Overweight and Obesity in Childhood Flashcards
What is the definition of overweight?
Abnormal or excessive fat accumulation that may impair health
What does overweight and obesity result from?
Long term positive energy imbalance = energy intake exceeds energy output
What would ideally be measured to assess being overweight?
Body fat = use weight as proxy instead
Why is BMI useful?
Corrects body weight for height of individual = healthy range changes with age and is different for boys and girls
Why is growth in height not always a useful measure?
Not always matched by weight and girls have their growth spurt earlier than boys
How is BMI plotted for children aged from 2-18 years?
Plotted against age on centile chart appropriate for gender = shows expected distribution of BMI values for children of that age and gender
What are the population thresholds for overweight and obesity?
>= 85th centile is high risk for overweight >= 95th centile is high risk of obesity
What are the clinical thresholds for overweight and obesity?
> = 95th centile is overweight
>=98th centile is clinically obese
At what age is BMI used to assess if a child is overweight?
From age 2 = able to measure height accurately
How is overweight and obesity assessed in children younger than two years old?
Use BMI conversion chart to provide an approximate BMI centile
Why is weight circumference not routinely measured?
No evidence that it improves diagnosis of body fatness or cardiometabolic risk factors = should not be used to diagnose overweight and obesity
What are some risk factors for a child being overweight by three years old?
Parental overweight, black ethnicity, greater birthweight, smoking during pregnancy, lone motherhood, pre-pregnancy overweight, maternal employment >= 21hrs/week, solid foods before 4 months
What is protective against obesity?
Breastfeeding >= 4 months
How do babies with Prader-Willi syndrome present at birth?
Very floppy, absent or weak ability to suck, tube feeding common
What is hyperphagia?
Food seeking and lack of satiety after eating
How do children with Prader-Willi present?
Hyperphagia, reduced energy requirements due to low muscle tone, learning difficulties, hypogonadism, short stature
What are some symptoms and signs of Bardet-Biedl syndrome?
Visual impairment, renal abnormalities, polydactyly, learning difficulties, hypogonadism, obesity, hyperphagia
Is obesity seen as a child protection issue?
Yes = its seen as a form of neglect and children may be taken away from their parents if there is a risk to their health
What kind of approach has had the best effect of reducing BMI?
Combined dietary, physical activity and behavioural programmes are shown to significantly and clinically relevantly decrease BMI
How are children clinically assessed for overweight and obesity?
BMI (plot on centile chart), social and school history, eating habits, physical activity patterns, screen time, emotional/psychological issues, family support, stature of close family, family history (diabetes, obesity)
What co-morbidities are children who are overweight or obese assessed for?
Metabolic syndromes, respiratory problems, hip and knee problems, diabetes, CHD, sleep apnoea, hypertension
Why might a child be referred for paediatric review because of their weight?
Serious obesity related morbidity that needs weight loss
Children suspected of underlying medical cause
Children < 24 months who are severely obese (BMI >=99.6th centile)
What are some obesity related morbidities that children may need a referral for?
Benign intracranial hypertension, sleep apnoea, orthopaedic problems
What are the treatment goals for overweight or obese children?
Overweight and obese children = weight maintenance
Severely obese children = maximum weight loss of 0.5-1kg per month
What are free sugars?
Added to foods plus those naturally present in fruit juices, syrups and honey
What is the recommended intake of sugar for children?
Age 4-6 = 19g/day (5 cubes)
Age 7-10 = 24g/day (6 cubes)
Age >11 = 30g/day (7 cubes)
What are the recommendations about free sugars?
Account for <= 5% daily dietary energy intake
Where do most free sugars come from?
In children aged 11-18, 1/3 of free sugars come from fruit juice and soft drinks
What effect does portion size have on food intake?
People exposed to larger portion sizes consume more food = consistently select larger quantities of food when given larger plates
What is some advice for families regarding portion size?
Use smaller plates, have parents serve meals rather than children, cook only required quantity, use age appropriate portions
What are the recommendations for physical activity in children < 5 years old who aren’t self-mobile yet?
Encourage activity through floor-based play and water-based activities
How much physical activity should self-mobile children <5 years old get?
At least 180 mins spread throughout the day
What is the association between sedentary behaviour and obesity?
> 2hrs sedentary behaviour per day is associated with significantly increased risk of overweight and obesity
Why does increased screen time lead to obesity?
Eating energy dense foods while watching TV, exposure to food advertising/product placement, reduced or disrupted sleep
What are some behavioural strategies?
Self-monitoring
Goal setting = use to plan gradual behaviour changes
Contracting = appropriate rewards for achieving goals
Stimulus control = environment aids goal achievement
Relapse prevention
What is self monitoring important for?
Essential for setting goals, assessing progress and rewarding success
How can relapse be prevented?
Use problem solving to deal with new challenges
Plan ahead for potentially difficult situations
What are some parenting strategies?
Modelling of positive behaviours (set example for child)
Change environment and make reasonable demands
Effective praise = consistent, specific and timely
Reward good behaviour and ignore “bad behaviour”
How does Orlistat work?
Inhibits gastric and pancreatic lipase to reduce absorption of dietary fat
What are the GI side effects of Orlistat?
Oily stools, faecal urgency, nausea, abdominal pain
How should Orlistat be prescribed initially?
6-12 moth trial in specialist clinic with regular reviews
What children would be suitable for Orlistat prescription?
Adolescents with very severe to extreme obesity (BMI >= 3.5SD above median) or severe obesity (BMI >= 99.6th centile) with co-morbidities
In what age group is Orlistat not recommended in?
Children <12 years old = only prescribed if there are life threatening co-morbidities
What are some surgical options for treatment of overweight or obese children?
LAGB, RYGB, LSG
How does a LAGB work?
Acts like a belt around the top of the stomach to create a small pouch thus limiting amount of food eaten
What is done in a RYGB?
Top section of stomach divided off by staples to form small pouch = new exit from stomach made into Y loop from small intestine so food bypasses old stomach and part of small intestine
What happens in a LSG?
Stomach is divided vertically in two from top to bottom to reduce size of stomach by about 75%
What are some complications of weight loss surgery?
Nutrient deficiencies, hernias, wound infection, small bowel obstruction, cholelithiasis
What children would be eligible for weight loss surgery?
Post pubertal adolescents with very severe to extreme obesity and severe co-morbidities
