Pediatric Obesity: Health Implications

Question 1

Body Mass Index for Age charts

Answer 1

1. 2-20 years
2. correlates with body fat strongly above 95th percentile, modestly 85-95 percentile
3. identification of excessive weight gain relative to linear growth

Question 2

5 categories Body mass index in children

Answer 2

1. Overweight: 85-94%
2. Obese: >95%
3. Severe obesity
   a. >99th
   b. > 120th of the 95th percentile: corresponds to adult class II

Question 3

BMI association with co-morbidities

Answer 3

> 95th association

>99th greatly increased co-morbidities

Question 4

current pediatric overweight & obesity status

Answer 4

• Obese: 18% US age 2-19 (BMI?95)
• Overweight/ obese: 30%
• income difference accounts for most ethnic variation

Question 5

common health effects of childhood obesity

Answer 5

• obstructive sleep apnea
• metabolic syndrome: insulin resistance + hyperlipidemia + HTN
• hepatic: NAFLD
• Decreased QOL: mood/ anxiety

Question 6

less common health effects of childhood obesity

Answer 6

• endocrine: T2DM, PCOS

- Orthopedic

Question 7

persistence of overweight into adulthood

Answer 7

related to: parent’s weight, age of onset, severity

Question 8

childhood obesity and risk of heart disease and T2DM

Answer 8

reversible if obesity resolves by young adulthood

Question 9

what infant factor correlates strongly with later obesity?

Answer 9

early infant weight gain: highest quartile

Question 10

physical activity

• daily goal
• sleep at 2-5yrs, 6-12 yrs, 13-18yrs

Answer 10

> 1hr active play/day

Sleep:

• 2-5yrs: 11hrs
• 6-12yrs: 10hrs
• 13-18yrs: 9hrs

Question 11

physical exam

Answer 11

HTN
acanthosis nigricans
acne/ hirsustism
striae
organomegaly
joint pain
stigmata of genetic syndromes
neurologic function

Question 12

labs

Answer 12

Start: age 10 or tanner 2; or age 2-9 if severely obese BMI >99%

• fasting lipids
• ALT
• fasting glucose +/- HgA1c q1-2yrs

Question 13

4 APP Stages of Interventions

Answer 13

1. Prevention Plus: primary care
2. structured weight management: PCP + dietician/ psych
3. comprehensive, multidisciplinary weight management: diet, exercise, behavior
4. tertiary care: controlled/ supervised diets, meds, surgery

Question 14

Prevention Plus weight loss plan

Answer 14

5210+:
5 fruits
2 hours tv or less
1 hour activity
0 SSB
\+others

Question 15

motivational interviewing

Answer 15

• identify family’s motivating values

- Use QARrrrS: open ended questions, affirmations, reflections, rolling with resistance, reframing, summaries

Question 16

principles of treatment for overweight child

Answer 16

1. motivational interviewing
2. family involvement
3. Environment cleanup
4. collaborative management: joint decision making (MD gives menu of changes)
5. cognitive behavioral techniques: self monitoring & accountability

Question 17

collaborative management

Answer 17

• change both diet and PA
• joint prioritizing and decision making
• MD does not dictate but gives menu of changes

Question 18

CBT

Answer 18

1. self-monitoring: if you can’t count it, you can’t change it
2. Accountability: reinforcement/rewards for behavior change