Pediatric Overweight & Obesity Flashcards
Classification of overweight, obese, and seriously obese in children
Overweight: BMI of age & sex between 85th – 94th %
Obese: BMI for age & sex > 95th %
Severe obesity: two numerically similar definitions:
1) BMI ≥ 99th percentile
2) BMI ≥120% of the 95th percentile corresponds to Class II adult
Expressing % above the 95th percentile allows tracking of severe obesity
The term “morbid obesity” is reserved for adults
Clinical significance of BMI in children
BMI > 95th % associated with co-morbidities; BMI > 99th% greatly increases co-morbidities
Current status/trends in childhood obesity
18% of U.S. children ages 2-19 yr are obese (BMI > 95th%);
30% children are either overweight or obese, plateau nationally since ~ 2007, local trends vary
Rates differ by ethnicity (higher in American Indian, African American and Latino); income difference accounts for most of ethnic variation; increases with age; rates not significantly different by sex
Health impact of obesity in childhood (clinical problems)
Effects observed in every physiologic system:
Most common: Obstructive sleep apnea, metabolic syndrome (insulin resistance, hyper/dys-lipidemia, hypertension), hepatic(NAFLD/NASH), decreased quality of life – mood and anxiety disorders
Less common, not rare: Endocrine (T2DM, PCOS), orthopedic (Blount’s disease, SCFE)
Persistence of overweight into adulthood: related to parent’s weight, age of onset, severity; Risk of heart disease and type 2 DM is reversible if obesity resolves by young adulthood
Medical assessment of overweight/obese children
CALCULATE & PLOT BMI AT LEAST ONCE/YR FOR ALL CHILDREN > 2 YR
- Take a targeted history:
Dietary factors – many evidence-based candidate behaviors: sugar sweetened beverages (SSB); juice; fruits & veg intake (start in infancy); restaurant food; portion sizes; meal patterns (skipping/grazing); snacks, fiber, breakfast, family meals, eating in front of TV
Physical activity/sedentary behavior: goal 1+hrs active play/day
Amount of sedentary time, especially screen time, TV in bedroom
Organized sports/activities, Outdoor time/free play
Adequate Sleep - Family history: Obesity, cardiovascular disease, type 2 diabetes;
- Review of systems: look for symptoms of co-morbidities
- Physical exam: looking for signs of co-morbidities (e.g. hypertension, acanthosis nigricans, acne/hirsutism, striae, organomegaly, joint pain, stigmata of genetic
syndromes, neurologic function) - Labs: screening labs in obese: fasting lipids, ALT, fasting glucose and/or HgA1c q1-2yrs
Treatment of pediatric obesity
Start Early! Tailor treatment to severity – ie, be realistic. AAP Stages of Treatment:
- “Prevention Plus” (most feasible for primary care setting)
a. 5210+: 5 fruits/vegetables, 2 hours TV or less, 1 hour activity, 0 SSB, +others - Structured Weight Management (PCP plus dietitian and/or psych)
- Comprehensive, multidisciplinary weight management (diet, exercise, behavior program)
- Tertiary care intervention (e.g. controlled/supervised diets, meds, surgery)
Prevention Plus
Basic treatment for an overweight child
Use motivational interviewing skills:
Involve the family – the younger the child, the more important the parent
Clean up the environment: e.g. get problem foods out of home
Collaborative Management:“Negotiate” w/ family on a few behaviors to target for change for both diet & PA
Joint prioritizing & decision making (ie, MD does not dictate but may give menu of changes)
Cognitive Behavioral Techniques:
Self monitoring – “If you can’t count it, you can’t change it.” e.g. daily steps, F/V servings, water
Accountability, +Reinforcement/Rewards for behavior change – child & parent work together
If an obese child becomes a healthy weight, what happens to their lifelong risk of Type II diabetes, HTN, atherosclerosis, etc?
Goes back to normal as long as they maintain a healthy weight!
Obesity prevalence study
Triples 1980-2005
Plateau last 10 years
