Childhood Obesity

Question 1

Overweight and obese definitions in kids

Answer 1

Overweight BMI of age & sex between 85th – 94th %
Obese: BMI for age & sex > 95th %
Severe obesity: two numerically similar definitions:
1) BMI ≥ 99th percentile
2) BMI ≥120% of the 95th percentile corresponds to Class II adult
Expressing % above the 95th percentile allows tracking of severe obesity
The term “morbid obesity” is reserved for adults

Question 2

BMI weight status that is at high risk for comorbidities

Answer 2

> 95th percent with comorbidities
and greatly increased when >99th: severely obese
~4% US pop

Question 3

Kids to worry about

Answer 3

kids rapidly moving upward thru lines on BMI chart

• skinniest point should be 5-6 yo (meant to be thin)
• then adiposity rebound

Question 4

What word shouldn’t you use in counseling?

Answer 4

obese

Use “unhealthy weight” or “unhealthy BMI”

Question 5

Common effects of obesity in childhood

Answer 5

Every organ system affected
Psychosocial (poor self esteem, dep, eating disorders)
pulm (sleep apnea, asthma, exercise intolerance)
GI: gallstones, steatohepatitis
Renal: glomerulosclerosis
MSK
CV: dyslipidemia, HTN, coagulopathy, chronic inflammation, endothelial dysfunction
Endocrine: T2D, precocious puberty, polycysitc ovary, hypogonadism
Most common:
Obstructive sleep apnea, metabolic syndrome (insulin resistance, hyper/dys-lipidemia, hypertension), hepatic(NAFLD/NASH), decreased quality of life – mood and anxiety disorders
AVOIDABLE RISKS:
T2DM
HTN
Carotid atherosclerosis
arthritis, colon, breast cancer

Better in sports, energy, confidence, clothing

Question 6

Obesity prevalence

Answer 6

tripled from 1980-2005
Plateau in last 10 yrs

higher prevalence groups:
Older children –> adolescents
Native American, Black, Latino
Low socioeconomic status:
SES explains much of variation by race/ethnicity
Maternal Education most important SES predictor

Question 7

If a child is hypoxic (saO2), obesity hypoventilation syndrome

Answer 7

• if give large amounts of oxygen, must monitor respiratory status
• May stop breathing because less sensitive to CO2 levels, more sensitive to low O2 (may stop breathing.

Question 8

Right sided heart failure in ED?

Answer 8

use BNP

Question 9

Pulmonary issues

Answer 9

Obstructive Sleep apnea (Snoring most nights, apnea, poor sleep, nocturnal enuresis,
AM headaches, fatigue, poor school performance)

Obesity hypoventilation syndrome (Severe obesity, restrictive lung disease, may lead to right heart failure, hypoxemic respiratory drive)

Question 10

Acanthosis Nigricans

Answer 10

• thick, dark skin
• external sign that they are at risk for developing type 2 diabetes
• consuming more energy /carbs than burning off with exercise
• insulin stimulates melanocytes
• sign of impaired glucose metabolism

Question 11

Polycystic ovarian syndrome

Answer 11

-cysts on U/S not required for teens
-two of three:
1.hyperandrogenism + 2.oligomenorrhea + 3.polycystic ovaries;
insulin resistance; risk of infertility and endometrial cancer

ROS:
oligomenorrhea (

Question 12

Hypothyroid

Answer 12

-assoc w/ poor linear growth

Question 13

Pseudotumor cerebri

Answer 13

rare

headaches often worse in AM or supin

Question 14

NAFLD

Answer 14

10-25%+ of obese youth;
Elevated ALT;
Rule out other liver disease with persistent elevation > 2 x normal; Steatohepatitis –>fibrosis –>cirrhosis

Question 15

Where is hip pain referred? What could this be?

Answer 15

knee, groin
-get XR
-Slipped Capital femoral epiphysis (SCFE): likely to become bilateral disease in obese
-Blount’s disease:
stress injury to medial tibial growth plate, often painless: bowed legs, knee pain

Question 16

Labs

Answer 16

Lipids, Glucose/HgA1c, ALT

-when age 10 or Tanner II

Question 17

Sedentary Time?