Pediatric Overweight and Obesity Flashcards
Obese childhood
over the 95%
95% specific, 75% sensitive for excess adiposity
Overweight childhood
85-95%
50% specific for excess adiposity
Severe obese kids
> 99%
Kids to be concerned about
kids moving up the chart rapidly
When should a kid be there thinnest
5-6 yo
Meant to be very thin
so many kids going off the top of the growth chart. How do you eval them?
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
Avoidable health risks for obese kids 11 yrs–> 30-40 yrs
Obese kids who stay obese ↑ risk for:
Type 2 DM
HTN
Atherosclerosis
Complications of childhood obesity
- Self esteem, depression, eating disorder
- sleep apnea, asthma
- Gallstones
- Glomerulosclerosis
- Type 2 DM
- PCOS
- Psuedotumor Cerebri
*every organ system is affected
Obstructive Sleep Apnea
snoring most nights, poor sleep, AM HA, fatigue
Obesity Hypoventilation
Syndrome
Obese–> restrictive lung disease
==> Right heart failure, hypoxemic
s/s: Dyspnea, edema, somnolence
What explains most childhood obesity demos
SES is the most important
Maternal Education most important SES predictor
Polycystic Ovarian Syndrome (PCOS)
Two of three: 1.hyperandrogenism
2.oligomenorrhea
3.polycystic ovaries;
insulin resistance; risk of infertility and endometrial cancer
Hypothyroid
asc with poor growth
cold intolerance, decline in school performance, coarse features, thin hair
Pseudotumor Cerebri
Headaches (severe, recurrent)
often worse in AM or supine
-Papilledema, peripheral vision loss
Rare
Can occur with rapid weight loss
Gallstone
Are kid’s gonna “grow out of it”
only 1 in 10 will grow out of obesity
1:5 maybe
What do you think of acanthosis nigricans
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
PCOS in kids
kids wont have the cysts on US
FAtty liver disease
10-25% obese will have this
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
Slipped Capital Femoral Epiphysis
More likely to progress to bilateral disease in obese
Weight managment emergency
Lost one hip, may lose another hip
Blount’s
disease
Stress injury to medial tibial growth plate, often painless
Bowed legs, + knee pain
Potentially Disabling
Medical Assessment – Obese Child
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
Treatment for Childhood Obesity
Start early -5 fruits and vegetables -2 hrs of TV or less -1 hr of activity -0 sugary beverages start with 1-2 things
