Obesity

Question 1

Define obesity and overweight

Answer 1

Obesity = BMI >98th centile
Overweight = BMI >91st centile

Question 2

What are the causes of obesity

Answer 2

Lifestyle and overnutrition: large portion size, sedentary lifestyle, eating disorder, MHx
Endocrine: hypothyroidism, Cushing’s syndrome, PCOS, Diabetes mellitus, GH deficiency
Prader-Willi syndrome
Down’s syndrome
Laurence-Moon-Biedl
Leptin deficiency (<3yo and severely obese)

Question 3

When does the National Child measurement programme measures height and weight

Answer 3

Reception (4-5)
Year 6 (10-11)

Question 4

What investigations should be done for obesity

Answer 4

Growth chart plotting
- BMI percentile adjusted for age and gender (MOST ACCURATE to ascertain the degree of obesity)
Nutritional assessment (BMI, Triceps skinfold thickness)

Bedside: Urine dip (?glycosuria)
Bloods: Lipid, TFTs, GH, steroids

Others: US/CT/MRI head for OSA, polysomnography

Question 5

What is the management for obesity

Answer 5

Any complications → specialist paediatric assessment
Endogenous cause suspected → specialist paediatric assessment (paediatric endocrinologist)

Lifestyle changes:
Healthier eating (regular, eat as family, low glycaemic index, increase fruit/veg, drink water, reduce sugary drink)
Physical activity (at least 60mins every day)
Screen time/sedentary (limit TV and small screen <2 hours, encourage to monitor activity)
Behaviour changing strategies (Positive parenting skills training, including problem-solving skills, encouraging all members to eat healthily)

± psychology support

Question 6

What is glycaemic index

Answer 6

ranking of carbohydrate-containing foods based on the overall effect on blood glucose level
Slowly absorbed foods have a high glycaemic index and rapidly absorbed foods have a lower index.

Question 7

What pharmacological options can be considered for childhood obesity

Answer 7

Considered for children >12yo who have physical co-morbidities OR severe psychological problems

First line: Orlistat (Lipase inhibitor, reduces absorption of fat)
Second line: Bariatric surgery
Considered for those who have achieved or nearly achieved maturity | BMI >40 | BMI 35-40 + complications | All other interventions have failed | fit for anaesthetic and surgery | can commit to a long-term follow up

± psychology support

Question 8

What are the complications of obesity

Answer 8

Orthopaedic - SUFE, tibia vera (bow legs), abnormal foot structure and function
Hypoventilation syndrome (daytime somnolence, sleep apnoea, snoring, hypercapnia, heart failure)
GI: NAFLD, Gall bladder disease/gallstones
PCOS
T2DM
Hypertension
Abnormal blood lipids
Asthma
Increased risk of malignancy: breast, endometrial, colon
Psychological: low self-esteem, teasing, depression
Metabolic syndrome: insulin resistance, atherogenic dyslipidaemia

Question 9

What is the prognosis for childhood obesity

Answer 9

Diet and exercise leads to 10% in body weight in short term but relapse in >50%
Bariatric surgery has best efficacy
Likely to be obese in adulthood
Significant risk of atherosclerosis if metabolic syndrome X
Increasing incidence of T2DM