Overweight and obesity in childhood

Question 1

What is the definition of overweight and obesity?

Answer 1

Abnormal or excessive fat accumulation that may impair health
Results from long term positive energy imbalance

Question 2

What are the ranges of BMI?

Answer 2

Healthy: 18.5-25
Overweight: 25-30
Obesity: Over 30

Question 3

What are the pitfalls to BMI in childhood?

Answer 3

Growth in height not always matched by a proportionate increase in weight
Growth spurt occurs later in boys than girls

Question 4

On a growth chart, what do the different centiles represent?

Answer 4

Over 85th: high risk of being overweight
Over 95th: high risk of obesity
91st: overweight
98th: clinical obesity

Question 5

What is the best measure of adiposity from the age of 2?

Answer 5

BMI when height can be measured accurately

Question 6

What is the best measure of adiposity in a child under 2?

Answer 6

Use BMI conversion chart to provide a BMI centile

Question 7

Should waist circumference be used in children?

Answer 7

NO
No evidence that is offers improved diagnosis of either body fatness or cardiometabolic factors
WC should not be used to diagnose an overweight or obese child

Question 8

What are risk factors for being overweight at 3 yrs?

Answer 8

Parental overweight
Black ethnicity
Greater birthweight 
Smoking during pregnancy
Lone motherhood
Pregnancy overweight
Maternal employment over 21hrs a week
Solid foods before 4 months
Breastfeeding after 4 months is protective

Question 9

How will prader willi syndrome present at birth?

Answer 9

Very floppy
Ability to suck weak or absent
Tube feeding common

Question 10

How will prader willi syndrome present in childhood?

Answer 10

Hyperphagia 
Reduce energy
Learning difficulties
Hypogonadism
Short stature

Question 11

What causes and what is the inheritance of prader willi syndrome?

Answer 11

Deletion in chromosome 15

Rarely inherited

Question 12

What are the signs and symptoms of bardet biedl syndrome?

Answer 12

Visual impairment
Renal abnormalities
Polydactyly
Learning difficulties
Obesity
Hyperphagia

Question 13

What causes bardet bidel syndrome and what is the inheritance?

Answer 13

Mutations in BBS gene which plays a role in the formation of cilliia
Autosomal recessive

Question 14

What are the negative consequences of overweight and obesity in childhood?

Answer 14

Poorer health in childhood inc hypertension and metabolic disorders
Low self esteem
Higher likelihood of being bullied
Poorer school attendance levels and poorer school achievements
Poorer health in adulthood inc a higher risk of obesity and CV disease
Poorer employment prospects as an adult, and a lower paid job

Question 15

What is included in the clinical assessment of obesity?

Answer 15

BMI - plot on centile chart
Eating habits, physical activity, screen time
Social and school history 
Emotional/psychological issues
Family support
Stature of close family relatives
Family history e.g. obesity, diabetes

Question 16

How are comorbidities assessed in obese children?

Answer 16

Metabolic syndrome
Respiratory problems
Hip and knee problems
Diabetes
CHD
Sleep apnoea
Hypertension

Question 17

When should obese children be referred for paediatric review?

Answer 17

Serious morbidity that requires weight loss e.g. benign intracranial hypertension, sleep apnoea or orthopaedic problems
Children with a suspected endocrine cause
Children under 24 months who are severely obese

Question 18

What is the treatment goals for severely obese children?

Answer 18

Weight loss of 0.5-1.0kg per month

Question 19

What are the sugar recommendations?

Answer 19

Free sugars should make up less than 5% of daily dietary intake

Question 20

What is the advice to families regarding portion sizes?

Answer 20

Use smaller plates
Parent serves meals rather than child serves himself
Cook only required food quantity
Age appropriate portion sizes

Question 21

What are the physical activity guidelines for under 5 and not walking?

Answer 21

Encourage through floor based play and water based activities in safe envirnoments

Question 22

What are the physical guidelines for those under 5 and walking?

Answer 22

Should be physically active for 180 mins a day

On average an extra 30-60 mins per day

Question 23

What parenting strategies are good?

Answer 23

Modelling of positive behaviours - encouraged to follow programme themselves and set a good example to the child
Change the environment, not the child
Make reasonable demands
Effective praise - consistent specific and timely
Reward good behaviour

Question 24

What is the mechanism of action of orlistat?

Answer 24

Inhibits gastric and pancreatic lipase to reduce absorption of dietary fat

Question 25

What are the GI side effects of orlistat?

Answer 25

Oily stools
Faecal urgency
Nausea
Abdo pain

Question 26

When should orlistat be prescribed?

Answer 26

In adolescents with very severe to extreme obesity or severe obesity with comorbiditie

Question 27

What are the different surgical managements of obesity?

Answer 27

Laparoscopic adjustable gastric banding
Roux en Y Gastric bypass
Laparoscopic sleeve gastrectomy

Question 28

What does a gastric band entail?

Answer 28

Acts like a belt around the top of the stomach to create a small pouch thus limiting amount of food eaten

Question 29

What does a RYGB entai?

Answer 29

Top section of stomach divided off by staples to form small pouch. New exit from pouch made into Y loop from small intestine so food bypasses old stomach and part of small intestine

Question 30

What does a sleeve gastrectomy entail?

Answer 30

Divided stomach vertically from top to bottom to reduce size of stomach by 75%. Stomach function unaltered

Question 31

What is the guidelines for surgery in children?

Answer 31

Can be considered for post pubertal adolescents with very severe to extreme obesity and severe comorbidities
Possible complications and long term commitment to follow up discussed