Pediatric Obesity and Weight Management

Question 1

What are the weight classifications for children 2-20 years old?

Answer 1

Based on body mass index (BMI) for age and gender

Overweight: 85th-94th percentile

Obese: > 95th percentile

Question 2

Obesity is more commonly found in?

Answer 2

Hispanics

Non-Hispanic black

Question 3

What are barriers for screening for obesity?

Answer 3

Training, time, and resources

Question 4

How often should BMI be checked?

Answer 4

At least annually.

Question 5

What should be looked at to identify abnormal weight gain and growth abnormalities?

Answer 5

Growth trends rather than single data points.

Question 6

What factors are determined in the assessment to better help determine treatment?

Answer 6

Medical risk (child history and exam, growth, parental obesity, family history)

Behavior risk (physical activity, eating, sedentary time)

Attitudes (family and patient concern and motivation)

Question 7

What is Stage 1 of treatment?

Where does this take place?

Answer 7

Prevention Plus

Primary care office

Question 8

What is Stage 2 of treatment?

Where does this take place?

Answer 8

Structured Weight Management

Primary care office with support

Question 9

What is Stage 3 of treatment?

Where does this take place?

Answer 9

Comprehensive Multidisciplinary Intervention

Pediatric weight management center

Question 10

What is Stage 4 of treatment?

Where does this take place?

Answer 10

Tertiary Care

Tertiary care center

Question 11

If child has a BMI >95th percentile, where do the start their prevention?

Answer 11

Begin with Stage 1 treatment

Question 12

If child has a BMI 85th-94th percentile, where do they start their prevention?

Answer 12

Depending on the assessment…

If NO evidence of health risk, they will work on targeting identified behaviors.

If evidence of health risk, they will begin at Stage 1 treatment.

Question 13

What is the focus of each treatment stage?

What interventions does each treatment stage use?

Answer 13

Stages 1-3: targets behavior strategies to change eating and activity behaviors.

Examples: goal setting, self-monitoring, incentives to promote healthy lifestyle changes

Stage 4: intensive interventions

Examples: pharmacotherapy, bariatric surgery

Question 14

What is the weight goal for patients aged 2-5 with BMI in the below categories?

BMI 5th-84th percentile (with no health risks)
BMI 85th-94th percentile (with health risks)
BMI >95th percentile

Answer 14

BMI 5th-84th percentile - weight velocity maintenance, begin prevention counseling

BMI 85th-94th percentile - weight maintenance or slow weight gain, begin Stage 1

BMI >95th percentile - weight maintenance OR weight loss of up to 1 lb./month, begin Stage 1

Question 15

What is the weight goal for patients aged 6-11 with BMI in the below categories?

BMI 5th-84th percentile (with no health risks)
BMI 85th-94th percentile (with health risks)
BMI 95th-99th percentile
BMI >99th percentile

Answer 15

BMI 5th-84th percentile - weight velocity maintenance, begin prevention counseling

BMI 85th-94th percentile - weight maintenance, begin Stage 1

BMI >95th percentile - gradual weight loss of 1 lb./month, begin Stage 1

BMI >99th percentile - weight loss of 2 lbs./week, begin Stage 1 (2 or 3 IF family motivated)

Question 16

What is the weight goal for patients aged 12-17 with BMI in the below categories?

BMI 5th-84th percentile (with no health risks)
BMI 85th-94th percentile (with health risks)
BMI 95th-99th percentile
BMI >99th percentile

Answer 16

BMI 5th-84th percentile - weight velocity maintenance, begin prevention counseling

BMI 85th-94th percentile - weight velocity maintenance, begin prevention counseling

BMI >95th percentile - weight loss of 2 lbs./week, begin Stage 1

BMI >99th percentile - weight loss of 2 lbs./week, begin Stage 1 (2 or 3 IF family motivated)

Question 17

When should a patient advance to the next stage of treatment?

Answer 17

After 3-6 months of treatment with no significant progress in improving weight status or resolving obesity-related medical complications

Question 18

Each stage is designed with increasing intensity and structure to?

Answer 18

▫ Improve eating habits

▫ Increase level of physical activity

▫ Decrease sedentary behavior

▫ Promote family support and involvement

Question 19

What nutrition topics are discussed in nutrition assessment?

Answer 19

• Sugar sweetened beverages
• Fruits and vegetables
• Fast food
• Meal schedule
• Portion sizes
• Eating behaviors

Question 20

When does a dietary assessment call for an adult present?

Answer 20

Dietary assessment in very young children is conducted with the adult caregiver only

Dietary assessment in school-aged children commonly includes the adult caregiver and the child

Dietary assessment with older adolescents most commonly does not include an adult caregiver

Question 21

What are the nutrition recommendations for children?

Answer 21

Decrease fast food
Decrease added sugars
NO sugar-sweetened beverages (or limit to 6oz./day)
Decrease HFCS
Decrease high fat, high sodium, processed foods
Whole fruits in place of fruit juice
Portion size education
Decrease saturated fat (>2 years old)
Timely, regular meals
Recognition of eating cues (bored, stress, lonely, screen time)
Single portion packaging
Encourage fiber, fruits and vegetables

Question 22

What diets showed significant improvement in weight status at completion of intervention?

Answer 22

• Low Carbohydrate
• Reduced Glycemic-Load Diet
• Modified Stoplight Diet for Children

Question 23

At what age should physical activity self-reporting be provided by adult caregiver?

Answer 23

Children 10 years of age and younger should not be relied on for self-reporting of physical activity

Question 24

Physical activity recommendations for children and adolescents?

Answer 24

Aerobic: most of 60 minutes should be moderate or vigorous intensity
-Include vigorous activity at least 3 days/week

Muscle-strengthening: include on at least 3 days/week

Bone-strengthening: include on at least 3 days/week

Question 25

What should physical activity look like for toddlers?

Answer 25

* Building an environment that promotes movement instead of screen time is beneficial * Finding movement that child enjoys is key ▫ Dancing to music ▫ Helping with laundry ▫ Playing Hide and Go Seek

Question 26

What are recommendations for screen time?

Answer 26

Includes any time in front of a screen: TV, video games, computer, cell phones All screens turned off 30 minutes before bedtime TV, computer, and other screens not be allowed in children’s bedrooms Recommended limit: Age 2-5: 1 hour/day Older kids: -Place consistent limits on time spent using media -Develop rules regarding types of media allowed -Make sure media does not take the place of adequate sleep, physical activity, and other behaviors essential to health -Designate media-free times together (e.g,. meals, driving) and media-free locations at home (e.g., bedrooms)

Question 27

What does family-based behavior modification look like?

Answer 27

▫ Adult caregiver modeling (adult caregiver makes all of the same changes in behaviors as child (diet, physical activity, sedentary behavior) ▫ Change the home environment (stimulus control) for eating, activity, and sedentary behaviors ▫ Problem-solving and pre-planning ▫ Adult caregiver and child self-monitoring behaviors ▫ Increasing positive reinforcement (praise, contingency contracting, point systems) ▫ Reducing negative reinforcement ▫ Using extinction for problematic behaviors (tantrums around food, etc.)

Question 28

What are obesity medications for children?

Answer 28

Orlistat (Xenical) ▫ Only prescription weight-loss medication in US approved by FDA for obesity treatment ▫ Lipase inhibitor ▫ Must be 12 years old Alli ▫ Reduced-strength, nonprescription version of Orlistat ▫ Not approved under age 18 to prevent use without medical supervision Recommended to be taken fat-soluble vitamins (ADEK)

Question 29

When is metformin prescribed for adolescents?

Answer 29

* Not FDA-approved for treatment of obesity * Approved for treatment of Type 2 Diabetes in children 10 years and older * Anti-hyperglycemic drug, can reduce insulin resistance and hyperinsulinemia (can reduce hunger and decrease fat storage)

Question 30

When would bariatric surgery be recommended to child?

Answer 30

May be an option for adolescents with severe obesity, often with serious comorbidities, who have failed to benefit from medically supervised treatment for at least 6 months Considerations ▫ Age: growth has stopped (identified through x-ray of growth plate) ▫ BMI >40 OR BMI >35 + major comorbidities ▫ Co-morbidities ▫ Adherence to medication/supplement regimen ▫ Social support

Question 31

What are the bariatric surgery options for adolescents?

Answer 31

* Roux-en-Y gastric bypass (RYGB) * Laparoscopic adjustable gastric banding (LAGB) * Sleeve gastrectomy (SG)