Child Healthy weight

Question 1

Instead of obese use….

Answer 1

Outside the healthy weight range
Unhealthy weight

Question 2

BMI is

Answer 2

body weight for height

Question 3

BMI changes with — and is different for –and —

Answer 3

age
boys and girls

Question 4

Need to plot BMI against —

Answer 4

age appropriate for gender

Question 5

Clinical Thresholds for BMI?

Answer 5

> 91st centile=Overweight
98th centile=clinical obesity

Question 6

To assess the toddlers,—— is the best measure of adiposity from age of —-, when height can be measured accurately

Answer 6

BMI
2

Question 7

To assess an infant, under —- age, use — to provide an approximate BMI centile.

Answer 7

under age of 2
BMI conversion chart

Question 8

—- should not be used to diagnose overweight and obesity in children

Answer 8

Waist circumference

Question 9

Risk factors for being overweight at 3 years?

Answer 9

• Parental overweight
• Black ethnicity
• Greater birthweight
• Smoking during pregnancy
• Lone motherhood
• Pre-pregnancy overweight
• Maternal employment ≥21 hrs/week
• Solid foods before 4 months
  
  • Breastfeeding ≥ 4 months protective

Question 10

Genetic causes of severe obesity?

Answer 10

• Prader-Willi Syndrome (floppy, weak muscle tone, short, hyperphagia (tendency to eat sm)
• Barget-Biedl Syndrome( hyperphagia, visual impairment, renal abnormalities)

Question 11

Clinical assessment for overweight and obesity?

Answer 11

• BMI - plot on centile chart
• Eating habits, physical activity patterns, screen time
• Social circumstances
• School history
• Emotional/ psychological issues
• Family support
• Stature of close family relatives
• Family history e.g. obesity/diabetes

Assessment of co-morbidities
- Metabolic syndrome
- Respiratory problems
- Hip and knee problems
- Diabetes
- CHD
- Sleep apnoea
- Hypertension

Question 12

When do Referral for paediatric review?

Answer 12

• Serious obesity-related morbidity that requires weight loss (benign intracranial hypertension, sleep apnoea, orthopaedic problems)
• Children with suspected underlying medical (e.g. endocrine) cause of obesity
• Children under 24 months who are severely obese (BMI ≥99.6th centile)

Question 13

—– is the treatment goal for overweight and obese children.

Answer 13

Weight maintenance

Question 14

How to change eating habit?

Answer 14

• Follow Eatwell guide
• Free sugars ≤ 5% daily dietary energy intake
• Use smaller plates
• Parent serves meals rather than child serving themselves
• Cook only required food quantity
• Age appropriate portion sizes

Question 15

For Physical activity, —– NOT —–, encourage through floor-based play and water-based acitivities in safe environments

Answer 15

Under 5s
walking

Question 16

Under —– —— - should be physically active daily for at least —– mins, spread throughout the day, all movement counts

Answer 16

Under 5s
Walking
180 mins

Question 17

——- years - at least —— minutes a day across the week, including muscle and bone strengthening —– x week

Answer 17

5-18
60 mins

Question 18

Improving —- hygiene is key

Answer 18

Sleep

Question 19

Behavioural strategies

Answer 19

Question 20

Pharacological and surgical options?

Answer 20

Orlistat

• Inhibits gastric and pancreatic lipase to reduce absorption
  of dietary fat ~30%
• GI side effects - oily stools, faecal urgency, nausea, abdominal pain
• Orlistat should only be prescribed in adolescents with very severe to extreme obesity (BMI ≥3.5 SD above median) or severe obesity (BMI ≥99.6th centile) with comorbidities

Surgical management

• Bariatric surgery
• Most common options in the UK: LAGB, RYGB, LSG