Overweight

Question 1

What is the definition of overweight and obese in children?

Answer 1

> 85% percentile = overweight, >95% percentile = obese

Question 2

What are some contributing factors to increased weight in children?

Answer 2

• Ethnicity
• Socioeconomic disadvantage
• Maternal Obesity/Parental Obesity
• Sleep duration
• Screen time/sedentary activity
• Food affordability
• Urbanisation (lack of safe zones for physical activity/active play)
• Reduced rates of breastfeeding
• Reduced breastfeeding duration
• Early protein hypothesis - formula feeding:
○ Formulas have too much protein -> obesity?

Question 3

Complications of increased weight in children

Answer 3

• Psychosocial: poor self-esteem, social isolation, body image issues, consequent mental health issues
• Respiratory: OSA, asthma, poor exercise tolerance
• Orthopaedic: back pain, SUFE
• Hepatobiliary: NAFLD, gallstones
• Reproductive: PCOS, menstrual abnormalities
• Cardiovascular: HTN, dyslipidaemia, increased CVD risk
• Endocrine: diabetes and metabolic syndrome

Question 4

Outline a brief history for overweight children

Answer 4

• Assessment of puberty
• General development
• General health and sleep problems
• FHx of diabetes, HTN, CVD, obesity (including bariatric surgery)
• Diet and exercise history
	○ Average daily food intake
	○ Activity levels
• Time spent sedentary (e.g. TV, computer use)

Question 5

What Ix might you do to investigate overweight children

Answer 5

• Fasting glucose/insulin or OGTT
• Lipid profile
• LFTs
• TFTs
• FBE and iron studies
• HbA1c
• Vitamin D
• B12 and folate
• CMP +/- PTH
• Optional: bone age, PCOS work-up, genetic studies, sleep studies
• Bioimpedance
	○ Assesses body composition 
	○ Also reflects total body water - fat less aqueous and therefore poorer conductor of electrical current 
	○ 2/4 limb 
	○ Feet need to be >6yrs old

Question 6

What are the principles of Mx for overweight children?

Answer 6

5 E’s:
• Empathise
• Evaluate
○ Anthropometry, degree and distribution of adiposity
○ Body composition
○ Metabolic complications
○ FHx
○ Is the family ready to make change?
• Explore behaviour change options
• Education about current and future health status, specifics of eating and activity
○ Show the growth chart to the family, SMART goals
• Empowerment - encourage child and family to aim for what is achievable

Question 7

What kinds of food changes might you suggest to families to help weight control?

Answer 7

• Eat regular and healthy meals and snacks
○ E.g. fruit kebabs, low fat yoghurt, boiled egg
• Control portion size
• Minimise take-away foods, pre-packaged food
• Try to eat meals as a family
• Encourage children to drink water and cut out soft drinks/cordial/juice
• Change to low-fat milk
• Education about food label interpretation
• No food rewards

Question 8

What are some indications for referral to a specialist for overweight children?

Answer 8

• Height below 10th centile, unexpectedly short for family or slowed growth velocity
• Precocious or late puberty
• Significant learning disability
• Severe and progressive obesity under 2 years of age
• Symptoms/signs of genetic/endocrine issues
• Serious associated morbidity (e.g. sleep apnoea, NIDDM, HTN)
• Psychological issues (e.g. disordered eating)