Childhood Obesity

Question 1

what type of energy imbalance results in obesity?

Answer 1

positive energy imbalance

Question 2

why is measuring overweight and obesity difficult in children?

Answer 2

BMI healthy ranges is different in boys and girls
growth in height not always matched by proportionate increase in weight
growth spurt occurs later in boys than girls

Question 3

what are the thresholds on a growth chart for overweight, obese and risk?

Answer 3

high risk of overweight = >85th centile
overweight = >91st centile
high risk of obesity = >95th centile
clinical obesity = >98th centile

Question 4

from what age can BMI be used as a measure?

Answer 4

2 years

Question 5

how is adiposity measured in children too young for BMI?

Answer 5

children <2 use BMI conversion chart to provide an approximate BMI centile

Question 6

is waist circumference used as a measure in children?

Answer 6

no

does not offer improved diagnosis of body fat or cardiometabolic risk factors

Question 7

list 8 risk factors for being overweight at 3 yrs old?

Answer 7

parental overweight
black ethnicity
greater birthweight
smoking during pregnancy
lone motherhood
pre-pregnancy overweight
maternal employment >21 hrs per week
solid foods before 4 months old

Question 8

what is the most common cause of childhood obesity?

Answer 8

Prader-willi syndrome

Question 9

what are the features of prader-willi?

Answer 9

at birth - very floppy, ability to suck is weak or absent, tube feeding common
childhood - hyperphagia (food seeking and lack satiety) and reduced energy requirements due to low muscle tone
learning difficulties
hypogonadism
short stature

Question 10

how does bardet-biedl syndrome present?

Answer 10

visual impairment
renal abnormalities
polydactyly
learning difficulties
hypogonadism
obesity
hyperphagia - leads to obesity

Question 11

what reduction in BMI is associated with a significant decrease in insulin resistance?

Answer 11

> 0.5

Question 12

what cases of obesity are referred for paediatric review?

Answer 12

serious obesity-related morbidity which requires weight loss
children with suspected underlying medical cause of obesity
children under 24 months who are severely obese (BMI > 99.6th centile)

Question 13

what are the treatment goals for overweight and obese children?

Answer 13

weight maintenance

Question 14

what are the treatment goals for severely obese children?

Answer 14

maximum weight loss of 0.5-1kg per month

Question 15

what are free sugars and what are the dailt recommendations?

Answer 15

added to foods plus those naturally present in fruit juices, syrups and honey
should make up <5% of daily dietary energy intake

Question 16

what are the physical activity guidelines for under 5s who are walking?

Answer 16

should be physically active daily for at least 180 mins throughout the day
on average 30-60 mins extra per day

Question 17

how does orlistat work?

Answer 17

inhibits gastric and pancreatic lipase to reduce absorption of dietary fat by 30%

Question 18

what are the side effect of orlistat?

Answer 18

oily stools
faecal urgency
nausea
abdo pain

Question 19

who can orlistat be prescribed for?

Answer 19

only prescribed in adolescents with very severe to extreme obesity (BMI >3.5 above median) or severe obesity with co-morbidities
must be prescribed by specialist clinic

Question 20

what are the 3 methods of surgical management for obesity?

Answer 20

LABG = belt around top of stomach creating a small pouch
RYBG = top section of stomach divided off by staples to form a small pouch and new exit from pouch which bypasses part of small intestine
LSG = divides stomach vertically from top to bottom to reduce size of stomach by 75%

Question 21

how effective is bariatric surgery at 1 year?

Answer 21

reduced BMI by 13.5

resolves associated conditions (sleep apnoea, hypertension etc)