Pediatric obesity

Question 1

1. State the definitions and classification of childhood weight status, including use of BMI-for-age charts.

Answer 1

BMI growth charts 2-20 yrs
severe obesity is above the chart
>99th percentile is severe obese
>95 th percentile is obese
overweight 85-95

Question 2

2. Describe the current demographics of childhood overweight and obesity, including national rates, ethnic and age distributions.

Answer 2

prevalaence tripled since 1980, flat since 2005
all marginalized pops are higher

4% of general population
11% of low income population

Question 3

3. Describe the major co-morbidities associated with childhood obesity.

Answer 3

Pulmonary
-sleep apnea-
-obesity hypoventilation syndrome
CV
-atherosclerosis
Endocrine
-Diabetes (acanthosis nigricans)
-Polycystic ovarian syndrome(acne, hirsutism, elevated testerone, oligomenorhea)
-Hypothyroidism (check TSH)
Neuro
-Pseudo tumor cerebri
GI
-Non-alcoholic Fatty liver disease, elevate ALT
-Gallstones
-constipation
Ortho
-Slipped capital femoral epiphysis (hip groin knee pain) (likely to happen b/l)
-Blounts disease- bowed legs
Psych
-depression
-anxiety (they often improve with obesity)
-eating disorders
Derm
-acanthocys nigricans - too much insulin

psych
neuro
pulm-
CV
GI

arthritis, colon cancer/breast cancer

Question 4

4. Describe key components of assessment including diet, physical activity, family history (hx), review of systems, physical exam, positive and negative labs.

Answer 4

Plot- BMI
Assess- diet and activity and family history
ROS- look for comorbidities
Physical exam- comorbidities
Labs- lipids, glucose/A1C, ALT (10 years old start)

Question 5

5. Briefly describe treatment principles.

Answer 5

prevention plus

structured wt management

multidisciplinary weight management

Tertiary care- surgery