Pediatric Obesity and Weight Management Flashcards
What are the weight classifications for children 2-20 years old?
Based on body mass index (BMI) for age and gender
Overweight: 85th-94th percentile
Obese: > 95th percentile
Obesity is more commonly found in?
Hispanics
Non-Hispanic black
What are barriers for screening for obesity?
Training, time, and resources
How often should BMI be checked?
At least annually.
What should be looked at to identify abnormal weight gain and growth abnormalities?
Growth trends rather than single data points.
What factors are determined in the assessment to better help determine treatment?
Medical risk (child history and exam, growth, parental obesity, family history)
Behavior risk (physical activity, eating, sedentary time)
Attitudes (family and patient concern and motivation)
What is Stage 1 of treatment?
Where does this take place?
Prevention Plus
Primary care office
What is Stage 2 of treatment?
Where does this take place?
Structured Weight Management
Primary care office with support
What is Stage 3 of treatment?
Where does this take place?
Comprehensive Multidisciplinary Intervention
Pediatric weight management center
What is Stage 4 of treatment?
Where does this take place?
Tertiary Care
Tertiary care center
If child has a BMI >95th percentile, where do the start their prevention?
Begin with Stage 1 treatment
If child has a BMI 85th-94th percentile, where do they start their prevention?
Depending on the assessment…
If NO evidence of health risk, they will work on targeting identified behaviors.
If evidence of health risk, they will begin at Stage 1 treatment.
What is the focus of each treatment stage?
What interventions does each treatment stage use?
Stages 1-3: targets behavior strategies to change eating and activity behaviors.
Examples: goal setting, self-monitoring, incentives to promote healthy lifestyle changes
Stage 4: intensive interventions
Examples: pharmacotherapy, bariatric surgery
What is the weight goal for patients aged 2-5 with BMI in the below categories?
BMI 5th-84th percentile (with no health risks)
BMI 85th-94th percentile (with health risks)
BMI >95th percentile
BMI 5th-84th percentile - weight velocity maintenance, begin prevention counseling
BMI 85th-94th percentile - weight maintenance or slow weight gain, begin Stage 1
BMI >95th percentile - weight maintenance OR weight loss of up to 1 lb./month, begin Stage 1
What is the weight goal for patients aged 6-11 with BMI in the below categories?
BMI 5th-84th percentile (with no health risks)
BMI 85th-94th percentile (with health risks)
BMI 95th-99th percentile
BMI >99th percentile
BMI 5th-84th percentile - weight velocity maintenance, begin prevention counseling
BMI 85th-94th percentile - weight maintenance, begin Stage 1
BMI >95th percentile - gradual weight loss of 1 lb./month, begin Stage 1
BMI >99th percentile - weight loss of 2 lbs./week, begin Stage 1 (2 or 3 IF family motivated)
What is the weight goal for patients aged 12-17 with BMI in the below categories?
BMI 5th-84th percentile (with no health risks)
BMI 85th-94th percentile (with health risks)
BMI 95th-99th percentile
BMI >99th percentile
BMI 5th-84th percentile - weight velocity maintenance, begin prevention counseling
BMI 85th-94th percentile - weight velocity maintenance, begin prevention counseling
BMI >95th percentile - weight loss of 2 lbs./week, begin Stage 1
BMI >99th percentile - weight loss of 2 lbs./week, begin Stage 1 (2 or 3 IF family motivated)
When should a patient advance to the next stage of treatment?
After 3-6 months of treatment with no significant progress in improving weight status or resolving obesity-related medical complications
Each stage is designed with increasing intensity and structure to?
▫ Improve eating habits
▫ Increase level of physical activity
▫ Decrease sedentary behavior
▫ Promote family support and involvement
What nutrition topics are discussed in nutrition assessment?
- Sugar sweetened beverages
- Fruits and vegetables
- Fast food
- Meal schedule
- Portion sizes
- Eating behaviors
When does a dietary assessment call for an adult present?
Dietary assessment in very young children is conducted with the adult caregiver only
Dietary assessment in school-aged children commonly includes the adult caregiver and the child
Dietary assessment with older adolescents most commonly does not include an adult caregiver
What are the nutrition recommendations for children?
Decrease fast food
Decrease added sugars
NO sugar-sweetened beverages (or limit to 6oz./day)
Decrease HFCS
Decrease high fat, high sodium, processed foods
Whole fruits in place of fruit juice
Portion size education
Decrease saturated fat (>2 years old)
Timely, regular meals
Recognition of eating cues (bored, stress, lonely, screen time)
Single portion packaging
Encourage fiber, fruits and vegetables
What diets showed significant improvement in weight status at completion of intervention?
- Low Carbohydrate
- Reduced Glycemic-Load Diet
- Modified Stoplight Diet for Children
At what age should physical activity self-reporting be provided by adult caregiver?
Children 10 years of age and younger should not be relied on for self-reporting of physical activity
Physical activity recommendations for children and adolescents?
Aerobic: most of 60 minutes should be moderate or vigorous intensity
-Include vigorous activity at least 3 days/week
Muscle-strengthening: include on at least 3 days/week
Bone-strengthening: include on at least 3 days/week
What should physical activity look like for toddlers?
- Building an environment that promotes movement instead of screen time is beneficial
- Finding movement that child enjoys is key
▫ Dancing to music
▫ Helping with laundry
▫ Playing Hide and Go Seek
What are recommendations for screen time?
Includes any time in front of a screen: TV, video games, computer, cell phones
All screens turned off 30 minutes before bedtime
TV, computer, and other screens not be allowed in children’s bedrooms
Recommended limit:
Age 2-5: 1 hour/day
Older kids:
-Place consistent limits on time spent using media
-Develop rules regarding types of media allowed
-Make sure media does not take the place of adequate sleep, physical activity, and other behaviors essential to health
-Designate media-free times together (e.g,. meals, driving) and media-free locations at home (e.g., bedrooms)
What does family-based behavior modification look like?
▫ Adult caregiver modeling (adult caregiver makes all of the same changes in behaviors as child (diet, physical activity, sedentary behavior)
▫ Change the home environment (stimulus control) for eating, activity, and sedentary behaviors
▫ Problem-solving and pre-planning
▫ Adult caregiver and child self-monitoring behaviors
▫ Increasing positive reinforcement (praise, contingency contracting, point systems)
▫ Reducing negative reinforcement
▫ Using extinction for problematic behaviors (tantrums around food, etc.)
What are obesity medications for children?
Orlistat (Xenical)
▫ Only prescription weight-loss medication in US approved by FDA for obesity treatment
▫ Lipase inhibitor
▫ Must be 12 years old
Alli
▫ Reduced-strength, nonprescription version of Orlistat
▫ Not approved under age 18 to prevent use without medical supervision
Recommended to be taken fat-soluble vitamins (ADEK)
When is metformin prescribed for adolescents?
- Not FDA-approved for treatment of obesity
- Approved for treatment of Type 2 Diabetes in children 10 years and older
- Anti-hyperglycemic drug, can reduce insulin resistance and hyperinsulinemia (can reduce hunger and decrease fat storage)
When would bariatric surgery be recommended to child?
May be an option for adolescents with severe obesity, often with serious comorbidities, who have failed to benefit from medically supervised treatment for at least 6 months
Considerations
▫ Age: growth has stopped (identified through x-ray of growth plate)
▫ BMI >40 OR BMI >35 + major comorbidities
▫ Co-morbidities
▫ Adherence to medication/supplement regimen
▫ Social support
What are the bariatric surgery options for adolescents?
- Roux-en-Y gastric bypass (RYGB)
- Laparoscopic adjustable gastric banding (LAGB)
- Sleeve gastrectomy (SG)
