Lecture 10: Obesity Flashcards
How long should a mother exclusively breastfeed?
AAP recommendation
First six months
then do BF + foods until 12
then however long mom wants
What are the benefits of BFeeding for baby?
- Protective effect against illnesses
- Reduce risk of SIDS
- 15-30% Reduced risk of obesity
- emotional connection
what illnessees does breast feeding protect against
- respiratory
- GI disease
- ear infections
- allergies (eczema, asthma, atopic dermatitis)
what are benefits of breastfeeding for mom?
- reduced PP hemorrhage
- longer amenorrhea
- reduced risk of ovarian and premenopausal breast cancers
- possible reduced risk of osteoporosis
- emotional connection
What are the disadvantages of BFeeding?
- Tired
- Mother is on special meds
- Baby needs special diet
- Cannot Bfeed if alcoholic or on drugs
- Need to supplement Vit D still
When do you feed a baby?
When its hungry
How do you know a baby is hungry?
- Licking lips
- Sticking tongue out
- Rooting
- Hand to mouth
- Opening mouth
- Fussy
- Sucking on everything (altho sucking can also be for comfort)
Hunger cues
Crying is a LATE sign of hunger
How often does a newborn eat on average?
Every 2-3 hours or 8-12 times every 24 hrs
How do newborn feeding amts increase?
- First days of life: 0.5 oz/feed
- 1-2 weeks: 1-2 oz/feed
- 2 weeks: 2-3 oz/feed
- 2 Months: 2-4 oz/feed (feeding slows Q3-4h)
- 4 months: 4-6 oz/feed
- 6 months: 6-8 oz/feed (feeding slows Q4-5h)
Formula-wise: 1oz per month until they get to 7-8 oz/feed.
What kind of baby is most likely to overfeed?
Bottle fed
How do you know a baby is getting enough to eat?
- Beginning days: 2-3 WET diapers daily.
- By 1 week: 5-6 WET diapers daily.
How much Vit D does a baby need?
400 IU QD until they drink 1 qt of whole milk
Milk would not start until 1 year at minimum.
What kind of babies need Vit D supplementation?
Any baby being BFeed or not drinking at least 32oz of formula
What is the recommended iron supplementation for a newborn baby being BFed?
1mg/kg/d of liquid iron until 6 months
They usually start eating food with iron by 6mo.
What is the recommended iron supplementation for a newborn baby being Formula-Fed?
Just use iron-fortified formula for the first year. make sure it contains 4-12 mg of iron
How does a baby’s wt change in the first 2 weeks of life?
DROPS by 7%, should be gained back by 10-14 days of life
How much wt do we expect a baby to gain daily?
15g
100-120 kcal/kg/d needed for this.
When do you check a newborn’s wt?
3-5 days after its born.
You would expect a small DROP in wt.
How does formula affect growth of babies
- High risk for obesity in childhood.
- rapid growth especially at 3/4 mo
what are th possible compositions of formula
- reconstitiuted skimmed cows milk
- mix of skim cow milk and electrolye depleted cow milks whey/casein protein
What are the biggest benefits of formula?
- Catering to special needs (MPA, galacto, etc)
- No other supplementation is generally required.
When can you start single grain rice cereal at the earliest?
4 months via a spoon BID
how often should you introdduce a new food to a baby
at 6 mo of age introduce a new fruit/veggie every 3-4 days
When can you start meats in children?
9 months of age
What 4 things signal a child is ready for complementary feeding?
- Can hold head up unassisted
- Can sit unassisted
- Bring objects to mouth (interest)
- Ability to track spoon and open mouth
What is the danger of introducing peanut foods in the first year to an infant?
It is preferred that you DO introduce them to it to reduce their risk of developing an allergy to it.
Unless you have anaphylaxis to it i guess
When is juice recommended to children?
NEVER
Diabetes!!
How do milk recommendations change for a baby?
- 16 oz of Whole milk starting at age 1.
- Switch to skim/2% at age 2.
How many meals/snacks should a 2 year old eat daily?
- 3 healthy meals
- 2 snacks
When does a baby start getting picky?
Around age 1 there is a sharp drop in appetite with increased pickiness
When should you start flintstone vitamins for a kid?
18mo, start with 1/2
What is the suggested macronutrient breakdown for a baby?
- 55-60% carbs (1/2 should be WHOLE grains!) high fiber!
- < 30% fats. (saturated and polyunsaturated should be <10% total calories each)
- 10% Protein?
When are chunks of food a choking hazard for kids?
Under 4
What is the approximate ratio of calories to height for a kid?
40 cal/inch
32 inches = 1300 cal
how should toddlers serving sizes compare to adult serving sizes
childrens serving size should be 1/4 of adults
what is the approximate amount of calories that a child should consume based on age groups
2-3: 1000
4-8: 1400
9-13: 1600F, 1800M
14-18: 1800F, 2200M
What did the Bogalusa study reveal about childhood obesity and adult obesity?
Obesity at 2-5 years old = 90% chance of obesity as an adult
What is the risk for a child to become obese if 1 parent is? Both parents?
- 1 parent: 3x risk
- Both parents: 15x risk
What are the not so obvious RFs for obesity?
- Later bedtime
- Ghrelin/leptin hormone dysfunction
- Diabetic mothers
Which hormone, as it rises, makes us LESS hungry?
Leptin
where is leptin produced
adipose fat tissue. when body fat decreases leptin levels fall and appetite increases
Which hormone, as it rises, makes us MORE HUNGRY?
Ghrelin
Ghrelin Gets Hangry
where is ghrelin produced
the stomach wall.
what hormone suppresses appetite after meals and counteracts ghrelin? where is this hormone produced
- PYY
- small intestine
How does wt gain affect leptin?
- More fat = more leptin
- More leptin = body starts getting resistant to it
- Your brain thinks you’re hungry
What medications are associated with obesity?
- Glucocorticoids
- Megace (appetite stimulant)
- Sulfonylureas (Glipizide, glyburide)
- TCAs
- MAOIs
- OCPs
- Insulin (excess)
- TZDs
- Risperidone
- Clozapine
What hormones among these are increased in obesity?
- Leptin
- Estrogens
- Cortisol
- GH
- Insulin
- Testosterone (male/female)
- Leptin = INCREASED
- Estrogens = INCREASED
- Cortisol = INCREASED
- GH = DECREASED
- Insulin = resistance
- Testosterone = DECREASED in men, increased in women
what BMI percentages coordinate to underweight, healthy weight, overweight, obese, and severely obese?
underweight - <5
healthy weight - 5-84
overweight - 85-95
obese - >95 -99
severe obese - >99
What two abdominal organs are we concerned most about in our ROS for an obese child?
- Gallbladder
- Fatty Liver
What disease should we question in the ROS for an obese child?
Diabetes!!!!
polyuria, polydipsia, GU itches, blurry vision
What is the ideal approach when discussing weight?
- Use nicer terms like excess weight or elevated BMI
- Show them a growth chart
- Emphasize that lowering BMI even a little lowers CV risk!
What is the general AAP recommendation regarding cholesterol screening in children?
ALL children 9-11 should get screened.
When is it indicated to screen a child earlier than 10y for cholesterol?
- Parents/GP had ACS/CVA prior to 55 in men, 65 in women.
- Parents/GP have total cholesterol > 240
- Child has heart dz, DM, HTN, smoking, obese, or unknown.
What does 5 2 1 0 mean?
- 5 fruits/veggies a day
- 2 hours of screen time max
- 1 hour of play daily
- 0 sugar-sweetened drinks
What is the recommendation regarding diet drinks?
NO DIET DRINKS!
Makes you wanna snack even more
Recommendation regarding low-fat diets in children?
NO! You want to just aim for healthier fats, not less.
Unsaturated fats are your friends: MUFAs and PUFAs
What are the 4 golden rules of eating?
- Divide responsibilities
- Eat when you’re hungry, stop when you’re full
- Do not force your child to clean the plate!!!
- Eat together
What does lack of sleep do to your hormones?
- Increased ghrelin
- Decreased leptin
- Increased evening cortisol => insulin resistance
Sleep is #1
What is the #1 cause for bullying at school?
Obesity
What is the FDA approved tx for obesity?
Technically not for children
Qsymia (topiramate/phentermine combo) this is NOT FDA approved for children but is approved for obestiy.
what other treatments are not FDA approved but have been used for weight loss in childhood obesity?
- topiramate
- phentermine (tachycardia, psychosis, panic, HF)
Generally, what are the minimum requirements for a bariatric sx?
- Older than 15
- BMI >= 40 or beyond 100% of IBW
what is the MC bariatric procedure
Gastric bypass (vertical banded gastroplasty)
Safest/reversible bariatric procedure?
Laparoscopic Adjustable Gastric Banding (LAGB)
Vit D deficiency is associated with what lab finding that can lead to obesity?
increased fasting inculin levels
What is the guideline regarding Vit D levels of around 20-29?
Normal > 30
- D3 OTC 1000U daily
- Q3mo checks
What is the guideline regarding Vit D levels of < 20?
Normal > 30
- D2 (Rx) 50,000U/week
- Q3mo
What underlying female condition may lead to obesity?
PCOS
what dx has increased free testosterone? what about decreased?
increased - PCOS
decreased - Klinefelter syndrome
What genetic male condition may lead to obesity?
Klinefelter
Low T, and often are obese when adolescents.
Metabolic syndrome criteria in children
- Waist circumference >= 90th percentile
- Hypertriglyceridemia >= 110
- Low HDL <= 40
- HTN >= 90th percentile
- Impaired glucose/FBG >= 110
What is the MC syndrome form of obesity?
Prader Willi Syndrome
Where is the Prader Willi Syndrome abnormality?
Chromosome 15q
Loss of paternally expressed genes
How does Prader Willi Syndrome present?
- Short w/ GH deficiency
- Hyperphagia w/ obesity
- Resistant to diet and exercise
Why is dieting and exercise hard in Prader Willi Syndrome?
- Hypotonia
- Hyperphagia drive is insatiable :(
- They have low metabolism due to their hormonal imbalances
They wanna eat no matter what :(
What are the major criteria for PWS? (7)
1 pt ea
- Hypotonia
- Feeding issues
- Excessive Wt gain
- Hypogonadism
- Facial anomalies
- Developmental delay
- Hyperphagia
Overall, how do we approach monitoring pediatric obesity?
- Q1-3 mo
- If no change in 3-6 mo, call wt loss and dietician
