Pediatric Obesity

Question 1

Can you visually assess a kid’s BMI?

Answer 1

NO! use BMI chart

Question 2

talking to families:
100% avoidable diseases
(if obese at 11 yr old - 35 yr old)

Answer 2

5x Type II DM
3x HTN
2x Carotid Atherosclerosis

• Talk to kids too!
• sports, E, confidence, clothing

Question 3

____% of obese 12 yo will be obese as adults

Answer 3

80%

*84% remained obese at 27yo

Question 4

Higher prevalence groups

Answer 4

1. older children
   (they just get fatter and fatter)
2. Native Am, black, Latino
3. Low SES

Question 5

Incidence of obstructive sleep apnea in obese youth?

• Dx how?
• ROS

Answer 5

13-33%
Dx by polysomnogram

ROS:
Snoring most nights, apnea, poor sleep, nocturnal enuresis, AM headaches, fatigue, poor school performance

Question 6

Obesity hypoventilation syndrome

Answer 6

restrictive lung disease –> may lead to RHF

• hypoxemic respiratory drive
• dyspnea, edema, somnolence

Question 7

70% of obese children had two or more of these tests

Answer 7

1. high LDL
2. low HDL
3. High BP
4. Insulin resistance

*progression of HD does begin in early childhood and cause problem in adults

Question 8

Acanthosis Nigricans

Answer 8

“Dark thick skin”

1. This is the external sign that this kid is at risk for dev T2D
2. Internally, consuming too much carbs+fats than he can get rid of
   - Becomes sugar in his blood –> insulin takes it out –> insulin has side effect - it looks like growth hormone for melanocytes of deep layer or skin

• can fade away in 6-8 mo
• take dietary hx

Question 9

T2D fasting glucose

+ OGGT

Answer 9

> 126 fasting glucose

OGGT: >200

Question 10

FBG and OGGT in a kid with acanthosis nigracans

Answer 10

elevated FG: 100-125

OGGT: 140-199

Question 11

Polycystic ovarian syndrome (PCOS)

Answer 11

2 of 3
1. hyperandrogenism 2. Oligomenorrhea
-

Question 12

Pseudotumor cerebri ROS

Answer 12

Headaches (severe, recurrent), often worse in AM

Peripheral vision loss

Question 13

Hips pain

Answer 13

usually localized to knee and groin

Question 14

Non alcoholic fatty liver disease

Answer 14

10-25% of obese youth
Elevated ALT
Rule out other liver disease with persistent elevation >2x normal

steatophepatitis –> fibrosis –> cirrhosis

Question 15

Slipped capital femoral epiphysis (SCFE)

Answer 15

more likely to progress to bilateral disease in obese

Question 16

Blount disease

Answer 16

stress injury to medial tibial growth plate, often painless

• bowed legs + knee pain
• potentially disabling

Question 17

Comorbidities with Obesity

• Neuro
• Ortho
• Derm
• Psych

Answer 17

• Neuro: pseudotumor cerebri

- Ortho:
Blount disease (genu varum)

• Derm:
  Acanthosis Nigricans
• Psych:
  Depression/Anxiety

Question 18

Comorbidities with Obesity

• Pulm
• CV
• GI
• ENDO

Answer 18

• Pulm:
  Obstructive sleep apnea
• CV:
  HTN , lipid ab.
• GI:
  NAFLD
• ENDO:
  Impaired glucose met

Question 19

1st degree relatives should be assessed for?

Answer 19

1. severe obesity
2. CVD
3. Hypothyroidism
4. Psychiatric issues