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Child Health > Overweight and Obesity in Childhood > Flashcards

Overweight and Obesity in Childhood Flashcards

1
Q

What is the definition of overweight?

A

Abnormal or excessive fat accumulation that may impair health

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2
Q

What does overweight and obesity result from?

A

Long term positive energy imbalance = energy intake exceeds energy output

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3
Q

What would ideally be measured to assess being overweight?

A

Body fat = use weight as proxy instead

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4
Q

Why is BMI useful?

A

Corrects body weight for height of individual = healthy range changes with age and is different for boys and girls

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5
Q

Why is growth in height not always a useful measure?

A

Not always matched by weight and girls have their growth spurt earlier than boys

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6
Q

How is BMI plotted for children aged from 2-18 years?

A

Plotted against age on centile chart appropriate for gender = shows expected distribution of BMI values for children of that age and gender

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7
Q

What are the population thresholds for overweight and obesity?

A 
>= 85th centile is high risk for overweight
>= 95th centile is high risk of obesity
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8
Q

What are the clinical thresholds for overweight and obesity?

A

> = 95th centile is overweight

>=98th centile is clinically obese

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9
Q

At what age is BMI used to assess if a child is overweight?

A

From age 2 = able to measure height accurately

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10
Q

How is overweight and obesity assessed in children younger than two years old?

A

Use BMI conversion chart to provide an approximate BMI centile

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11
Q

Why is weight circumference not routinely measured?

A

No evidence that it improves diagnosis of body fatness or cardiometabolic risk factors = should not be used to diagnose overweight and obesity

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12
Q

What are some risk factors for a child being overweight by three years old?

A

Parental overweight, black ethnicity, greater birthweight, smoking during pregnancy, lone motherhood, pre-pregnancy overweight, maternal employment >= 21hrs/week, solid foods before 4 months

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13
Q

What is protective against obesity?

A

Breastfeeding >= 4 months

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14
Q

How do babies with Prader-Willi syndrome present at birth?

A

Very floppy, absent or weak ability to suck, tube feeding common

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15
Q

What is hyperphagia?

A

Food seeking and lack of satiety after eating

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16
Q

How do children with Prader-Willi present?

A

Hyperphagia, reduced energy requirements due to low muscle tone, learning difficulties, hypogonadism, short stature

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17
Q

What are some symptoms and signs of Bardet-Biedl syndrome?

A

Visual impairment, renal abnormalities, polydactyly, learning difficulties, hypogonadism, obesity, hyperphagia

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18
Q

Is obesity seen as a child protection issue?

A

Yes = its seen as a form of neglect and children may be taken away from their parents if there is a risk to their health

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19
Q

What kind of approach has had the best effect of reducing BMI?

A

Combined dietary, physical activity and behavioural programmes are shown to significantly and clinically relevantly decrease BMI

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20
Q

How are children clinically assessed for overweight and obesity?

A

BMI (plot on centile chart), social and school history, eating habits, physical activity patterns, screen time, emotional/psychological issues, family support, stature of close family, family history (diabetes, obesity)

21
Q

What co-morbidities are children who are overweight or obese assessed for?

A

Metabolic syndromes, respiratory problems, hip and knee problems, diabetes, CHD, sleep apnoea, hypertension

22
Q

Why might a child be referred for paediatric review because of their weight?

A

Serious obesity related morbidity that needs weight loss
Children suspected of underlying medical cause
Children < 24 months who are severely obese (BMI >=99.6th centile)

23
Q

What are some obesity related morbidities that children may need a referral for?

A

Benign intracranial hypertension, sleep apnoea, orthopaedic problems

24
Q

What are the treatment goals for overweight or obese children?

A

Overweight and obese children = weight maintenance

Severely obese children = maximum weight loss of 0.5-1kg per month

25
Q

What are free sugars?

A

Added to foods plus those naturally present in fruit juices, syrups and honey

26
Q

What is the recommended intake of sugar for children?

A

Age 4-6 = 19g/day (5 cubes)
Age 7-10 = 24g/day (6 cubes)
Age >11 = 30g/day (7 cubes)

27
Q

What are the recommendations about free sugars?

A

Account for <= 5% daily dietary energy intake

28
Q

Where do most free sugars come from?

A

In children aged 11-18, 1/3 of free sugars come from fruit juice and soft drinks

29
Q

What effect does portion size have on food intake?

A

People exposed to larger portion sizes consume more food = consistently select larger quantities of food when given larger plates

30
Q

What is some advice for families regarding portion size?

A

Use smaller plates, have parents serve meals rather than children, cook only required quantity, use age appropriate portions

31
Q

What are the recommendations for physical activity in children < 5 years old who aren’t self-mobile yet?

A

Encourage activity through floor-based play and water-based activities

32
Q

How much physical activity should self-mobile children <5 years old get?

A

At least 180 mins spread throughout the day

33
Q

What is the association between sedentary behaviour and obesity?

A

> 2hrs sedentary behaviour per day is associated with significantly increased risk of overweight and obesity

34
Q

Why does increased screen time lead to obesity?

A

Eating energy dense foods while watching TV, exposure to food advertising/product placement, reduced or disrupted sleep

35
Q

What are some behavioural strategies?

A

Self-monitoring
Goal setting = use to plan gradual behaviour changes
Contracting = appropriate rewards for achieving goals
Stimulus control = environment aids goal achievement
Relapse prevention

36
Q

What is self monitoring important for?

A

Essential for setting goals, assessing progress and rewarding success

37
Q

How can relapse be prevented?

A

Use problem solving to deal with new challenges

Plan ahead for potentially difficult situations

38
Q

What are some parenting strategies?

A

Modelling of positive behaviours (set example for child)
Change environment and make reasonable demands
Effective praise = consistent, specific and timely
Reward good behaviour and ignore “bad behaviour”

39
Q

How does Orlistat work?

A

Inhibits gastric and pancreatic lipase to reduce absorption of dietary fat

40
Q

What are the GI side effects of Orlistat?

A

Oily stools, faecal urgency, nausea, abdominal pain

41
Q

How should Orlistat be prescribed initially?

A

6-12 moth trial in specialist clinic with regular reviews

42
Q

What children would be suitable for Orlistat prescription?

A

Adolescents with very severe to extreme obesity (BMI >= 3.5SD above median) or severe obesity (BMI >= 99.6th centile) with co-morbidities

43
Q

In what age group is Orlistat not recommended in?

A

Children <12 years old = only prescribed if there are life threatening co-morbidities

44
Q

What are some surgical options for treatment of overweight or obese children?

A

LAGB, RYGB, LSG

45
Q

How does a LAGB work?

A

Acts like a belt around the top of the stomach to create a small pouch thus limiting amount of food eaten

46
Q

What is done in a RYGB?

A

Top section of stomach divided off by staples to form small pouch = new exit from stomach made into Y loop from small intestine so food bypasses old stomach and part of small intestine

47
Q

What happens in a LSG?

A

Stomach is divided vertically in two from top to bottom to reduce size of stomach by about 75%

48
Q

What are some complications of weight loss surgery?

A

Nutrient deficiencies, hernias, wound infection, small bowel obstruction, cholelithiasis

49
Q

What children would be eligible for weight loss surgery?

A

Post pubertal adolescents with very severe to extreme obesity and severe co-morbidities

Child Health (27 decks)

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