Childhood and Adolescent Obesity - Pediatric - Lecture Slides, Slides of Pediatrics

Download Childhood and Adolescent Obesity - Pediatric - Lecture Slides and more Slides Pediatrics in PDF only on Docsity! Childhood and Adolescent Obesity docsity.com WHY WORRY ABOUT PEDIATRIC OBESITY? • Pediatric obesity is of epidemic proportion. • Pediatric obesity is the most common chronic disease of childhood. • The epidemic is worldwide docsity.com • Anthropometrics – Weight: 121 kg – Height: 175 cm docsity.com Advance Data No, 314 # June 8, Body mass index-for-age percentiles: Boys, 2 to 20 years 2 3 4 8 6 7 8 9 WN wo i 1 15 16 i7 18 19 a Age (years) SOURCE: Developed by the Nat ona Cent fr Head Skids vaabostion th ‘tha Natioral Cetay or Chonle Disease Provan and Heash Portion (2000, “ner Figure 16. Body mass index-or-age percentiles, boys, 2 to 20 years, CDC growth charts: United States How Do We Define Overweight in Children and Adolescents? docsity.com Classification of Overweight and Obesity in Adults Using BMI Obesity Class BMI Underweight <18.5 Normal 18.5-24.9 Overweight 25-29.9 Obesity I 30-34.9 II 35-39.9 III Extreme  40 docsity.com 35 36 37 39 38 4 3 University of Miami Blocking Machine docsity.com Height: 6-6 Weight: 98 kg 25 Height: 7-1 Weight: 154 kg docsity.com Increasing Incidence of Overweight in Children and Adolescents docsity.com  95th%ile for age and gender These #s double when including >85%ile docsity.com PERCENT OF OBESE CHILDREN WHO BECOME OBESE ADULTS 0 10 20 30 40 50 60 70 80 Preschool School-age Adolescent docsity.com • In modern industrial environment – easy access to calorically dense foods – encourages sedentary lifestyle • Metabolic consequences of these genes are maladaptive docsity.com Genetic Factors account for 20-40% of heritability of BMI • 173 human obesity cases due to single gene mutations in 10 different genes were reported by 2004 (Perusse, 2005) • > 600 genes, markers, and chromosomal regions have been linked with human obesity phenotypes Buchard 97 Rankinen 02 Familial Risk: 2-3 fold for moderate obesity 5-8 fold for severe obesity Bouchard 01 docsity.com More than 50 Obesity Associated Genetic Syndromes Bardet-Biedl Prader Willi Spina bifida Down Syndrome docsity.com What is Causing this Marked Increase in Overweight?? docsity.com Obesity is not a genetic shift, rather it is an environmental shift docsity.com Causes of Marked Increase in Overweight • Reflects a shift towards positive energy balance energy intake = energy expenditure calories McDowell 94; Kann 99; Troiano 00, NHANES II to III PE sed act docsity.com Physical Activity • Daily participation in PE declined from 42% to 29% between 1991 and 1999 (www.cdc.gov/HealthyYouth) • Walking and bicycling dropped 40% in kids aged 5-15 between 1977 and 1995 • What constitutes ―active‖ these days? docsity.com Increase in Sedentary Activity • Excessive TV watching– – The average child spent 6 hr/day watching TV or playing on computers. – Encourages overeating while viewing • Influences food choices – 80% of commercials on children’s programs are for food • Lower resting metabolic rate compared to at rest (Klesges 1993) • Reduces time available for more active pursuits docsity.com • Video and computer games • Parental work schedules • Unsafe neighborhoods – discourage parents from allowing children to play outdoors – force parents to drive children to school • Lack of recreational facilities in low- income neighborhoods Other Contributors to Sedentary Lifestyles docsity.com Type 2 Diabetes • 95% of teens with Type 2 diabetes have a BMI >85%ile • Tremendous public health implications – Longer duration of disease, > risks of complications • Obtain fasting glucose and insulin on all overweight children, especially those with.. Dabelea 99; Vinicor 00; Richards 85 docsity.com • Acanthosis Nigricans • Hyperpigmented, velvety plaques in body folds • Caused by hyperinsulinemia which stimulates formation • Associated with obesity docsity.com • Growth – Taller, advanced bone age, mature earlier – Early maturation is associated with • increased fatness and truncal fat distribution in adulthood – Short, obese children should be evaluated for hypothyroidism, Cushing syndrome or Turner syndrome Other Endocrinological Issues docsity.com Psychological and Economic Consequences of Pediatric and Adolescent Obesity • Discrimination, rejection and low self- esteem (Gortmaker 93), particularly for females • Less participation in PE and sports activities • Lower college acceptance rates (Canning 1966) docsity.com Who Needs to be Evaluated? docsity.com Evaluating For Overweight in a Primary Care Setting BMI Overweight BMI  95th% Not at risk BMI  85th% At risk for Overweight BMI 85-95th% •Family history •Blood pressure •Lipids •Lg  in BMI •Concern re wt •Note in chart •No therapy •Return next yr Return next yr for screen In depth medical assessment +  docsity.com Social hx • Only child • High school sophomore, gets good grades • No exercise or organized sports activities • Spends 6 hrs/day watching TV and playing video games docsity.com Dietary Information • Picky eater • Consumes NO fruits or vegetables • Mom prepares separate meals for him docsity.com 24-Hour Recall • Breakfast--none • Mid morning--16 oz ginger ale • Lunch--none – generally has lunch at school of chocolate milk, pizza, and french fries • Dinner--10 beef tacos, 2 cans of soda docsity.com General Treatment Goals • Behavioral goals – Promote life long healthy eating and activity behaviors • Medical goals – Prevent complications of obesity in childhood and potentially adulthood – Improve or resolve existing complications of obesity docsity.com Refer? • Formal obesity clinic--Team approach – Physician, therapist, dietitian, exercise therapist – Intensive multi-session programs • Parent and child/teen participate – Advantages • Multidisciplinary approach, frequent visits – Disadvantages • Expensive, time consuming, require parent participation docsity.com If Going It Alone… Where Do You Start? • Assess child’s and family’s willingness to change • Negotiate with child/family on specific, targeted changes • Develop realistic, achievable goals • Involve the entire family in making changes • Establish a monitoring/assessment tool docsity.com Anthony’s Lab Data • Lipid panel – Total cholesterol 156 (<200) – Triglycerides 129 (35-250) – HDL 34 (35-82) – LDL 96 (<100) • HgbA1C 5.8 (4.3-5.3) • Fasting glucose 77 • Insulin 30.3 (0-30) docsity.com • Weight – 97 kg – Down 53# • Height – 179 cm – Up 4 cm docsity.com Advance Data No, 314 # June 8, Body mass index-for-age percentiles: Boys, 2 to 20 years 2 3 4 8 6 7 8 9 WN wo i 1 15 16 i7 18 19 a Age (years) SqURCE: Developed by the Nat ona Cent fr Head Slits vaabostion th ‘tha Natioral Cetay or Chonle Disease Provan and Heash Portion (2000, “ner Figdre 16. Body mass index-for-age percentiles, boys, 2 to 20 years, CDC growth charts: United States PREVENTION: POST CONCEPTION • Routine prenatal care • Achieve normal weight gain during pregnancy – LGA infants and infants of diabetic mothers have higher rates of subsequent obesity – SGA infants also at higher risk • Hediger ML et: Pediatrics 104:e33, 1999 • Promote breast feeding docsity.com docsity.com PREVENTION: SCHOOL • Promote physical activity • Provide nutritious meals • Control vending machines • Have nutrition education incorporated into regular school curriculum. • Encourage children to walk or bike to school safely. docsity.com PREVENTION: PRIMARY CARE PROVIDER • Be an advocate • Provide anticipatory guidance to families docsity.com NUTRITION ANTICIPATORY GUIDANCE • Beverages – Encourage water intake – Limit sweet beverages • Juice, juice drinks: 120 calories / 8 oz – No nutritional need for any juice <6 months of age – 1-6 years: 4-6 oz – 7-18 years: 8-12 oz – Discourage free use of box drinks – Discourage continuous access to sippy cups • Soda: 150 calories / 12 oz docsity.com NUTRITION ANTICIPATORY GUIDANCE • Eat 5 fruits and vegetables a day • Structured meal and snack time • Do not use food as a reward • Know what the child is eating outside the home: school meals, day care etc. docsity.com ACTIVITY ANTICIPATORY GUIDANCE • Decrease sedentary activity – Limit TV, video games and computer to 1-2 hours per day • > 2 hours a day associated with higher rates of obesity and hyperlipidemia – Do not have a TV in the child’s room • Children with TVs in bedroom watch more TV docsity.com BEHAVIORAL ANTICIPATORY GUIDANCE • Encourage parents to act as role models – Nutrition – Activity • Promote parent child interaction • Have special ―family time‖ that is physically active docsity.com BEHAVIORAL ANTICIPATORY GUIDANCE • Limit eating out – More calorically dense food – Larger portion sizes – Less intake of fruits and vegetables docsity.com