Pediatric Overweight and Obesity

Question 1

Obese childhood

Answer 1

over the 95%

95% specific, 75% sensitive for excess adiposity

Question 2

Overweight childhood

Answer 2

85-95%

50% specific for excess adiposity

Question 3

Severe obese kids

Answer 3

> 99%

Question 4

Kids to be concerned about

Answer 4

kids moving up the chart rapidly

Question 5

When should a kid be there thinnest

Answer 5

5-6 yo

Meant to be very thin

Question 6

so many kids going off the top of the growth chart. How do you eval them?

Answer 6

Now we look at percent above 99%
Recommended by American Heart Association

ex:
BMI >120% of 95th percentile BMI for age

There is also a severe obese chart

Question 7

Avoidable health risks for obese kids 11 yrs–> 30-40 yrs

Answer 7

Obese kids who stay obese ↑ risk for:
Type 2 DM
HTN
Atherosclerosis

Question 8

Complications of childhood obesity

Answer 8

• Self esteem, depression, eating disorder
• sleep apnea, asthma
• Gallstones
• Glomerulosclerosis
• Type 2 DM
• PCOS
• Psuedotumor Cerebri

*every organ system is affected

Question 9

Obstructive Sleep Apnea

Answer 9

snoring most nights, poor sleep, AM HA, fatigue

Question 10

Obesity Hypoventilation

Syndrome

Answer 10

Obese–> restrictive lung disease

==> Right heart failure, hypoxemic

s/s: Dyspnea, edema, somnolence

Question 11

What explains most childhood obesity demos

Answer 11

SES is the most important

Maternal Education most important SES predictor

Question 12

Polycystic Ovarian Syndrome (PCOS)

Answer 12

Two of three: 1.hyperandrogenism

2.oligomenorrhea

3.polycystic ovaries;
insulin resistance; risk of infertility and endometrial cancer

Question 13

Hypothyroid

Answer 13

asc with poor growth

cold intolerance, decline in school performance, coarse features, thin hair

Question 14

Pseudotumor Cerebri

Answer 14

Headaches (severe, recurrent)
often worse in AM or supine

-Papilledema, peripheral vision loss

Rare

Question 15

Can occur with rapid weight loss

Answer 15

Gallstone

Question 16

Are kid’s gonna “grow out of it”

Answer 16

only 1 in 10 will grow out of obesity

1:5 maybe

Question 17

What do you think of acanthosis nigricans

Answer 17

It is thick dark skin

It is the only external sign of DM

Insulin looks like a growth hormone for melanin, it makes AN

Moderate ↓ in BMI will ↓ AN

Question 18

PCOS in kids

Answer 18

kids wont have the cysts on US

Question 19

FAtty liver disease

Answer 19

10-25% obese will have this

Question 20

progressive left knee and groin pain for the past week. It is worse with activity. You notice she limps with her foot externally rotated. Passive range of motion of the hip is painful

Answer 20

Slipped Capital Femoral Epiphysis

More likely to progress to bilateral disease in obese

Weight managment emergency

Lost one hip, may lose another hip

Question 21

Blount’s

disease

Answer 21

Stress injury to medial tibial growth plate, often painless

Bowed legs, + knee pain

Potentially Disabling

Question 22

Medical Assessment – Obese Child

Answer 22

plot yearly
access diet and FH
ROS
PE

Labs:

• Lipids
• Glucose, A1C
• ALT

2-10yrs if severely obese or +Fam Hx early CAD
Otherwise start labs after age 10 yrs or Tanner 2

Question 23

Treatment for Childhood Obesity

Answer 23

Start early 
-5 fruits and vegetables
-2 hrs of TV or less
-1 hr of activity
-0 sugary beverages
start with 1-2 things