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Pediatric Primary Care Exam 4 > Obesity > Flashcards

Flashcards in Obesity Deck (39):

Obesity Facts (3)

1. Increased prevalence of overweight children and families in the U.S.

2. Obesity now affects 18% of all children ages 6-11 years

3. Adolescents obesity has increased to nearly 21%


Obesity Contributing Factors (8)

1. Working families

2. Decrease in family income

3. Scholastic pressure on children today

4. Sedentary activities (gaming)

5. Food availability

6. Eating patterns

7. Media

8. Ethnic diversity


Childhood obesity prevalence (6)

1. Remains high→ Has remained fairly stable at about 17% in youth in the United States

2. More than doubled in children and quadrupled in adolescents

Significant racial and age disparities among children
3. Hispanic children - 21.9%
4. Non Hispanic Black – 19.5%
5. Non Hispanic White – 14.7%
6. Asian – 8.6%


How is obesity measured?



BMI (5)

1. BMI is a measure to determine childhood overweight and obesity

2. Calculated using weight and height
*Weight in pounds/height in inches/height in X 703

3. BMI is an indicator of body fatness – it does not measure body fat directly

4. BMI levels correlate with body fat

5. Plot using age and sex specific percentile charts for children; CDC Growth charts


Definition of Overweight

Defined as a BMI at or above the 85th percentile and lower then the 95th percentile (85th to 94th%) compared to children of the same age and sex


Definition of Obesity (4)

1. Defined as a BMI at or above the 95th percentile for children of the same age and sex OR BMI > 30kg/m2 whichever it lower

2. Weight for height is > 95%

3. Greater than the 99th % severe obesity

4. Values for children < 2 years of age BMI normative values are not available


How do you measure for birth-23 months?

Should be monitored and plotted on WHO normative growth charts at every health care visit


How do you measure for 2-19 year olds? (3)

1. CDC growth charts used to determine the corresponding BMI for age and sex percentile
*Children and adolescents 2yr-19yrs

2. BMI does not directly measure body fat

3. High BMI predicts future adiposity and morbidity
*Good indicator of body composition


Definition of underweight

<5% BMI


Definition of healthy weight

BMI 5%-84%


obesity epidemiology (4)

1. Prevalence of obesity is on the rise in developed countries

2. Hispanics, African-Americans and Native Americans are disproportionately affected

3. Lower education and higher poverty levels = greatest risk

4. Prevention and Treatment of obesity critical to avoid health risks


Obesity Clinical Presentation (2 scenarios)

Usually present to provider in 2 scenarios:
1. Parents concerned “overweight” or “will become overweight”

2. Parents do not recognize that their child is overweight (more common because perceived as big=healthy)
*Lack of awareness
*Parents do not know risks


Pathophysiology of obesity (4)

1. Evolving and the risk factors are multifactoral

2. Neurohormones affect appetite, satiety, and balance between fat storage and energy production

3. Obesity results when energy intake exceeds expenditure

4. Excess calories stored = obesity


Enivornmental pathophysiology of obesity (6)

1. Obseogenic environment- facilitates unhealthy behaviors

2. Interact with genetics and lead to increase % of obese children

3. Easily accessible calorically dense, large portion foods

4. Less physical activity – sedentary lifestyle

5. Safety concerns with outdoor activity

6. TV, Video games and school pressure


Dietary assessment of obesity

24 hour recall, food frequency questionnaires


Ways to assess obesity (5)

1. 24 hour dietary recall

2. Target problem behaviors
*Fast food, sugary drinks, large portion size
*These should be decreased/eliminated

Explore the following
3. TV time, screen time, type and freq of physical activity, routine activity
*Want screen time to be decreased and physical activity to increase

4. Assess family history for risk
*Parental weight status, DM and hyperlipidemia

5. Look at Social and environmental barriers


ROS with obesity (7)

1. Abdominal pain
3. Joint pain
4. Sleep disorders
5. Skin
6. Menstrual disorders (androgen excess PCOS)
7. Mental health


Obesity Mental Health Comorbidities (4)

1. Younger children – body weight is not associated with self esteem

2. Older children – more likely to have poor self-esteem, poor emotional and social functioning

3. Bullying (cyber and face-to-face)

4. Depression and suicide risks
*Poor school performance


Combatting Obesity Recommendations (4)

1. Decrease sugary drinks completely
*Drink water and low fat milk

2. Decrease screen time

3. Decrease/eliminate fast foods

4. Physical activity


Obesity Physical Exam (7)

1. Plotting growth parameters on a BMI chart
*Over the age of 2 years old at every well child visit

2. Waist circumference is a better estimate of visceral adipose tissue
*Better prediction of Insulin resistance, BP, increased cholesterol

3. Examine for dysmorphic features – underlying genetic syndromes

4. Assess for potential complications of obesity
*HTN, hyperlipidemia, type 2 DM, nonalcoholic fatty liver disease, orthopedic problems (SCFE), bullying, depression, academic and social problems

5. Skin
*Examined for striae, acanthosis nigricans = Insulin resistance in children
*Hirsutism, acne = PCOS in females

*Joint alignment, ROM = SCFE or Blount disease

*Tanner staging = for premature puberty


What are some potential complications of obesity to look for in PE? (7)

1. HTN
2. hyperlipidemia
3. type 2 DM
4. nonalcoholic fatty liver disease
5. orthopedic problems (SCFE)
6. bullying
7. depression
8. academic and social problems


Obese 12 year old with constant hip and knee pain?

Differential should include SCFE or Blounts


Obese girl with agrican nicrothans?

differential includes insulin resistance or PCOS in females


Metabolic Syndromes Cluster of Traits with Obesity (4)

1. Hyperinsulinemia
2. Obesity
3. HTN
4. Hyperlipidemia

*The higher the BMI=the higher the risk for metabolic syndromes


When do you start labs? (3)

1. Labs are recommended to evaluate for potential complications of obesity

2. Starting at 10 years – or before if there are specific concerns

3. If there are concerns
-Severe obesity
-Strong family history of type 2 DM
-Strong family history of hyperlipidemia


Labs for Obesity (2)

1. Fasting glucose and fasting lipid panel

2. HgA1c
> 10 years with BMI > 95th %
Or BMI > 85th% with risk factors


What labs do you do if BMI is 85-94th percentile and child is over or equal to 2 years old?

fasting lipid panel repeated every 2 years


What labs do you do if BMI is equal to or greater than 95th percentile and child is 10 years or older? (3)

1. fasting lipid panel
2. fasting glucose
3. AST and ALT (repeat q2years)


Endocrinology tests to do with obesity

1. Thyroid function studies
2. Consult as needed
3. Only refer to endocrinology if there are abnormalities in labs or if there is poor linear growth; outside of that then manage in the office


Referrals to make with obesity (3)

1. Endocrine if poor linear growth or abnormal labs

2. Ortho if pain with hips, knees, etc.

3. Imaging studies if ortho has concern about the obesity


Management of obesity (9)

1. Identify risk factors early

2. Promote healthy behaviors

3. Assess family history and parental behaviors

4. Children (between the ages of 3yr-5yrs) of obese parents are at greater risk for future obesity
*Close surveillance and intervention

5. Motivational Interviewing

6. Eating and activity plans

7. Community Resources

8. Weight loss programs

9. Bariatric surgery centers


Stage 1 for treatment of obesity

Prevention plus initial treatment
*Behavioral strategies, eating and activity based


Stage 2 for treatment of obesity (4)

1. If no improvement in 3-6 months after stage 1 started
2. STRUCTURED weight management started
3. Targeted goals for eating, activity, and decreasing sedentary time
4. Self-monitoring important


Stage 3 for treatment of obesity (2)

1. if no improvement within 3-6mths after stage 2
2. Comprehensive, multidisciplinary management in pediatric weight management center ideal


Stage 4 for treatment of obesity (5)

1. (BMI > 99th% or severe comorbidities)
2. Tertiary care intervention in a facility
3. Oversees more targeted medical weight loss
4. Possible surgical approaches (>14 years of age)
5. In patient program/much closer observation and structure


Suggestions for All (9)

1. Drink more water
2. Decrease/eliminate sugar beverages
3. Decrease frying food
4. Shop the perimeter of the grocery for healthier choices
5. Portion size – size of your fist
6. Eat more vegetables
7. Limit fast foods
8. Limit TV to 2 hours a day (max)
9. Increase physical activity daily movement


PCP Goals to reduce BMI (5)

Focus on assisting with behavior and lifestyle modifications...
1. Sustainable and healthy eating
2. Physical activity
3. Not disordered eating/inappropriate body image
4. Slow weight gain

5. More advanced weight loss – but slow
A. 2- 5yrs of age = not more than 1 lb per month
B. > 5yrs = 2 lb per month
*We want slow and steady! Slow and steady wins the race; don’t want a lot of jumps because it is more difficult to maintain


PCP Actions (9)

1. Individualize care and plan for each child

2. Involve the family

3. Access community resources

4. Support groups

5. Activity centers after school

6. ***Apps for Smartphones
a. Set goals and send reminders
b. Help with ‘eating out’
c. Don’t feel socially isolated

7. Motivational Interviewing techniques

8. Family based behavioral treatment plans work best

9. Support and encourage