Overweight and obesity in childhood Flashcards
What is the definition of overweight and obesity?
Abnormal or excessive fat accumulation that may impair health
Results from long term positive energy imbalance
What are the ranges of BMI?
Healthy: 18.5-25
Overweight: 25-30
Obesity: Over 30
What are the pitfalls to BMI in childhood?
Growth in height not always matched by a proportionate increase in weight
Growth spurt occurs later in boys than girls
On a growth chart, what do the different centiles represent?
Over 85th: high risk of being overweight
Over 95th: high risk of obesity
91st: overweight
98th: clinical obesity
What is the best measure of adiposity from the age of 2?
BMI when height can be measured accurately
What is the best measure of adiposity in a child under 2?
Use BMI conversion chart to provide a BMI centile
Should waist circumference be used in children?
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
What are risk factors for being overweight at 3 yrs?
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
How will prader willi syndrome present at birth?
Very floppy
Ability to suck weak or absent
Tube feeding common
How will prader willi syndrome present in childhood?
Hyperphagia Reduce energy Learning difficulties Hypogonadism Short stature
What causes and what is the inheritance of prader willi syndrome?
Deletion in chromosome 15
Rarely inherited
What are the signs and symptoms of bardet biedl syndrome?
Visual impairment Renal abnormalities Polydactyly Learning difficulties Obesity Hyperphagia
What causes bardet bidel syndrome and what is the inheritance?
Mutations in BBS gene which plays a role in the formation of cilliia
Autosomal recessive
What are the negative consequences of overweight and obesity in childhood?
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
What is included in the clinical assessment of obesity?
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
How are comorbidities assessed in obese children?
Metabolic syndrome Respiratory problems Hip and knee problems Diabetes CHD Sleep apnoea Hypertension
When should obese children be referred for paediatric review?
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
What is the treatment goals for severely obese children?
Weight loss of 0.5-1.0kg per month
What are the sugar recommendations?
Free sugars should make up less than 5% of daily dietary intake
What is the advice to families regarding portion sizes?
Use smaller plates
Parent serves meals rather than child serves himself
Cook only required food quantity
Age appropriate portion sizes
What are the physical activity guidelines for under 5 and not walking?
Encourage through floor based play and water based activities in safe envirnoments
What are the physical guidelines for those under 5 and walking?
Should be physically active for 180 mins a day
On average an extra 30-60 mins per day
What parenting strategies are good?
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
What is the mechanism of action of orlistat?
Inhibits gastric and pancreatic lipase to reduce absorption of dietary fat
