pediatric obesity

Question 1

Childhood obesity definition

Obese =

Answer 1

> 95th percentile BMI

Question 2

Childhood overweight definition

Answer 2

85-95 percentile BMI

Question 3

Childhood underweight

Answer 3

<5% BMI

Question 4

Childhood severely obese?

Answer 4

> 99% BMI

COMORBIDITIES

Question 5

What percent of US is severely obese?

Answer 5

4% BMI

Question 6

What percent of us children are obese?

Answer 6

18%

Question 7

What percent of us children are overweight?

Answer 7

30%

Question 8

When does BMI usually reach nadir - what does early nadir indicate

Answer 8

Usually 6 years
early rebound associated with obesity later in child and adulthood

peak at 7mo

Question 9

What is another way to define severe childhood obesity other than >99% BMI?

Answer 9

Percent of 95th percentile

BMI >120% of 95th percentile
or
>35kg/m2

Question 10

Should we use the term obese?

Answer 10

Apparently not

use unhealthy BMI

Question 11

When communicating with families what should we discuss?

Answer 11

Avoidable health risks!
Type IIDM
HTN
Atherosclerosis

Discuss with child quality of life issues

Question 12

Higher prevalence groups of childhood obesity?

Answer 12

older children –> adolescents
native american, black, latino
low SES

Question 13

What is the most important predictor of childhood obesity worldwide

Answer 13

maternal education

Question 14

Medical assessment of obesity

Answer 14

Calculate BMI >2
Use w/l <2
Don’t eyeball!

Question 15

Childhood obesity and CV risk factors?

Answer 15

CV risk factors in up to 70%

Obesity persists

Question 16

Severely obese children CVD relative risk ?

Answer 16

10

Question 17

Severely obese children greatest risk?

Answer 17

early mortality in adulthood :(

Question 18

Atherosclerosis

Answer 18

Obese children have increased risk of atherosclerosis - increased risk with increased risk factors (dyslipidemia too)

Question 19

Pulmonary problems

Answer 19

Obstructive sleep apnea

Question 20

Severe pulmonary problems seen in severely obese children?

Answer 20

obesity hypoventilation syndrome - restrictive lung disease - can lead to right heart failure and hypoxemic respiratory drive

ROS –> Dyspnea / edema / somnolence

Question 21

Acanthosis nigricans

Answer 21

Seen with impaired glucose metabolism (diabetes)

Question 22

Prevalence of T2DM

Answer 22

1:10,000

Question 23

PCOS

ROS

Answer 23

Oligomenorrhea

Hyperandrogenism - hirsutism and severe acne

Question 24

Uber fat kids can have neurologic manifestation =

Answer 24

psuedotumor cerebri

Question 25

GI complication of fatties

Answer 25

NASLD - elevated ALT
GER
Gallstones
Constipation

Question 26

Orthopedic problems in fatties

Answer 26

Slipped capital femoral epiphysis - more likely to progress to bilateral disease in obese

Blount’s disease - bowed legs - stress injury to medial tibia growth plate from being so large

Question 27

Medical assesment of obese child

Answer 27

Plot BMI
Assess diet and FHX
ROS
Vitals / PE
Labs

Question 28

Key factors in weight in children

activity and sleep?

Answer 28

60+ minutes

inadequate sleep - weight gain

Question 29

Treatment basics

Answer 29

Involve family
1-2 changes at a time
MONITOR CHANGE

Question 30

OARrrrS?

Answer 30

Open ended 
Affirmation
Reflection 
roll with resistance and reframe
Summaries