Obesity Flashcards
Causes of obesity (3)
- Nutritional obesity->tall for age, family history of obesity/diabetes/CVD, early puberty, psychosocial
- Endocrinological->V rare: thyroid, cushings, hypothalmic lesions
- Genetic: short, learning abnormalities, dysmorphic, hypogonadism, congenital
Consequences of obesity for child (10)
- Psychological: Depression, low self esteem, eating disorders, body image disorders
- Fertility: PCOS, menstrual irregularities
- CV- hypertension, cholesterol, chronic inflammation
- Endocrine: insulin resistance, diabetes
- Respiratory: asthma, snoring, exercise intolerance, Sleep apnea
- Orthopedic: dislocated hips, flat feet
- GIT: Abnormal LFTs
Important history
Lifestyle and diet Growth and development School, emotional/psychological Features of underlying endocrinological Family history Complications: asthma, OSA, joint, CV, diabetes Learning
Investigations
1. Looking for a cause TSH Free urinary cortisol Karyotyping MRI 2. Look for complications Lipids Glucose->urinary, OGTT LFTs
Examination
- Growth and devlopment
- Endocrinology
- Dysmorphic
- Complications->acanthosis nigricans, BP, joints
Define childhood overweight and obesity
OW= >85th percentile Obesity= >95th percentile
Management overview
- Support
- Physical activity, restrict TV/game consoles to 1 hour / day
- Diet->balanced, not crash dieting
- Monitoring->weight, growth, diet, PA, psychology, complications
Advice to parents->?puupy fat and managing
Cannot be sure it is just puppy fat. AT a risk of adult obesity, diabetes, lipid, high blood pressure. If they can hold weight steady, she is likely to do more growing before reachign adult height.
Needs changing of lifestyle, engage with someone who can encourage healthy eating and activity. Crash diets are discouraged because tends to lead to rebound weight gain, and is potentially damaging.
School based health weight promotion
- Healthy eating
- Physical activity
- Reducing sedentary
Teachers are trained, few sessions over several weeks.
Not resulted in significant changes in BMI.
Individual family based prevention
Primary care setting
Adopt healthy lifestyle with specific strategies
Group family based
- Child centred physical activity
- Dietary modification
- Parental education and support
Children together, couple hours, few weeks
Making physical activity fun
Recognising hungry vs non-hungry eating, rather than dieting
Discussing childs weight with parent
Sensitive issues.
Ask the parent their views
If express concern: discuss ideas for changes
If not concerned: raise awareness of the issue->talk about health more broadly, rather than narrowing into weight straight away
Parents should fous on behavioural change
- Increasing physical activity->make part of family life, fun
- Maintaining healthy consumption of nutritious food and drinks
- Aware of what constitutes nutritious foods and drink, and encourage healthy lifestyle
Adverse effects of television watching
- Television and video games take over from physical activities
- Decreased metabolic rate while watching
- Increased amount of high energy food consumed
- Frequent advertising of generally high calorie and poor quality foods during children’s program
