Obesity

Question 1

define Obesity

Answer 1

BMI greater than 95th percentile for age.

Overweight >85%

Question 2

Differentiate nutritional obesity from other causes

Answer 2

Nutritional obesity - these children are overweight and tall
Endocrine causes - overweight and short
Genetic causes and learning difficulties - overweight from a young age, short and have dysmorphic features

Question 3

Ix for obesity

Answer 3

only for children who are overweight, short and have dysmorphic features or learning difficulties require further investigation looking for underlying aetiology.
Look for cause - T4, TSH, Urnary free cortisol, Karyotype and DNA analysis (Genetic eg prayer Willi syndrome), MRI of brain.
Look for consequences - Urinary glucose or oral glucose, Fasting lipid, LFT.

Question 4

Ix for obesity

Answer 4

only for children who are overweight, short and have dysmorphic features or learning difficulties require further investigation looking for underlying aetiology.

Question 5

Causes of obesity

Answer 5

Nutritional obesity - due to lifestyle factors, Increase sedentary, decrease physical and increase energy dense foods.
Endocrine cause
- Hypothyroidism
- Cushing’s
- Hypothalamic lesion
Genetic syndromes and single gene defects 9rare)
- not finished

Question 6

Describe principles of life-style management of obesity

Answer 6

Needs to be holistic, family focused and delivered in a skilled way that builds motivation.
Includes:
Support for any bullying or psychological disturbance due to obese
Encouraging physical activity and reducing sedentary behaviour
A balanced healthy diet- no crash diet, aim for weight maintenance
Monitoring for comorbidity and mx
Restrict TV to 1 HR a day

Question 7

Consequence of obesity in children

Answer 7

Low self esteem
School problems - bullied and bullies
Orthopaedic - MSK strain and SLIPPED CAPITAL FEMORAL EPIPHYSES
Asthma
Sleep apnoea
Polycystic ovary syndrome
Impaired glucose tolerance - diabetes
HTN
Dyslipidaemia
Abnormal liver function tests.

Question 8

Name some population interventions that have been used to prevent obesity.

Answer 8

Breast feeding in infancy is protective
Promotion of good nutrition in the early years when food habits are developing
Physical activity need to encourage in all children
Active Q about these especially in adolescence. When high intake of high fat foods and decrease exercise is common.

Question 9

Hx Q for children with obesity

Answer 9

Lifestyle and diet
Emotional and behavioural problems eg social and school problems, depression and bulling
Complications - MSK symptoms due to increase load on joints, Snoring, lethargy or tiredness for sleep apnoea, Diabetes and CVS
Learning difficulties - genetic cause
Symptoms - endocrine eg Hypothroidism and cushing’s
Fm Hx - Obesity, early onset T2D, Heart disease

Question 10

EX for child obesity

Answer 10

Growth - If tall = Nutritionally obese. If short or fall-off = pathological cause. Calculate BMI and plot
Endocrinology signs - In poor growth look for signs of Hypothroidism (Goitre, developmental delay, slow tendon reflexes, bradycardia), Steroid excess (moon face, buffalo hump, striae, HTN, bruising).
Sign of Dysmorphic syndromes - short stature, microcephalic, hypogonadism, hypotonia and congenital anomalies.
Signs of complications - BP, acanthosis nigricans.

Question 11

Cx of sleep apnoea

Answer 11

Increased lung perfusion
Increased BP
Increased RVH
Tachycardia