Childhood obesity Flashcards
1
Q
What is the epidemiology of obesity in children (7)
A
- NCMP target to halve obesity by 2030 impossible to meet
- 10% of children aged 4-5 obese, extra 12% overweight
- 23.4% of children aged 10-11 obese, extra 14.3% overweight
- boys slightly more than girls (increases with age)
- Link with deprivation/racial background
- Link with age: rates of obesity double between the ages of 4-5 years and 10-11 years and that this is observed across the social gradient
- Children are the unwitting victims of obesity and all parts of society have a role to play in addressing obesity
2
Q
How does ethnicity affect obesity (3)
A
- Obesity prevalence varies between ethnic groups
- the highest levels for Black or Black British children, followed closely by the Bangladeshi ethnicity
- White, Chinese and Mixed Asian ethnicities have the lowest levels of obesity
3
Q
How does deprivation affect obesity (6)
A
- The obesity from the most deprived areas is more than double that of those from the least deprived areas in both age ranges.
- For 4-5 year olds the figures are 13.6% and 6.2%
- The gap between levels of deprivation and obesity is not getting smaller but increasing.
- For 4-5 year olds the figures were 4.5% in 2006
- 6.3% in 2019
- 10.7 now
4
Q
What are potential reasons explaining the link of obesity and deprivation levels (7)
A
- Note: deprivation effects on obesity are reversed in low income countries
- Rise (continues despite some action) of obesity promoting food environment
- Food insecurity: unhealthy foods 3 times cheaper than healthy foods (Broken Plate Report)
- Socio-economic disadvantage leads to psychological distress and emotional illbeing- overeating and overindulging become a coping mechanism
- Socio-economic disadvantage = poor health = worse jobs, ability to ‘hunt’ for food, lower access to healthy activities and worse mental health
- C-19 pandemic had worsening effects in obesity in all ages, especially in older boys- the effect was worse in families with lower
- socioeconomic status: access to sport/activities, access to school meals, access to school activities, increased eating as coping with anxiety
5
Q
Why is childhood obesity a concern of the NHS (7)
A
- Obese children are more likely to become obese adults
- Also parental obesity more than doubles the risk of childhood obesity: vicious circle
- The Health Survey for England 2016 showed most parents do not recognise excess weight or obesity in their children.
- Parents from deprived backgrounds are more likely to NOT recognise the true weight of their child
- Health professionals also find it difficult, with a significant underestimation of overweight and obesity.
- Due to the high prevalence of obesity, being overweight has become somewhat ‘normalised’ and therefore it can be difficult to recognise when a child is overweight.
- This highlights the importance of completing a clinical assessment of BMI, to ensure weight status is accurately and objectively assessed
6
Q
How can we fix childhood obesity (7)
A
- Expansion of behavioural weight management services for children and families
- Continue NCMP, refer children from school
- Focus should be on areas of lower deprivation and habited by the most affected ethnicities- however we know the opposite is true (with lower access to basic services such as nurseries, dentists, GPs, and by extent dieticians and specialised services
- Child obesity to become part of safeguarding pathway
- Food in schools/nurseries
- Research of links between NDD and obesity
- Creation of green spaces and increase access to healthy activities
7
Q
What is the aetiology of obesity (5)
A
- Individuals are less physically active than previous generations
- Food Consumption: default choice tends to be less than healthy
- Physiology and energy balance: it is estimated that men and women tend to be consuming approximately 300 and 200 calories a day more than they need
- Societal influences: society expects and has become accustomed to choice: abundance of food and drink
- Individual psychology: habitual behaviour
8
Q
What are the physical implications of obesity in health (8)
A
- increases the risk of a number of diseases and conditions
- Hypertension
- asthma
- Type 2 diabetes in childhood
- Adult morbidity
- heart disease
- liver disease
- some cancers
9
Q
What are the social impacts of obesity (12)
A
- Psychological impact
- bullying
- isolation
- low self-esteem
- depression
- conduct disorders
- reduced school performance
- social functioning.
- Societal biased attitude towards obesity
- ‘‘Less likely to be successful in job interviews”
- “Could lose weight if they tried”
- “NHS should not pay for them”
10
Q
What are the NHS impacts of obesity (4)
A
- Direct estimated cost of obesity to the NHS is £6.1 billion per year
- Social care cost estimated at £352m per year
- Problems attributable to excess weight in the UK cost the wider economy about £16 billion per year
- benefits, loss of earnings and reduced productivity due to higher levels of sickness and absence from work
11
Q
What is the categorisation of obesity in children (6)
A
- BMI charts for children over 2 years
- Different for boys and girls
- Different for patient subgroups
- The growth of children under 2 years of age should be plotted on the more detailed Royal College of Paediatrics and Child Health UK-WHO 0-4 years growth charts
- Waist circumference is not recommended as a routine measure
- Lower threshold to action than in adults
12
Q
What is the classification of obesity in children (4)
A
- Population overweight classification = 85th centile BMI
- Population obese classification = 95th centile BMI
- Clinical overweight classification = 91st centile BMI
- Clinical obese classification = 98th centile BMI
13
Q
What is the usual child development weight (5)
A
- Some normal, healthy babies may gain little or no weight in a week, making up for this in subsequent weeks
- To avoid unnecessary concern, discourage very frequent weighing
- Weight variance on a daily basis is usually due to fluid changes rather than any real changes in body mass
- The majority of babies of average birth weight double their weight in the first five months and treble it in the first year
- It is worth having a broad idea of what average weights are for different age groups so that large variances can be confirmed
14
Q
What are the age bands (3)
A
- 1 month -1 year
- 1-5 years
- 6- 18 years
15
Q
When is age banding okay to use (5)
A
- Use age-banding only for children whose weight is average for their age!
- Clinically overweight children: risk of underdose
- Underweight children: risk of overdose
- Use a weight based dose if available
- Or use the dose for the age-band that matches their weight
16
Q
What is the weight consultation checklist if the family approaches you (9)
A
- Measurements with child-friendly equipment
- further assessment:
- Let’s Talk About Weight: A step by step guide to conversations about weight management with children and families for health and care professionals
- Identify Red flags: if present: REFER (see next slide)
- Do a ‘History of the complaint’
- Ask the difficult questions: psychosocial distress, such as low self-esteem, teasing and bullying:
- Explore the child and family’s willingness and motivation to change lifestyle
- Suggest a lifestyle diary (diet and physical activity)
- Consider environmental, social and family factors in your advice
17
Q
What are the medical causes requiring referral (12)
A
- hypothyroidism
- Cushing Syndrome
- growth hormone deficiency
- Reduced mobility: spina bifida and cerebral palsy (difficult to manage if learning difficulties)
- Prader-Willi syndrome: hyperphagia/insatiable appetite and learning difficulties: difficult to treat!
- Bardet-Biedl syndrome
- Pseudohypoparathyroidism
- Trisomy 21 and general learning difficulties
- Significant emotional and behavioural problems related to obesity
- Significant adverse cardiorespiratory/physical problems due to obesity
- Clinically severe obesity: ≥98th centile
- Clinically extremely obese: ≥99.6th centile
18
Q
What must you discuss in a weight consultation (8)
A
- How putting weight on works: balance between what you eat and what you burn
- Role of calories and how much energy (“in”) come from different food sources
- Suggest gradual changes in dietary habits - amount of sugar, salt and saturated fat consumed
- Suggest gradual changes in meal sizes
- Suggest gradual changes in physical activity habits
- Suggest gradual changes in the amount of alcohol consumed (if relevant!)
- Ascertain if there is a support network (parents, family, friends)
- Encourage parents to role-model desired behaviours.
19
Q
What are population interventions (5)
A
- Change4Life is a government initiative encouraging families to lead healthy lifestyles.
- The booklet ‘Top Tips for Top Kids’ that includes information on why maintaining a healthy weight is important, and simple steps that can help children develop healthier lifestyles.
- NHS Choices provides a range of information and tools around healthy living - Includes a healthy weight calculator that can be used for both adults and children (over the age of 2 years)
- There is also a search tool for finding local physical activity options
- Discriminate adult vs child resources in all these tools!
20
Q
What are weight management services (7)
A
- Exist for adults and children as part of obesity care pathways.
- For children, they should support the whole family
- Focus on weight maintenance (not loss) and to grow into healthier weight
- Commercial weight management services are effective in supporting adults to lose a clinically significant amount of weight
- Dietetic referral: useful to support individuals and their families to integrate positive dietary changes into their lifestyle. But services often unavailable due to pressures.
- Physical activity services: delivered locally which your local leisure service
- Let’s Get Moving: behaviour change intervention for adults
21
Q
What reflects a more specialist level of care (3)
A
- BMI of 30 or more for whom tier 2 interventions have been unsuccessful
- Those with existing complex co-morbidities
- or those who are showing signs of developing comorbidities.
22
Q
When is drug treatment recommended (4)
A
- Only consider if severe life-threatening comorbidities (such as sleep apnoea or raised intracranial pressure)
- In children > 12 years, treatment with orlistat is recommended only if physical comorbidities or severe psychological comorbidities are present.
- Metformin off label
- Newer treatments with Liraglutide (Saxenda) and Semaglutide (Wegoby) only available in tertiary centres led by paediatric endocrinologists
23
Q
What is bariatric surgery (5)
A
- Bariatric surgery is surgery on the stomach and/or intestines to help a patient with extreme obesity to lose weight.
- The choice of surgical intervention should be made jointly by the patient and their clinician.
- Lifestyle changes are an important part of surgery, as well as psychological support.
- Surgery is not generally recommended for children or young people.
- under 12 years old, only in exceptional circumstances
24
Q
What are social barriers to change (4)
A
- Healthy food being too expensive
- Cheap fast food too easily available
- Finding time to exercise
- Having a sedentary lifestyle
25
What are psychological barriers to change (5)
1. Lack of safe spaces to exercise
2. Perceives as unimportant: significant challenge
3. Lack of confidence or self-worth: vicious cycle
4. Failed previous attempts
5. Failed to recognise that their children are overweight/obese
26
What are the professional barriers to change (3)
1. Own weight: lead by example
2. ‘Telling’ approach - instead you’ll want to guide
3. Pharmacists used to ‘Directing/telling style’
27
What are tips for successful weight consultation goal setting (5)
1. Specific - Stick to clear aims
2. Measurable - Patients can look back on a week and clearly assess which meals improved or on how many days they exercised.
3. Achievable - Suggest small, relatively easily achievable goals to increase positive beliefs and self esteem and the overall chances of success. Ambitious goals could be divided up into smaller steps
4. Relevant - choose goals that apply to your circumstances.
5. Time specific
28
How can you document and summarise a weight consultation (5)
1. Summarise what has been discussed.
2. Provide a copy of this summary to the patient
3. So you’ve decided you are
4. This is because
5. Specifically, you are going to
29
How do you follow up a weight consultation (3)
1. Follow up on the patient’s progress at regular intervals
2. Encouraging support from family members and/or seeking community/peer support relating to weight management is helpful.
3. Praise successes – however small – at every opportunity
