Overweight and obesity in Children Flashcards
Why do you not use BMI alone to measure obesity in children?
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
What do use to measure obesity in children?
BMI plotted against age on the centile chart appropriate for gender
What are the population threshold for BMI?
> /= 85th centile - at high risk of being overweight
> /= 95th centile - at a high risk for obesity
What are the clinical thresholds for BMI?
>/= 91st centile - overweight >/= 98th centile - clinical obesity
What is the best measure of adiposity from the age of 2?
BMI, as height can be measured accurately from then
What is used to assess children <2 years?
use BMI conversion chart to provide an approximate BMI centile
Is waist circumference used to diagnose oveweight and obesity in children?
No
What are the risk factors for being overweight at 3 years?
Parental overweight Black ethnicity Greater Birthweight Smoking during pregnancy Lone motherhood Pre-pregnancy overweight Maternal employment >/= 21 hours/ week Solids foods before 5 months
What is a protective factor to reduce the risk of being overweight at 3 years?
breastfeeding >/- 4 mon ths procedure
What is the common genetic obesity condition in children?
Prader-Willi Syndrome
What are the features of Prader-Willi syndrome?
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
What are the features of Bardet-Biedel Syndrome?
Visual Impairement renal abnormalities polydactyly (extra digits of the hands or feet) learning difficulties hypogonadism obesity hyperphagia control access to food - families
How do you clinically assess obesity?
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
What are the treatment goals for overweight and obese children?
Weight maintenance
When will a child get referred for a paediatric review?
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
What is the treatment goal for a severely obese child?
0.5 - 1.0 kg per month
How much should free sugar consitute the dialy energy intake of a child?
= 5%
What factors are associated with sugar sweetened beverages?
high added sugar content, low satiety, incomplete compensatory reduction in in energy intake after intake at subsequent meals?
How does portion size affect you health?
bigger the plate size, bigger the portion size -> bigger the amount of
How long should children under 5 be active for?
atleast 180 min daily
on average - extra 30-60 min/ day
How does screen time affect weight?
> 2 hrs sedentary behaviour –> increased risk of overweight and obesity
What factors hould parents think of with regard to screen time?
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?
What is the recommended screen time for 2-5 yrs old?
<1 hr/ day
Which drug is givegn to children to reduce obesity?
Orlistat
inhibits gastric and pacreatic lipase to reduce absorption of dietary fat
side effects - oily stools, faecal urgency, nausea, abdomen pain
What are the recommendations for the use of Orlistat?
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
What are the surgical management options for obesity management in children?
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)
What are the associated complications of gastric surgeries?
nutrient deficiencies, hernias, wound infection, small bowel obstruction, cholelithiasis
When are children considered for surgery?
post-pubertal adolescents with very severe to extreme obesity and severe comorbidities
what is the risk for children in Scotland to develop obesity?
1/4
