Childhood Obesity

Question 0

Obese

Answer 0

BMI > 95 percentile

Severe >99 percentile

Increase in number or size of fat cells with caloric intake

Can reduce size but not number of fat cells

Parental obesity risk correlation

Screen for co-morbid conditions
Fasting glucose, insulin, lipids, ALT

Question 1

Childhood obesity negatives

Answer 1

Decrease in longevity

Increased medical costs

Correlation to depression, less friends

Question 2

Overweight

Answer 2

BMI >85 percentile

Give patient education, self-help materials

Follow up in 4 weeks

Question 3

Risk factors

Answer 3

Neurotransmission

5HT, histamine, dopamine

Leptin deficiency

Hypothyroidism low metabolic rate

Sedentary lifestyle

Lack of breastfeeding

Question 4

Medication risk

Answer 4

Antipsych
Antidepressants TCA, paroxetine

Protease inhibitors
Insulin
Antihistamine

Question 5

Healthy people 2020

Answer 5

Goal 10% reduction to 14.6%

Nutrition education parents&school

Physical education, play 60min

Limit TV 2 hours/day, remove from bedroom. No TV <2 years old

Breastfeed first 12 months

Regular fish intake

Whole grain, high fiber, low salt/sugar

Question 6

Juice

Answer 6

5oz. For 1-6 yo
10oz. For 7-18 years old

Recommend whole fruits

Question 7

5 areas of health risk

Answer 7

1) family history
2) blood pressure
3) cholesterol
4) large annual increase in BMI
5) concern about weight

Need long term treatment programs for entire family

Question 8

Pharmacotherapy

After intensive diet/exercise for a year

Answer 8

Orlistat
Metformin
Exanatide - highest weight/BMI loss

Question 9

Orlistat

Answer 9

Inhibit lipases and reduces GIvfat absorption by 30%

FDA approved 12yo and above

AE: malabsorption ADEK
Bone turnover, gallbladder disease

Question 10

Metformin

Answer 10

Biguanide

Decreases glucose production
Decreases intestinal absorption
Improves insulin sensitivity

FDA approved 10yo and older

Adjunct to low calorie diet

AE: gastrointestinal diabetes

Question 11

Exanatide

Answer 11

GLP1 agonist, injection

Increased leptin secretion and appetite suppression

For prediabetic kid

AE: NV abdominal pain, injection site

Question 12

Gastric bypass

Answer 12

For severely obese children

Question 13

Metabolic syndrome

Answer 13

Hypertension
Dyslipidemia
Type2DM

Poly cystic ovarian syndrome
Pubertal advancement

Question 14

Complications of childhood obesity

Answer 14

Orthopedic SCFE weight in joint

Hepatic steatosis (non-alc fatty liver)

LV Hypertrophy, atherosclerosis

Sleep apnea

Social/psych stress

Question 15

Hypertension

Answer 15

Annual screening at 3 years

Normal determined by height percentile, age, gender

Pre-HTN: SBP/DBP >90% or >120/80
Stage 1: SBPorDBP >95% plus 5
Stage 2: SBP/DBP >99% plus 5 mmHg

Goal <90% if T2DM

If stage 2 restrict sports (spike BP)

1) ACE captopril, enalopril, ARBZ
2) thiazide, CCB, beta blocker

Question 16

Dyslipidemia in children

Answer 16

Total cholesterol >200
LDL >130

Fasting lipid profile for children > 2yo with family history of dyslipidemia

Tx: CHILD 1 diet, statin

Question 17

Start Atorvastatin (drug of choice)

Answer 17

> 10yo
CHILD 1,2 Diet > 6 months

LDL>130 and DM or 2 high RF
LDL >160 and 2 CVD risk factors
LDL >190

Question 18

CVD high risk factors

Answer 18

HTN drug therapy
Cigarette smoker
BMI >97%
DM 
CKD, ESRD

Moderate BMI>95, HDL<40, HIV

Question 19

Screen for T2DM

Answer 19

Age 10
BMI >85 & FH, Hispanic, black, Alaska
Gestational diabetes

Signs of insulin resistance: HTN, PCOS, dyslipidemia, black neck

Goal FBG <7%

Tx: Metformin!