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

Download Childhood and Adolescent Obesity - Pediatrics - Lecture Slides and more Slides Pediatrics in PDF only on Docsity! Childhood and Adolescent Obesity | WATER ON MARS a New Hints of Life ‘ MYSELF & IRENE’ (2% xt The Wild Men of Sk eh < 3 ry 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 Definition of Overweight in Children and Adolescents • Overweight = BMI ≥ 95th %ile • At risk for overweight = BMI between 85th-95th %ile Expert Committee Recommendations from the Maternal and Child Health Bureau, 1997 Docsity.com Calculate Your BMI • kg ÷ m2 • Height in inches x 2.54 ÷ 100 = meters • Meters x meters = m2 • Weight in pounds ÷ 2.2 = kg • Divide your weight in kg by m2 = BMI 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 Etiology of Obesity • Genetic/heritablility • Molecular • Syndromes • Environmental Docsity.com Heritability • Survival advantage to conserve energy as fat through human evolution • Humans enriched for genes that promote energy intake and storage and minimize expenditure. • Enhance female fertility and ability to breastfeed offspring Docsity.com • In modern industrial environment – easy access to calorically dense foods – encourages sedentary lifestyle • Metabolic consequences of these genes are maladaptive Docsity.com • But doctor, my child must have a low metabolism…. – Little evidence that metabolic rate is different (Baker, 05) – Obese adolescents have a higher total daily energy expenditure and REE (Bandini, 90) – There may be small differences in metabolic efficiency but these are hard to measure 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 Physical Activity • Daily participation in PE declined from 42% to 29% between 1991 and 1999 • 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 Other Contributors to Sedentary Lifestyles • 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 Docsity.com • Acanthosis Nigricans • Hyperpigmented, velvety plaques in body folds • Caused by hyperinsulinemia which stimulates formation • Associated with obesity Docsity.com Other Endocrinological Issues • 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 Docsity.com More Complications • Hepatic Steatosis with elevated LFTs • Cholelithiasis – 50% of kids with cholecystitis are overweight • Orthopedic Problems Docsity.com Medical Assessment • r/o genetic syndromes, esp if associated with mental retardation • Blood pressure • Labs to include – Fasting lipid panel – Fasting glucose and insulin • OGTT – LFTs – Thyroid fx tests 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 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 PREVENTION: PRECONCEPTION • Prevention starts prior to conception – Obese adolescents have an 80% probability of being obese as adults – Today's adolescents are tomorrows parents – Parents are role models for their children – Obesity risk in a child born to obese parents is significantly increased – Educate and intervene at this time to help prevent obesity in subsequent generations Docsity.com 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 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