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DEMS unit 3 > Childhood obesity > Flashcards

Childhood obesity Flashcards

1
Q

Define Childhood weight status

A

BMI 85-94th % = overweight
BMI >95% = obese
BMI > 99th% or >120%of 95th percentile = severe obesity

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2
Q

describe demographics of obesity epidemic

A

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
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3
Q

Avoidable health risks in obese children who go on to remain obese as adults

A

Type II DM, HTN, Carotid atherosclerosis, arthritis, colon/breast cancer

  • also issues with sports, energy, confidence, clothing
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4
Q

cutoff for severe obesity

A

99th percentile of BMI

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5
Q

“obese” definition using BMI

A

> 95th percentile

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6
Q

Alternative “Severe Obesity” Chart

A

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
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7
Q

what age is a kid at their skinniest weight

A

5-6 years old

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8
Q

BMI charts

A

CDC and WHO charts available. CDC mostly used in US. Should show a dip around age 5-6 before gaining weight

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9
Q

underweight BMI

A
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10
Q

healthy BMI

A

5-85th percentile

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11
Q

overweight BMI

A

85-95th percentile for kids over age 2; >95th percentile for under age 2

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12
Q

obese BMI

A

> 95th percentile; excess adiposity

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13
Q

severely obese

A

> 99th percentile

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14
Q

higher prevalence groups

A

older children –> adolescents, native american, BLack, Latino, Low SES (explains much of race/ethnicity variation)
- maternal Education most important SES predictor

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15
Q

Psychosocial complications

A

poor self esteem, depression, eating disorders

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16
Q

pulmonary complications of obesity

A

sleep apnea, asthma, exercise intolerance

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17
Q

GI complications

A

gallstones, steatohepatitis

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18
Q

renal complications

A

glomerulosclerosis

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19
Q

MSK complications

A

slipped capital femoral epiphysis, Blount’s disease, forearm fracture, flat feet

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20
Q

CV complications

A

dyslipidemia, HTN, coagulopathy, chronic inflammation, endothelial dysfunction

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21
Q

what test to look at kid worried about chronic obstructive sleep apnea

A

B natriuretic peptide

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22
Q

endocrine complications

A

TIIDM, precocious puberty, polycystic ovary syndrome (Girls), hypogonadism (boys)

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23
Q

rate of sleep apnea in obese kids

A

13-33% youth

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24
Q

diagnose sleep apnea

A

polysomnogram

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25
Q

will kids grow out of their obesity

A

80-90% remain obese as adults

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26
Q

cutoff for severe obesity

A

99th percentile of BMI

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27
Q

“obese” definition using BMI

A

> 95th percentile

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28
Q

Alternative “Severe Obesity” Chart

A

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
29
Q

what age is a kid at their skinniest weight

A

5-6 years old

30
Q

BMI charts

A

CDC and WHO charts available. CDC mostly used in US. Should show a dip around age 5-6 before gaining weight

31
Q

Depression/Anxiety

A

can lead to highly prevalent, improve with obesity tx

- may lead to worsening obesity if untreated

32
Q

higher prevalence groups

A

older children –> adolescents, native american, BLack, Latino, Low SES (explains much of race/ethnicity variation)
- maternal Education most important SES predictor

33
Q

when to start labs on obese child

A

after 10 years or Tanner stage 2 unless severely obese or + Fam Hx of early CAD

34
Q

pulmonary complications of obesity

A

sleep apnea, asthma, exercise intolerance

35
Q

GI complications

A

gallstones, steatohepatitis

36
Q

renal complications

A

glomerulosclerosis

37
Q

what test to look at kid worried about chronic obstructive sleep apnea

A

B natriuretic peptide

38
Q

endocrine copmlications

A

TIIDM, precocious puberty, polycystic ovary syndrome (Girls), hypogonadism (boys)

39
Q

rate of sleep apnea in obese kids

A

13-33% youth

40
Q

diagnose sleep apnea

A

polysomnogram

41
Q

obesity hypoventilation syndrome

A

severe obesity with restrictive lung disease; may lead to right heart failure. Hypoxemic respiratory drive

  • may see dyspnea, edema, somnolence
42
Q

will kids grow out of their obesity

A

80-90% remain obese as adults

43
Q

acanthosis nigricans

A

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
44
Q

Impaired glucose tolerance in kids

A

2 hr OGGT 140-199

45
Q

elevated fasting glucose in kids

A

100-125

46
Q

T2DM in kids

A

fasting glucose >/= 126, 2hr OGGT/postprandial >200

HgA1c >6.5

47
Q

Polycystic ovarian Syndrome (PCOS)

A

Have 2 of the following

  • hyperandrogenism +
  • oligomenorrhea +/-
  • polycystic ovaries; insulin resistance; risk of infertility and endometrial cancer
48
Q

PCOS symptoms

A

oligomenorrhea (

49
Q

do you need transvaginal US for diagnosis of PCOS in obese teen girls

A

NO

50
Q

hypothyroid sxs

A

cold intolerance, decline in school performance, coarse features, thin hair

51
Q

neuro complications

A

pseudotumor cerebri

52
Q

slipped Capital Femoral epiphysis (SCFE)

A

when ball of femur separating from neck at growth plate; more likely to progress to bilateral dz in obese

53
Q

NAFLD

A

10-25% obese youth; elevated ALT
- steatohepatitis –> fibrosis –> cirrhosis

commonly asymptomatic

54
Q

Gallstones

A

can occur with rapid weight loss

55
Q

constipation/encopresis

A

due to low fiber diet

56
Q

Blounts Disease

A

stress injury to medial tibial growth plate, often painless

  • see bowed legs +/- knee pain; potentially disabling
57
Q

Depression/Anxiety

A
  • highly prevalent,

- may lead to worsening obesity if untreated

58
Q

Medical Assessment

A
  • 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)
59
Q

when to start labs on obese child

A

after 10 years or Tanner stage 2 unless severely obese or + Fam Hx of early CAD

60
Q

Key factors assd with obesity

A

sweetened beverages, fruit/veggie intake, energy dense foods (processed), restaurant meals, large portion sizes, frequency of eating

61
Q

Key activity factors

A

physical activity (60 min per day), sedentary time (

62
Q

meds for pediatric obesity

A

orlistat

63
Q

Orlistat efficacy

A

only about 5% weight loss

64
Q

Fam hx assessment in 1st degree relatives

A

severe obesity (single gene disorders rare), CV dz risk factors (DM, MI, HTN, Hyperlipidemia), hypothyroidism, psych issues (eating disorders)

65
Q

Treatment basics

A

involve family, clean up home environment, negotiate 1–2 specific changes, make a plan to monitor change

66
Q

plans to monitor change

A

increase awareness, accountability between parent-child and family-MD, positive feedback, planned rewards for success (doing something fun)

67
Q

Main idea of motivational interviewing

A

elicit change talk and perceived empathy

68
Q

Pseudotumor Cerebri

A

papilledema, peripheral vision loss possible
- consult neuro/pohtho

RARE
- may have severe, recurrent headaches often worse in morning

DEMS unit 3 (9 decks)

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