMI >99 percentile

5. .
WAIST CIRCUMFERENCE:
 Waist for age percentile
 Waist for height Ratio:Normaly waist should
be less than half of the height.

6. .
Below 2 years of age weight/height is used as a
measure of obesity.
OVERWEIGHT: weight/height >20% expected
normal.
OBESE: >50%
MORBID OBESITY: >80%

7. .

8. CAUSES OF OBESITY
ENDOCRINE:
• Cushing syndrome
• GH deficiency
• Hypothyroidism
• PHPT
GENITIC:
• Bardet-biedle syndrome
• Prader-Willi syndrome
• Alstrome syndrome
• Carpenter syndrome
• Down syndrome
• turner/klinefelter syndrome
• Frohlic syndrome
• Leptin,melanocortin deficiency
SAMPLE OBESITY:
• Increase intake,decrease expendature

9. Con’t….
DRUGS:
• Glucocorticoides(cortisole)
• Megace(synthetic progesteron)
• Sulfonylureas
• Tricyclic antidepressants (TCAs)
• Monoamine oxidase inhibitors (MAOIs), such as phenelzine
• Oral contraceptives
• Insulin (in excessive doses)
• Thiazolidinediones
• Risperidone
• Clozapine

10. HISTORY
 Time of obesity onset
 Feeding habits,pattern and peferences
 Physical activity
 Screen time
 Previous chronic diseases
 Sleeping patern
 Poor neighborhood safety
 Family history of obesity
 Mental status
 Brain damage
 Headach,vomiting and visual disturbance

11. EXAMINATION
1)Growth parameters
(.) Short stature (endocrine,syndromic)
(.) Tall (simple obesity,klinefelter synd)
2) Distribution of obesity
(.) Centeral (cushing)
(.) Generalized (others)
3)Tanner staging
(.) Pseudoprecosity (cushing)
(.) Hypogonadism (PW,BB,kallmann,Frohlich,klinefelter)
(.) Gynaecomastia (klinefelter)

12. Con’t….
4)Menatal status assissment
(.) Cognitive impairment (most of syndromes)
(.) Normal cognition (simple,endocrinal)
5)Faces
(.) Cherubic (GH deficiency)
(.) Moonface (cushing)
(.) Plethora (cushing,Pickwickian)
(.) Telangectasia (cushing)
(.) Coarse features (hypotyroidism)
(.) Downy faces

13. Con’t…..
6)Eye
(.) Almond shaped,squint (PW)
(.) Epicanthic folds,down slanting (down)
(.) Visual aquity:impaired(BB,Frohlich,Alstrom)
7)Hands
(.) Small (PW)
(.) Short 4th metacarpal(PHPT)
(.) Polydactaly((BB)

14. Con’t…..
8)Abdomen
(.) Hepatomegaly (RVF in Pickwikian synd)
(.) Adrenal mass (tumers)
(.) striae
9)Look for complications
(.) slipped capital femoral epipysis
(.) hypertension
(.)bowing of tibia and femur(blount disease)

15. .

16. OBESITY ASSOCIATED COMORBIDITIES
• Dyslipidemia
• Hypertension
• Diabetes type 2
• Polycystic overy
• Gallblader disease
• Non alcohlic fatty liver disease
• Pseudotumer cerebri
• Migrain
• Orthopedic complications
• Social and psychological
• Asthma
• Obstructive sleep apnea

17. MANAGEMENT
Prevention is better than cure
Decrease energy intake and increase
expendature
But its not so simple…….
Obesity is a chronic disabling disease which
need mutiple preventive and therapeutic
measures to be control.

18. .
 Goal
Weight maintenance or gradual weight loss until
BMI is <85th percentile and should not exceed 1
lb/month in children aged 2–5 years, or 2 lb/week
in older obese children and adolescents

19. NONPHARMACOLOGICAL
Lifestyle Modification:
() Physical activities
() decreasing sreen time
() videos game
() tobacco smoking outweigh the benifits

20. .
DIETARY MODIFICATIONS:
Traffic Light Diet Plan
GREEN LIGHT FOODS
fruits , vegetables
YELLOW LIGHT FOODS
lean meats, dairy, starches, grains
RED LIGHT FOODS
Fatty meats, sugars, sweetened beverages

21. www.aap.org/bookstore

22. PHARMACOLOGICAL THERAPY
o The only US FDA approved medication for
obesity in childern >16yr old is “ORLISTAT”
which decrease fat absorption by inhibiting
intestinal lipases.
60mg with each faty meal.
ADVERSE EFFECTS: Flatulance,oily stool and
spotting.
o Phentermine + topiramate
o Amylin + Leptin

23. BARIATRIC SURGERY
American pediatric surgical association guideline
recommends that surgery be consider only after
complete or near complete skeletal maturity in
patient with….
 BMI >40kg/m2 and complication from obesity,after
they have fail 6 mo weight management program.
 PROCEDURES:
)) Roux-en-Y
)) Adjustable gastric band