9/25b Childhood Obesity (Examination, Evaluation, Intervention) Flashcards
BRFSS Charts of obesity trends over time for adults
steadily increasing over the course of 30-40 years (start date was in 1985)
Obesity BMI
over 30
Prevalence of childhood obesity and overweight
slight drop for all, but not really true for majority of the children.
the only age range that may acutally have a decrease is the 2-5 age range because parents are becoming more aware
Weight status of the child based on BMI for age**
- age range
- male/female
- education levels of the parents
- federal poverty line
difference between overweight and obese
Measured in BMI (weight in kg/(height in meters)^2)
- healthy = 18.5-24.9
- Overweight = 25-29.9
- Obese = over 30
- -Class I = 30-34
- -Class II = 35-39.9
- -Class III = over 40 (morbid)
what are the percentages of underweight, normal weight, overweight, and obese children age 10-17 y/o nationwide?
Underweight - 6.3% (less than 5th percentile)
Normal Weight - 62.6% (5th to 84th percentile)
Overweight - 15% (85th to 94th percentile)
Obese - 16.1% (95th percentile)
what is the difference between weight status of children based on BMI for male vs female?
there are more obese and underweight males, but there are more normal weight and overweight females
what is the impact of a parent’s education status on the weight status of their children (BMI for children ages 10-17)
The highest number of normal weight children is with parents who have a college degree or higher, and the lowest number of normal weight children is for parents who have less than a highschool education.
While it is the inverse for obese children. Obese children are more prevalent when the parent has less than high school education vs a college degree or higher
what is the impact on childhood obesity for families that fall within the federal poverty line
the FPL was $24k for a family of 4 (low)
correlation between income generating potential and food accessibility and safe places for play and exercise
BMI for age charts - for children and adolescents
Overweight >= 85th percentile for age and sex
Obese >= 95th percentile for age and sex
Quantifying childhood obesity
limitations of BMI alone, clinically we can also measure:
- waist circumference
- body composition
- fitness and performance
- examine change with intervention
current trends on why americans are getting larger?
current trends:
- cafeteria choices
- vending machine income
- advertising
- food accessibility: certain parts of the city just have quickmarts and there is not access to a fresh food restaurant
- portion distortion
Role of the BMI for age charts for children
good indication for screening
portion distortion
- Portion sizes are expanding
- “value” menu
- consumer desires
goal for a obese patient who is getting PT
can’t make goal weight loss, but can make it energy expenditure
reasons for the current trends in the increase in obesity in children
- decreased PE time
- limited after school programming
- increased screen time(b/c of access to safe places outside and parents want their kids to stay in doors)
- urban sprawl, decreased outdoor play
- mom and dad aren’t exercising either: modelling good behavior for children
number of days that children are spending engaged in vigorous physical activity
- 1-3 days is the most common nation wide
- boys complete more activity daily, while females complete more activity 1-3 days a week
- 6-11 year olds exercise more every day than 12-17 years old. Kids stop playing when sports get more competitive as you get older. High school kids are more likely to spend more sedentary activity
Percentage of high school students who met intentional strength training/aerobic exercise
30% of boys met guidelines and even lower for girls
Complications of obesity
Musculoskeletal cardio/pulm integumentary Neuromuscular/neurological GI/Reproductive Psychologic
Musculoskeletal complications of obesity
Pediatric Orthopedic Disorders Related to Increased
BMI:
– Slipped Capital Femoral Epiphysis (SCFE)
– Tibia Vara (Blount’s Disease)
– Spine (compression fractures, back pain)
– Fractures
cadio/pulm complications of obesity
• Early markers of cardiovascular disease
– Endothelial function
– Biomarkers of inflammation
• Dyslipidemia (high level of lipids in the blood)
• Hypertension
• Metabolic syndrome (syndrome x, central adiposities, increased abdominal girth, high bp, low HDL, high LDL, pre-diabetic and insulin resistance
integumentary complications of obesity
• Dermatological Changes (many can occur with obesity,
but not only in obese patients) Indicators more than anything:
– Acanthosis nigricans: darkened thickened skin around axilla (b/c of insulin resistance)
– Acrochordons (skin tags): in folds where there may be increased adipose tissue
– Ulceration and cellulitis: skin breakdown, infection of the adipose tissue
– Stretch marks (rapid weight gain)
neuromuscular and neurological complications of obesity
• Migraine - conflicting data • Psuedotumor cerebri/Idiopathic Intracranial HTN (increased pressure in the brain and CNS, reversible with management of weight) • Obesity as a comorbidity – impulsivity, overeating disorders • Changes in patients with obesity and diabetes: - peripheral neuropathy - AchR changes at NM junction
GI system complications of obesity
- GERD (gastroesophageal reflux disease)
- Gallstones
- Non-Alcoholic Fatty Liver Disease: reversible
endocrine and reproductive system complications of obesity
• Role of adipokines (ex. leptin helps with satiety) • Early-onset Type 2 diabetes mellitus • Hormonal changes and regulation – Early onset of menses/development – Reproductive disorders, ex. PCOS
Pains, Sprains, and Strains with obesity
Hard to tease out if they are overweight or sedentary or both • Overuse • Tendonitis • Bursitis • Back Pain • Muscle/body weight imbalance
Gait impairment with obesity
• Decreased relative velocity
• Increased stance time (time spent on both legs in contact with the ground)
• Wider base of support
• Foot flat weight acceptance (heel-toe progression normally, but obese children have more of a flat foot because of weight shift)
• Risk of later development of OA with increased medial
knee joint loading
pulmonary impairment with obesity
obstructive sleep apnea
asthma
both improve with weightloss programs
pulmonary impairment with obesity
-obstructive sleep apnea
-asthma
both improve with weightloss programs
psychological system complications of obesity
• Potential impact on: – Self-esteem and Self-Image – Quality of Life – Depression – Anxiety • Causality? – Example: a hallmark of depression is a decreased interest in activity, but obesity may lead to poor self-image which may lead to a mood disorder
impact of pediatric obesity on PT practice
- altered gait pattern
- endurance
- standing balance/base of support
clinical exercise testing in pediatrics
• Referral base • Special Considerations – Size of equipment – Treadmill safety • Protocols – 2-3 minute increments – Constant or incremental load based on height, BMI or body surface area • Getting patient to understand of maximal effort = use OMNI scale of perceived exertion
Exercise response in pediatrics
• Baseline Values Relative to Adults: – Higher HR – Higher RR – Lower BP • Recovery: – Quicker recovery (HR, BP, etc) than adults – Children do not sweat as much, but higher BSA relative to mass
Exercise response in pediatrics
• Baseline Values Relative to Adults:
– Higher HR
– Higher RR
– Lower BP
• Recovery:
– Quicker recovery (HR, BP, etc) than adults
– Children do not sweat as much, but higher Body surface area relative to mass
how to intervene with pediatric obesity
PAG Guidelines with children
- 3 year old - physical activities throughout the day
- school age children (6-17): 60 minutes daily
how to intervene with pediatric obesity
PAG Guidelines with children
- 3 year old - physical activities throughout the day
- school age children (6-17): 60 minutes daily
ecological systems theory interaction with children who are obese
Individual > interpersonal > environment > society/public policy
