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Paeds: Gastro and Growth > Obesity > Flashcards

Obesity Flashcards

1
Q

What defines an overweight child?

A

BMI > 91st centile

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2
Q

What proportion of children are overweight between 2-5years in the UK?

A

25%

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3
Q

What proportion of children are overweight between 6-10 years in the UK?

A

30%

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4
Q

What proportion of children age 11-15 years are obese?

A

37%

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5
Q

What are 4 ways that doctors can help promote healthy eating?

A
  1. Supporting breastfeeding in infancy
  2. Advising parents and young people on healthy lifestyles
  3. Monitoring growth parameters and the consequences of obesity
  4. Advocacy and support for local and national healthy lifestyle programmes
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6
Q

What are 13 complications of obesity in childhood?

A
  1. Orthopaedic
  2. Idiopathic intracranial hypertension
  3. Hypoventilation syndrome
  4. Non-alcoholic fatty liver disease
  5. Gall bladder disease/ gallstones
  6. Polycystic ovarian syndrome
  7. Type 2 diabetes mellitus
  8. Hypertension
  9. Abnormal blood lipids
  10. Asthma
  11. Changes in left ventricular mass
  12. Increased risk of certain malignancies (endometrial, breast, colon cancer)
  13. Psychological sequelae - low self-esteem, teasing, depression
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7
Q

What are 3 orthopaedic complciations of obesity?

A
  1. Slipped upper femoral epiphysis
  2. Tibia vera (bow legs)
  3. Abnormal foot structure and function
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8
Q

What are 5 features of hypoventilation syndrome?

A
  1. Daytime somnolence
  2. Sleep apnoea
  3. Snoring
  4. Hypercapnia
  5. Heart failure
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9
Q

What are 3 key cancers that obesity increases the risk of?

A
  1. Endometrial
  2. Breast
  3. Colon
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10
Q

How is BMI expressed in children?

A

[weight in kg/(height in m)2] expressed as a BMI centile in relation to age-matched and sex-matched population

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11
Q

What is the definition of obesity in children?

A

BMI over the 98% centile

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12
Q

What is the programme that involves measurement of weight and height of children?

A

National Child Measurement Programme

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13
Q

What are the 2 key points at which the National Child Measurement Programme measures height and weight of children?

A
  1. Reception: 4-5 years
  2. Year 6: 10-11 years
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14
Q

What has happened to the trend in childhood obesity in the last 20 years?

A

has risen, highest among 11-15 year olds

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15
Q

What proportion of children in the UK are overweight or obese?

A

more than a third

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16
Q

What is thought to be the cause of a marked increase in prevalence of obesity in children? What is there limited evidence on?

A
  • changes in environment and diet and activity behaviours
  • energy dense foods widely consumed, including high-fat fast foods and processed foods
  • however, no conclusive evidence obese children eat more than children of normal weight
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17
Q

What has happened to household energy intake since the 1970s?

A

it ha fallen; amount of fruit purhased has increased by 75%, intake of full fat milk decreased 80%

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18
Q

What does the comparison of household energy intake now compared with the 70s suggest about children’s energy expenditure?

A

it has undoubtedly decreased: fewer children walk to school, transport in cars increased, less time at school spent doing physical activities, spend more time in front of small screens rather than playing outside

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19
Q

What risk factor increases likelihood of obesity in children?

A

lower socioeconomic homes

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20
Q

What appears to be the single most effective factor in preventing obesity?

A

reduction in time spent on small screens (even compared with fat intake, fruit and vegetables, increased physical activity and education)

21
Q

How does overnutrition affect childhood growth?

A

accelerates linear growth and puberty; obese children are relatively tall

22
Q

When should you consider an endogenous cause of obesity?

A

if child obese and short; especially if falling height velocity

23
Q

What are the 2 key endogenous causes of obesity to rule out?

A

Hypothyroidism, Cushing syndrome

24
Q

What should be considered in children who are obese with learning disabilities and are dysmorphic?

A

underlying syndrome

25
Q

What is the most common syndrome that can cause obesity?

A

Prader Willi syndrome

26
Q

What are 6 features of Prader Willi syndrome?

A
  1. Obesity
  2. Hyperphagia
  3. Poor linear growth
  4. Dysmorphic facial features
  5. Hypotonia
  6. Undescended testes in males
27
Q

What can be a possible cause of severe obesity in children under 3 years?

A

gene defects e.g. leptin deficiency

28
Q

In what setting are most obese children managed?

A

Primary care

29
Q

What are 2 situations when specialist paediatric assessment is indicated in childhood obesity?

A
  1. Complications present
  2. Endogenous cause suspected
30
Q

When should treatment for obesity in children be considered?

A

child above 98th centile for BMI and family willing to make necessary difficult lifestyle changes

31
Q

In treating obesity, what is a more realistic goal than weight reduction? Why is this still acceptable?

A

Weight maintenance; will result in demonstrable fall in BMI on centile chart as height increases

32
Q

What are the 3 key ways that weight maintenance in childhood obesity can be achieved?

A
  1. Healthy eating
  2. Physical activity increased
  3. Limiting television and other small screen activities to <2 hours a day
    4.
33
Q

What are 9 things to focus on with healthier eating when treating obesity?

A
  1. Regular meals
  2. Eating together as a family
  3. Nutrient-rich foods lower in energy and glycaemic index
  4. Increased vegetable and fruit intake
  5. Healthier snack food options
  6. Decreased portion sizes
  7. Drinking water as main beverage
  8. Redction in sugary drinks
  9. Involving whole family in making sustainable dietary changes
34
Q

What is meant by lower in glycaemic index?

A

GI is a ranking of carbohydrate-containing foods based on overall effect on blood glucose level; slowly absorbed goods have low GI rating and those more rapidly absorbed a higher rating

35
Q

What are 4 ways to increase physical activity?

A
  1. Walking or cycling for transport
  2. Household chores
  3. Playing
  4. Organised exercise programmes - encourage to choose activities they enjoy e.g. football, dancing, swimming
36
Q

What is the recommended amount of exercise for children?

A

60 minutes of moderate or greater intensity activity each day

37
Q

When does drug treatment have a part to play in children with obesity?

A

children >12 years, extreme obesity (BMI>40) or BMI over 35 and complications

38
Q

What is the key drug intervention used in special circumstances in childhood obesity?

A

Orlistat

39
Q

How does orlistat work to treat obesity?

A

reduces absorption of dietary fat and thus produces steatorrhoea

40
Q

In what age of children can orlistat be used to treat obesity?

A

>12 years

41
Q

What are 3 situations when you may consider using orlistat due to complications of obesity?

A
  1. orthopaedic comorbidities
  2. sleep apnoea
  3. severe psychological disturbance
42
Q

What type of surgery is available to treat obesity?

A

Bariatric surgery

43
Q

What are 2 of the ONLY situations when bariatric surgery is considered for children with obesity?

A
  1. Almost achieved maturity
  2. Very severe or extreme obesity with complications e.g. T2DM or HTN and all other interventions have failed to achieve or maintain weight lo
44
Q

What is the most appropriate type of bariatric surgery?

A

Laparoscopic adjustable gastric banding

45
Q

What should drug and surgical interventions be used in conjunction with?

A

Dietary, exercise and behavioural weight management programe

46
Q

What are the only places that can offer drug or surgical management of childhood obesity?

A

specialist centres with multidisciplinary expertise in managing severe obesity

47
Q

What does the UK need to do to improve its ability to tackle obesity?

A

Integration between health services, local government and other key partners based on needs of local population

48
Q
A

Paeds: Gastro and Growth (14 decks)

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