Pediatric Obesity: Health Implications Flashcards Preview

DEMS: Unit IIb > Pediatric Obesity: Health Implications > Flashcards

Flashcards in Pediatric Obesity: Health Implications Deck (17)
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1

Overweight: definition of childhood weight status

  • BMI of age and sex between 85th and 94th percentiles
  • Only 50% of these children have excess adiposity
  • This is the "yellow light" range when you need to watch them

2

"Obese" and "severe obesity" definitions

  • Obese: BMI > 95%ile
  • Severe/morbid obesity: BMI > 99%ile

3

Use of BMI-for-age charts

  • Have to use a chart for children
  • "Eyeballing" it is usually wrong

4

Epidemiology of childhood obesity

  • 2 --> 19 years old: 18% of children obese
  • Rates may be levelling off
  • 25-30% of children in overweight + obese range
  • Rates differ by ethnicity
    • Higher in American Indian, African American, Latino populations
  • Income difference accounts for most of this ethnic variation
  • Increases with age

5

Comorbidities associated with childhood obesity: pulmonary

  • Obstructive sleep apnea (OSA)
    • Need to fix hypoxia and monitor ventilation
  • Obesity hypoventilation syndrome
  • OSA --> hypercapnia + hypoxia --> pulmonary HTN --> right sided heart failure

6

Comorbidities associated with childhood obesity: cardiovascular

  • Atherosclerosis shown to begin very early
  • Metabolic symptoms
  • Dyslipidemia
  • Hypertension
  • Coagulopathy
  • Chronic inflammation
  • Endothelial dysfunction

7

Comorbidities associated with childhood obesity: endocrine

  • Acanthosis nigricans - sign/result of excess insulin 
  • Type 2 DM
  • Polycystic ovarian syndrome
    • Hyperandrogenism + oligomenorrhea +/- polycystic ovaries
    • Cysts may not develop until woman is in 20s or 30s
    • Defined by < 9 periods/year, hyperandrogenism, hirsuitism, acne
  • Hypothyroid
    • Associated with poor linear growth

8

Comorbidities associated with childhood obesity: gastrointestinal

  • Non-alcoholic fatty liver disease
    • 10-25% of obese youth affected
    • Elevated ALT
    • Steatosis may --> fibrosis and cirrhosis
    • Characterized by vague, recurrent abdominal pain
  • GERD
  • Gallstones: relatively uncommon
    • Associated with rapid weight loss
  • Constipation/encopresis: very common in children with low fiber diet

9

Comorbidities associated with childhood obesity: neurologic/ophthalmologic

  • Pseudotumor cerebri: 
    • Papilledema
    • Peripheral vision loss possible
    • Headache (am > pm, while supine)
    • 1/100,000
    • Refer to neuro

10

Comorbidities associated with childhood obesity: orthopedic

  • Slipped capital femoral epiphysis (SCFE)
    • Femoral head not in line with hip
    • Crush and strain on femoral head
    • Looks like "ice cream fell off of the cone"
    • Immobilize --> dx with X-ray
    • Weight loss so it doesn't happen in other hip
    • Presents as hip, groin, or knee pain, limp with leg held in external rotation
  • Blounts disease
    • Progressive bowing of the hips
    • Crush and strain on medial femoral condylar growth plates
    • Only the lateral growth plate can grow --> progressive bowing

11

Comorbidities associated with childhood obesity: psychiatric

  • Depression/anxiety
    • May lead to worsening obesity if untreated
    • Full psychosocial review including mood, school performance, peer and family relationships
  • Eating disorder
    • Routinely assess for binging +/- purging behavior in teenagers
    • Teenagers can have very unrealistic weight loss goals
    • 1 lb per week-month is okay

12

Key components of assessment (5)

  1. Plot BMI at least yearly > 2 years of age
  2. Assess
    • Targeted diet and activity history
    • Family history of CVD risk factors and obesity
  3. ROS for comorbidities
  4. Physical exam for comorbidities
  5. Labs in patients 2-10 years old with + family history or CVD risk factors / patients who are 10+ years old and obese: 
    • Fasting lipids
    • Glucose
    • ALT
    • HbA1c

13

Family history assessment

  • Severe obesity --> single gene disorders 
    • 10-12 are actually known
    • Rare - most in notably abnormal children
  • CVD risk factors
    • Early MI
    • T2DM
    • HTN
    • Hyperlipidemia/dyslipidemia

14

Components of motivational interviewing (6)

OARRrRS

  1. Open-ended questions
  2. Affirmations
  3. Reflections --> make them think again
  4. Roll with resistance --> resist the urge to tell them what to do
  5. Reframing
  6. Summaries

15

Treatment principles: diet

  • Yes:
    • fruits and vegetables
    • low fat dairy
  • No:
    • sweetened drinks
    • fast food (any eating out)
    • childhood snacks (poorly satiating carbohydrates)
    • large portion sizes
    • eating frequently
  • 5-2-1-0 rule
    • 5 fruits and veggies
    • < 2 hours screen time
    • > 1 hour activity
    • 0 sugar-sweetened beverages

16

Treatment principles: how to eat

  • Schedule meals and snacks
  • Meals and snacks regularly (every 3 hours)
  • Breakfast every morning
  • Don't stop eating or skip meals

17

Treatment principles: lifestyle

  • Moderate physical activity > 60 minutes per day
    • Infants: no TV, parents promote movement
    • Preschool: outdoor time and non-TV time
    • School-age: PE and recess, after-school free play
  • Sedentary time << 2 hours
    • TV, video games, computer, texting
  • Neighborhood resources/safety