MMT: childhood obesity

Question 1

Describe childhood obesity generally

Answer 1

Most common chronic and progressive childhood disease

Question 2

What is true of the likelihood of having adult obesity if you have childhood obesity

Answer 2

5x more likely to have adult obesity

Question 3

What part of the brain tells us when we’re full

Answer 3

Prefrontal cortex

Question 4

When do we start to discuss healthy eating with families

Answer 4

After infancy (1st year of life)

Question 5

What are some protective preventions of obesity

Answer 5

Home cooked meals, eating as a family, daily breakfast, encouraging physical activity in toddlerhood, removing screens from sleeping areas

Question 6

What do we do as an immediate pediatric obesity intervention

Answer 6

Early referral to intensive health behavior and lifestyle treatment; it is recommended the child has over 26 hours of behavioral intervention over 12 months!

Question 7

What is the recommendation as far as BMI reduction following intervention in pediatric obesity

Answer 7

3% reduction in 1 month, predicted 5% in one year

Question 8

Following lifestyle intervention, what are other steps for treating pediatric obesity

Answer 8

Pharmacotherapy followed by surgical options

Question 9

How can doctors help reduce weight stigma in visits

Answer 9

Using neutral language; for example, labelling visits as nutrition visits as opposed to weight checks

Question 10

What is a tool we can use to discuss changes related to obesity risk with parents

Answer 10

Motivational interviewing and setting SMART goals

Question 11

What are SMART goals

Answer 11

Goals that are specific, measurable, attainable, relevant, and time-based

Question 12

Describe GLP-1 agonists (-glutide)

Answer 12

Medications used to treat pediatric obesity that enhance insulin secretion, depress glucagon, slow gastric emptying, and overall enhance satiety

Question 13

Describe phentermine

Answer 13

A norepi reuptake inhibitor that modules GABA receptors and is used to treat pediatric obesity

Question 14

Describe orlistat

Answer 14

Intestinal lipase inhibitor that blocks fat absorption

Question 15

Describe setmelanotide

Answer 15

A melanocortin4 receptor agonist that can be used in leptin receptor or POMC deficiency as well as Bardet Biedl syndrome

Question 16

How does bariatric surgery lead to weight loss

Answer 16

Restricts amount of food the stomach can hold, leads to malabsorption of (excess) nutrients, and helps change the neurohormonal response that regulates hunger

Question 17

A gastric sleeve procedure produces __% weight loss

Answer 17

60%

Question 18

RYGB procedure produces ___% weight loss

Answer 18

70%

Question 19

What are some post-surgery nutrient considerations

Answer 19

Risk of B12, iron deficiencies, anemia, and bone mineral density loss

Question 20

What are contraindications to bariatric surgery

Answer 20

Medically correctible causes, substance abuse in the preceding year, conditions preventing post-op dietary medication regimens, pregnancy

Question 21

What do guidelines say about treating obesity and comorbidities

Answer 21

Treat them all at the same time!

Question 22

What are some major comorbidities with pediatric obesity

Answer 22

HTN, T2DM, dyslipidemia, fatty liver disease, OSA, PCOS

Question 23

How do we measure HTN in kids less than 13

Answer 23

Percentiles!

Question 24

What is normal BP in kids

Answer 24

Less than 90th percentile

Question 25

What is elevated BP in kids

Answer 25

90-95th percentile

Question 26

What is stage 1 HTN in kids

Answer 26

Above 95th percentile or 95th percentile +12 mmHg

Question 27

What is stage 2 HTN in kids

Answer 27

Above 95th percentile +12 mmHg

Question 28

When do we start screening for T2DM

Answer 28

Start at 10 or onset of puberty and repeat every 3 years

Question 29

What is needed for diagnosis of diabetes in kids

Answer 29

random glucose over 200, fasting glucose over 126, HbA1c over 6.5

Question 30

What are guidelines for screening for dyslipidemia

Answer 30

screen all kids 9-11 and 17-21. Screen kids over 2 if the BMI is over 95th percentile

Question 31

What are risk factors for early CVD

Answer 31

premature CAD, dyslipidemia, HTN requiring medication, smoker, obesity

Question 32

A pediatric patient has LDL 130-159. What do you do

Answer 32

start statin if there are 2 risk factors for CVD

Question 33

A pediatric patient has LDL 160-189. What do you do

Answer 33

statin if family history of premature CVD, 1+ risk factors or 2+ moderate risk factors

Question 34

A pediatric patient has an LDL of 190-249. What do you do

Answer 34

start a statin

Question 35

Describe depression and obesity

Answer 35

pediatric patients with obesity are 30% more likely to develop depression, even higher in females

Question 36

Who do we screen for depression

Answer 36

all adolescents 12 and up

Question 37

What is SCFE

Answer 37

stress on the growth plate from obesity causes it to slip and displace the femoral head

Question 38

What is blount disease

Question 39

Describe idiopathic intracranial HTN

Answer 39

often in females with obesity, presents with tinnitus, headache, visual changes, papilledema

Question 40

What tool do we use to screen for obesity

Answer 40

BMI; it is a starting point

Question 41

Define overweight BMI status in kids

Answer 41

85th-95th percentile BMI

Question 42

Define class I obesity in kids

Answer 42

95th percentile to 120% of the 95th percentile BMI

Question 43

Define class II obesity in kids

Answer 43

120-140% of the 95th percentile BMI

Question 44

Define class III obesity in kids

Answer 44

More than 140% of the 95th percentile BMI

Question 45

What screening tool do we use if the child is under 2

Answer 45

Weight-for-length. Very similar to BMI

Question 46

What weight-for-length is concerning for obesity risk

Answer 46

Over 97th percentile

Question 47

What labs do we get for pediatric obesity

Answer 47

CMP, HbA1c, lipid panel, maybe TSH, genetic testing