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DEMS unit 3 > Childhood obesity > Flashcards

Childhood obesity Flashcards

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1
Q

Define Childhood weight status

A

BMI 85-94th % = overweight
BMI >95% = obese
BMI > 99th% or >120%of 95th percentile = severe obesity

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2
Q

describe demographics of obesity epidemic

A

about 4% of S population severely obese

  • 18% US children ages 2-19 are obese
  • 20% overweight or obese
  • prevalence tripled since 1980s but plateua last 10 years
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3
Q

Avoidable health risks in obese children who go on to remain obese as adults

A

Type II DM, HTN, Carotid atherosclerosis, arthritis, colon/breast cancer

  • also issues with sports, energy, confidence, clothing
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4
Q

cutoff for severe obesity

A

99th percentile of BMI

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5
Q

“obese” definition using BMI

A

> 95th percentile

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6
Q

Alternative “Severe Obesity” Chart

A

recalculated the BMI so that severely obese children can still be tracked on growth chart. It’s a function of what percentage of 95th percentile of BMI for age .

  • BMI >120% of 95th percentile BMI for age = severely obese
  • closely approximates 99th percentile
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7
Q

what age is a kid at their skinniest weight

A

5-6 years old

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8
Q

BMI charts

A

CDC and WHO charts available. CDC mostly used in US. Should show a dip around age 5-6 before gaining weight

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9
Q

underweight BMI

A
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10
Q

healthy BMI

A

5-85th percentile

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11
Q

overweight BMI

A

85-95th percentile for kids over age 2; >95th percentile for under age 2

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12
Q

obese BMI

A

> 95th percentile; excess adiposity

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13
Q

severely obese

A

> 99th percentile

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14
Q

higher prevalence groups

A

older children –> adolescents, native american, BLack, Latino, Low SES (explains much of race/ethnicity variation)
- maternal Education most important SES predictor

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15
Q

Psychosocial complications

A

poor self esteem, depression, eating disorders

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16
Q

pulmonary complications of obesity

A

sleep apnea, asthma, exercise intolerance

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17
Q

GI complications

A

gallstones, steatohepatitis

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18
Q

renal complications

A

glomerulosclerosis

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19
Q

MSK complications

A

slipped capital femoral epiphysis, Blount’s disease, forearm fracture, flat feet

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20
Q

CV complications

A

dyslipidemia, HTN, coagulopathy, chronic inflammation, endothelial dysfunction

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21
Q

what test to look at kid worried about chronic obstructive sleep apnea

A

B natriuretic peptide

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22
Q

endocrine complications

A

TIIDM, precocious puberty, polycystic ovary syndrome (Girls), hypogonadism (boys)

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23
Q

rate of sleep apnea in obese kids

A

13-33% youth

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24
Q

diagnose sleep apnea

A

polysomnogram

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25
will kids grow out of their obesity
80-90% remain obese as adults
26
cutoff for severe obesity
99th percentile of BMI
27
"obese" definition using BMI
> 95th percentile
28
Alternative "Severe Obesity" Chart
recalculated the BMI so that severely obese children can still be tracked on growth chart. It's a function of what percentage of 95th percentile of BMI for age . - BMI >120% of 95th percentile BMI for age = severely obese - closely approximates 99th percentile
29
what age is a kid at their skinniest weight
5-6 years old
30
BMI charts
CDC and WHO charts available. CDC mostly used in US. Should show a dip around age 5-6 before gaining weight
31
Depression/Anxiety
can lead to highly prevalent, improve with obesity tx | - may lead to worsening obesity if untreated
32
higher prevalence groups
older children --> adolescents, native american, BLack, Latino, Low SES (explains much of race/ethnicity variation) - maternal Education most important SES predictor
33
when to start labs on obese child
after 10 years or Tanner stage 2 unless severely obese or + Fam Hx of early CAD
34
pulmonary complications of obesity
sleep apnea, asthma, exercise intolerance
35
GI complications
gallstones, steatohepatitis
36
renal complications
glomerulosclerosis
37
what test to look at kid worried about chronic obstructive sleep apnea
B natriuretic peptide
38
endocrine copmlications
TIIDM, precocious puberty, polycystic ovary syndrome (Girls), hypogonadism (boys)
39
rate of sleep apnea in obese kids
13-33% youth
40
diagnose sleep apnea
polysomnogram
41
obesity hypoventilation syndrome
severe obesity with restrictive lung disease; may lead to right heart failure. Hypoxemic respiratory drive - may see dyspnea, edema, somnolence
42
will kids grow out of their obesity
80-90% remain obese as adults
43
acanthosis nigricans
thick, dark skin - only external sign that kid is at increased risk of developing TIIDM - tells us he is consuming more energy, esp carbs - high insulin (looks like growth hormone) so it makes skin grow thicker and darker particularly in areas with folds
44
Impaired glucose tolerance in kids
2 hr OGGT 140-199
45
elevated fasting glucose in kids
100-125
46
T2DM in kids
fasting glucose >/= 126, 2hr OGGT/postprandial >200 HgA1c >6.5
47
Polycystic ovarian Syndrome (PCOS)
Have 2 of the following - hyperandrogenism + - oligomenorrhea +/- - polycystic ovaries; insulin resistance; risk of infertility and endometrial cancer
48
PCOS symptoms
oligomenorrhea (
49
do you need transvaginal US for diagnosis of PCOS in obese teen girls
NO
50
hypothyroid sxs
cold intolerance, decline in school performance, coarse features, thin hair
51
neuro complications
pseudotumor cerebri
52
slipped Capital Femoral epiphysis (SCFE)
when ball of femur separating from neck at growth plate; more likely to progress to bilateral dz in obese
53
NAFLD
10-25% obese youth; elevated ALT - steatohepatitis --> fibrosis --> cirrhosis commonly asymptomatic
54
Gallstones
can occur with rapid weight loss
55
constipation/encopresis
due to low fiber diet
56
Blounts Disease
stress injury to medial tibial growth plate, often painless - see bowed legs +/- knee pain; potentially disabling
57
Depression/Anxiety
- highly prevalent, | - may lead to worsening obesity if untreated
58
Medical Assessment
- Plot BMI annually >2 years old - assess diet/activity and fam hx for CVD and obesity risk factors - ROS for comorbidities - PE - Labs: lipids, glucose/HgA1c, ALT (2-10 years if severely obese or + fam hx early CAD; otherwise start labs after 10 yrs or Tanner 2)
59
when to start labs on obese child
after 10 years or Tanner stage 2 unless severely obese or + Fam Hx of early CAD
60
Key factors assd with obesity
sweetened beverages, fruit/veggie intake, energy dense foods (processed), restaurant meals, large portion sizes, frequency of eating
61
Key activity factors
physical activity (60 min per day), sedentary time (
62
meds for pediatric obesity
orlistat
63
Orlistat efficacy
only about 5% weight loss
64
Fam hx assessment in 1st degree relatives
severe obesity (single gene disorders rare), CV dz risk factors (DM, MI, HTN, Hyperlipidemia), hypothyroidism, psych issues (eating disorders)
65
Treatment basics
involve family, clean up home environment, negotiate 1--2 specific changes, make a plan to monitor change
66
plans to monitor change
increase awareness, accountability between parent-child and family-MD, positive feedback, planned rewards for success (doing something fun)
67
Main idea of motivational interviewing
elicit change talk and perceived empathy
68
Pseudotumor Cerebri
papilledema, peripheral vision loss possible - consult neuro/pohtho RARE - may have severe, recurrent headaches often worse in morning

DEMS unit 3 (9 decks)

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