Obesity

Question 1

Define overweight/obese.

Answer 1

Obese - BMI greater than 95th percentile for age

Overweight - BMI between 85th and 95th percentiles for age

Question 2

How is BMI calculated?

Answer 2

Weight in kgs /height 2 in metres

Question 3

What are the common causes of childhood obesity?

Answer 3

Decreased exercise
Energy-dense foods
Decreased physical activity
and increased sedentary activities
Increased portion sizes

Question 4

What are some medical causes of childhood obesity?

Answer 4

Hypothyroidism
Cushing’s syndrome
Growth Hormone deficiency
Steroid excess
Polycystic ovary syndrome
… even diabetes insipidus

Question 5

What are the major consequences of childhood obesity?

Answer 5

• Endocrine
– Insulin resistance + Type 2
diabetes
– Pubertal advancement
– Menstrual abnormalities – ↓GH secretion ↑GH clearance

• Cardiovascular
– Metabolic Syndrome
– Hypertension
– Dyslipidaemia

• Gastroenterological
– NAFLD

• Pulmonary
– Asthma
– Sleep abnormalities

• Orthopaedic
– SUFE

• Neurological
– Idiopathic intracranial
hypertension

• Socio-economic
– Low self esteem
– Poor school performance

• Cancer

Question 6

Investigations for childhood obesity?

Answer 6

Fasting glucose/insulin or OGTT
• Lipid profile
• LFTs
• TFTs
– FBC and iron studies
– HbA1c
– Vitamin D
– B12 and folate
– Mg/Ca/PO4 +/- PTH
\+/- Bone age
\+/- PCOS work-up,
\+/- genetic studies (microarray, PWS, complex off-site)
\+/- Sleep studies

Question 7

Treatment of childhood obesity?

Answer 7

Explain the risks and potential benefits
Set realistic treatment goals – aimed at change in lifestyle not weight
Provide education and support – verbal and written
Involve the whole family, with an MDT approach if possible
Ask parents or the adolescent to make time – prioritise the problem
Dietetic information – regular meals, healthy snacks
Prescribe ‘fun-based’ exercise
Aim for weight stabilisation when setting out
Advise re TV, gaming, sleep routines etc
Organise necessary referrals

Question 8

How do you diagnose and track obesity in children?

Answer 8

BMI charts

Question 9

What are some nutrition goals you can educate patients on?

Answer 9

• Step 1 – Get organised
• Step 2 – Eat regular meals
• Step 3 – A healthy lunch box
• Step 4 – Portion size
• Step 5 – Cut out sugary drinks
Increase physical activity, reduce screen time

Question 10

What are the “5210” recommendations for children?

Answer 10

• 5: at least 5 fruit or vegetables per day
• 2: no more than 2 h screen time per day (and none for children
<2 years old)
• 1: 1 h physical activity most days • 0: no sweetened drinks

Question 11

Important things to examine in an obese child.

Answer 11

Growth.
Nutritionally obese children are tall. Short stature or fall-off in height suggests a pathological cause. Calculate body mass index (BMI) and plot on a chart

Endocrinological signs.
If growth is poor look for signs of hypothyroidism (goitre, developmental delay, slow tendon reflexes, bradycardia) and steroid excess (moon face, buffalo hump, striae, hypertension, bruising)

Signs of dysmorphic syndromes.
Short stature, microcephaly, hypogonadism, hypotonia and congenital anomalies

Signs of complications.
Check blood pressure and look for acanthosis nigricans (a dark velvety appearance at the neck and axillae)—a sign of insulin resistance

Question 12

What are some genetic syndromes relating to obesity?

Answer 12

Severe obesity from infancy 
• Short stature
• Dysmorphic features
• Learning disability
• Hypogonadism
• Other congenital abnormalities

Question 13

When to suspect nutritional obesity?

Answer 13

No obvious medical or congenital cause

• Family history of obesity is common
• Social/emotional difficulties
• Early puberty
• Penis may seem small (as it is
buried in suprapubic fat)
• Child tends to be tall

Question 14

Important things to ask on history of obese child.

Answer 14

• Lifestyle and diet.
• Emotional and behavioural problems.
• Complications - MSK symptoms, snoring, lethargy, DM, CVD
• Learning difficulties. Children with an obesity-related genetic syndrome have special educational needs
• Symptoms of endocrine causes, (hypothyroidism and Cushing’s rare)
• Family history.

Question 15

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

Answer 15

• Policies influencing food environments
  
  • Marketing of unhealthy foods and non-alcoholic
    beverages to children
  • Nutrition labelling
  • Food taxes and subsidies
• Physical activity policies
  
  • school based

Question 16

What is the difference in nutritional/endocrine/genetic obesity?

Answer 16

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