Childhood obesity Flashcards
Define Childhood weight status
BMI 85-94th % = overweight
BMI >95% = obese
BMI > 99th% or >120%of 95th percentile = severe obesity
describe demographics of obesity epidemic
about 4% of S population severely obese
- 18% US children ages 2-19 are obese
- 20% overweight or obese
- prevalence tripled since 1980s but plateua last 10 years
Avoidable health risks in obese children who go on to remain obese as adults
Type II DM, HTN, Carotid atherosclerosis, arthritis, colon/breast cancer
- also issues with sports, energy, confidence, clothing
cutoff for severe obesity
99th percentile of BMI
“obese” definition using BMI
> 95th percentile
Alternative “Severe Obesity” Chart
recalculated the BMI so that severely obese children can still be tracked on growth chart. It’s a function of what percentage of 95th percentile of BMI for age .
- BMI >120% of 95th percentile BMI for age = severely obese
- closely approximates 99th percentile
what age is a kid at their skinniest weight
5-6 years old
BMI charts
CDC and WHO charts available. CDC mostly used in US. Should show a dip around age 5-6 before gaining weight
underweight BMI
healthy BMI
5-85th percentile
overweight BMI
85-95th percentile for kids over age 2; >95th percentile for under age 2
obese BMI
> 95th percentile; excess adiposity
severely obese
> 99th percentile
higher prevalence groups
older children –> adolescents, native american, BLack, Latino, Low SES (explains much of race/ethnicity variation)
- maternal Education most important SES predictor
Psychosocial complications
poor self esteem, depression, eating disorders
pulmonary complications of obesity
sleep apnea, asthma, exercise intolerance
GI complications
gallstones, steatohepatitis
renal complications
glomerulosclerosis
MSK complications
slipped capital femoral epiphysis, Blount’s disease, forearm fracture, flat feet
CV complications
dyslipidemia, HTN, coagulopathy, chronic inflammation, endothelial dysfunction
what test to look at kid worried about chronic obstructive sleep apnea
B natriuretic peptide
endocrine complications
TIIDM, precocious puberty, polycystic ovary syndrome (Girls), hypogonadism (boys)
rate of sleep apnea in obese kids
13-33% youth
diagnose sleep apnea
polysomnogram
will kids grow out of their obesity
80-90% remain obese as adults
cutoff for severe obesity
99th percentile of BMI
“obese” definition using BMI
> 95th percentile
Alternative “Severe Obesity” Chart
recalculated the BMI so that severely obese children can still be tracked on growth chart. It’s a function of what percentage of 95th percentile of BMI for age .
- BMI >120% of 95th percentile BMI for age = severely obese
- closely approximates 99th percentile
what age is a kid at their skinniest weight
5-6 years old
BMI charts
CDC and WHO charts available. CDC mostly used in US. Should show a dip around age 5-6 before gaining weight
Depression/Anxiety
can lead to highly prevalent, improve with obesity tx
- may lead to worsening obesity if untreated
higher prevalence groups
older children –> adolescents, native american, BLack, Latino, Low SES (explains much of race/ethnicity variation)
- maternal Education most important SES predictor
when to start labs on obese child
after 10 years or Tanner stage 2 unless severely obese or + Fam Hx of early CAD
pulmonary complications of obesity
sleep apnea, asthma, exercise intolerance
GI complications
gallstones, steatohepatitis
renal complications
glomerulosclerosis
what test to look at kid worried about chronic obstructive sleep apnea
B natriuretic peptide
endocrine copmlications
TIIDM, precocious puberty, polycystic ovary syndrome (Girls), hypogonadism (boys)
rate of sleep apnea in obese kids
13-33% youth
diagnose sleep apnea
polysomnogram
obesity hypoventilation syndrome
severe obesity with restrictive lung disease; may lead to right heart failure. Hypoxemic respiratory drive
- may see dyspnea, edema, somnolence
will kids grow out of their obesity
80-90% remain obese as adults
acanthosis nigricans
thick, dark skin
- only external sign that kid is at increased risk of developing TIIDM
- tells us he is consuming more energy, esp carbs
- high insulin (looks like growth hormone) so it makes skin grow thicker and darker particularly in areas with folds
Impaired glucose tolerance in kids
2 hr OGGT 140-199
elevated fasting glucose in kids
100-125
T2DM in kids
fasting glucose >/= 126, 2hr OGGT/postprandial >200
HgA1c >6.5
Polycystic ovarian Syndrome (PCOS)
Have 2 of the following
- hyperandrogenism +
- oligomenorrhea +/-
- polycystic ovaries; insulin resistance; risk of infertility and endometrial cancer
PCOS symptoms
oligomenorrhea (
do you need transvaginal US for diagnosis of PCOS in obese teen girls
NO
hypothyroid sxs
cold intolerance, decline in school performance, coarse features, thin hair
neuro complications
pseudotumor cerebri
slipped Capital Femoral epiphysis (SCFE)
when ball of femur separating from neck at growth plate; more likely to progress to bilateral dz in obese
NAFLD
10-25% obese youth; elevated ALT
- steatohepatitis –> fibrosis –> cirrhosis
commonly asymptomatic
Gallstones
can occur with rapid weight loss
constipation/encopresis
due to low fiber diet
Blounts Disease
stress injury to medial tibial growth plate, often painless
- see bowed legs +/- knee pain; potentially disabling
Depression/Anxiety
- highly prevalent,
- may lead to worsening obesity if untreated
Medical Assessment
- Plot BMI annually >2 years old
- assess diet/activity and fam hx for CVD and obesity risk factors
- ROS for comorbidities
- PE
- Labs: lipids, glucose/HgA1c, ALT (2-10 years if severely obese or + fam hx early CAD; otherwise start labs after 10 yrs or Tanner 2)
when to start labs on obese child
after 10 years or Tanner stage 2 unless severely obese or + Fam Hx of early CAD
Key factors assd with obesity
sweetened beverages, fruit/veggie intake, energy dense foods (processed), restaurant meals, large portion sizes, frequency of eating
Key activity factors
physical activity (60 min per day), sedentary time (
meds for pediatric obesity
orlistat
Orlistat efficacy
only about 5% weight loss
Fam hx assessment in 1st degree relatives
severe obesity (single gene disorders rare), CV dz risk factors (DM, MI, HTN, Hyperlipidemia), hypothyroidism, psych issues (eating disorders)
Treatment basics
involve family, clean up home environment, negotiate 1–2 specific changes, make a plan to monitor change
plans to monitor change
increase awareness, accountability between parent-child and family-MD, positive feedback, planned rewards for success (doing something fun)
Main idea of motivational interviewing
elicit change talk and perceived empathy
Pseudotumor Cerebri
papilledema, peripheral vision loss possible
- consult neuro/pohtho
RARE
- may have severe, recurrent headaches often worse in morning
