Overweight and obesity in Children

Question 1

Why do you not use BMI alone to measure obesity in children?

Answer 1

can’t use BMI as height and weight changes over time
Growth spurt comes at different times in boys and girls
healthy BMI ranges are different for boys and girls

Question 2

What do use to measure obesity in children?

Answer 2

BMI plotted against age on the centile chart appropriate for gender

Question 3

What are the population threshold for BMI?

Answer 3

> /= 85th centile - at high risk of being overweight

> /= 95th centile - at a high risk for obesity

Question 4

What are the clinical thresholds for BMI?

Answer 4

>/= 91st centile - overweight
>/= 98th centile - clinical obesity

Question 5

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

Answer 5

BMI, as height can be measured accurately from then

Question 6

What is used to assess children <2 years?

Answer 6

use BMI conversion chart to provide an approximate BMI centile

Question 7

Is waist circumference used to diagnose oveweight and obesity in children?

Answer 7

No

Question 8

What are the risk factors for being overweight at 3 years?

Answer 8

Parental overweight
Black ethnicity
Greater Birthweight
Smoking during pregnancy
Lone motherhood
Pre-pregnancy overweight
Maternal employment >/= 21 hours/ week
Solids foods before 5 months

Question 9

What is a protective factor to reduce the risk of being overweight at 3 years?

Answer 9

breastfeeding >/- 4 mon ths procedure

Question 10

What is the common genetic obesity condition in children?

Answer 10

Prader-Willi Syndrome

Question 11

What are the features of Prader-Willi syndrome?

Answer 11

Feels hungry all the time
Keeps thinking about what they’ll eat next
reduced energy requirements due to low muscle tone
Hypogonadism
short stature
behavioural problems

Question 12

What are the features of Bardet-Biedel Syndrome?

Answer 12

Visual Impairement
renal abnormalities
polydactyly (extra digits of the hands or feet)
learning difficulties
hypogonadism
obesity
hyperphagia
control access to food - families

Question 13

How do you clinically assess obesity?

Answer 13

BMI _ plot on a centile chart
Eating habits, physical acitivty, screen time
Social and school history
family support
stature of close family relatives
family histroy eg: obesty/ diabetes

Question 14

What are the treatment goals for overweight and obese children?

Answer 14

Weight maintenance

Question 15

When will a child get referred for a paediatric review?

Answer 15

serious obesity related morbidity (bengin hypertension, sleep apnoea, orthopaedic problems)
Children with suspected endocrine causes of obesity
Children undere 24 months who are severyly obere >/= 99.6th centile

Question 16

What is the treatment goal for a severely obese child?

Answer 16

0.5 - 1.0 kg per month

Question 17

How much should free sugar consitute the dialy energy intake of a child?

Answer 17

= 5%

Question 18

What factors are associated with sugar sweetened beverages?

Answer 18

high added sugar content, low satiety, incomplete compensatory reduction in in energy intake after intake at subsequent meals?

Question 19

How does portion size affect you health?

Answer 19

bigger the plate size, bigger the portion size -> bigger the amount of

Question 20

How long should children under 5 be active for?

Answer 20

atleast 180 min daily

on average - extra 30-60 min/ day

Question 21

How does screen time affect weight?

Answer 21

> 2 hrs sedentary behaviour –> increased risk of overweight and obesity

Question 22

What factors hould parents think of with regard to screen time?

Answer 22

Is screen time controlled?
does screen use interfere wwith what your family wants to do?
Does screen use interfere with sleep?
Are you able to control snacking during screen time?

Question 23

What is the recommended screen time for 2-5 yrs old?

Answer 23

<1 hr/ day

Question 24

Which drug is givegn to children to reduce obesity?

Answer 24

Orlistat
inhibits gastric and pacreatic lipase to reduce absorption of dietary fat

side effects - oily stools, faecal urgency, nausea, abdomen pain

Question 25

What are the recommendations for the use of Orlistat?

Answer 25

In adolescents with very severe to extreme obesity ( BMI >/= 3.5 SD above median) or severe obesity (BMI >/= 99.6th centile) with co-morbidites
3 months mimimun for effort to be seen

Question 26

What are the surgical management options for obesity management in children?

Answer 26

LAGB (laparoscopic adjustable gastric band) - acts like a belt to crete a small pouch thus limiting the food eaten

RYGB (gastric bypass, top section of the stomach divided off by staples to form a small pouch, food bypassess old stomach and goes to the small intestine)

LSG (Laparoscopic sleeve gastrectomy - divides the stomach vertically from top to bottom to reduce the size of the stiomach)

Question 27

What are the associated complications of gastric surgeries?

Answer 27

nutrient deficiencies, hernias, wound infection, small bowel obstruction, cholelithiasis

Question 28

When are children considered for surgery?

Answer 28

post-pubertal adolescents with very severe to extreme obesity and severe comorbidities

Question 29

what is the risk for children in Scotland to develop obesity?

Answer 29

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