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By mohamoud mohamed mohamoud

Contents of presentation
Definitions Classification Etiology and risk factor Clinical manifestation Assessment Treatment Prevention

For children and adolescents (aged 219 years): Overweight is defined as a BMI at or above the 85th percentile and lower than the 95th percentile for children of the same age and sex.1 Obesity is defined as a BMI at or above the 95th percentile for children of the same age and sex.1

Childhood obesity is a condition where excess body fat negatively affects a child's health or wellbeing. Pediatric obesity is the most common chronic disease of childhood. Many obese children become obese adults The risk of remaining obese increases with age and the degree of obesity

The prevalence of obesity has increased to approximately 10% in children 4 to 5 years old. The largest increases in the prevalence of obesity were seen in the most overweight classifications and in certain ethnic groups

BMI categories from the 2007AAP Expert Committee report. <5th percentile or BMI less than 13: Underweight. 5th -84th percentile or BMI of 18: Healthy weight. 85th -94th percentile or BMI of 21: Overweight.

>95th percentile or BMI of 23: Obese. >99th percentile or BMI of : Severely obese (cutoff points for >99th percentile available at Pediatrics

Etiology is multifactorial Interaction of genetics and environment Energy imbalance Energy In = Energy Used + Energy Stored For every extra 100 calories consumed per day one will put on 10 pounds per year


Caloric intake has increased Eating unsupervised, lack of family meals Eating at multiple sites Eating out / take out food Beverages Calorically dense food

Physical activity has decreased Schools with less physical education After school programs Safety concerns Convenience activities Increased sedentary activities: TV, computer, video games

Physical activity TV / video games More time spent watching TV less time for physical activity. BMI and obesity associated with higher amount of time spent watching TV Higher cholesterol levels associated with greater amount of time spent watching TV

Risk factor
Increasing BMI % Family history High birth weight Lower socioeconomic status Ethnicity: Environmental / social Both parents work Little cognitive stimulation Lack of safe play areas Family stress

Clinical manifestation
Complications of obesity in children and adolescents can affect virtually every major organ system The clinician should direct the history and physical examination toward screening for many potential complications noted among obese patients in addition to specific diseases associated with obesity

Physical Consequences
Respiratory: Asthma exacerbation, OSA, cardiopulmonary deconditioning Cardiovascular: HTN, dyslipidemia, pulm HTN and cor pulmonale, inc risk of coronary heart disease as adult if still overweight/obese. G l: GERD, constipation, gallbladder disease, nonalcoholic fatty liver disease

Endocrine: DM2, PCOS, metabolic syndrome (incr.waist circ + 2 of following: Ttriglycerides,incr.HDL, HTN, insulin resistance) Orthopedic : Slipped capital femoral epiphysis, Blounts disease, musculoskeletal stress

Dermatologic : Intertrigo, acanthosis nigricans Neurologic : Pseudotumor cerebri (idiopathic intracranial hypertension) Psychiatric : Depression Premature death

Social consequences
are stereotyped as unhealthy, academically unsuccessful & lazy. may be teased or verbally abused by other children can become excluded from being a part of social groups and/or other activities. Economic impact

Psychological consequences
Discrimination can cause a negative self-image and poor self-esteem Sadness can occur, which can lead to depression Loneliness Eating disorders more prevalent in females


Early recognition of at risk for overweight or overweight children is essential. Anthropometric data, including weight, height, and calculation of BM Dietary and physical activity history

Physical examination:Bp adiposity distribution, markers of comorbidities, and physical stigmata of genetic syndrome Laboratory studies:fasting lipid, fasting insulin and glucose levels, liver function tests, and thyroid function tests

Behavioral goals Medical goals


Promote life long healthy eating and activity behaviors Prevent complications of obesity in childhood and potentially adulthood Improve or resolve existing complications of obesity

Stage 1: Prevention plus - prev counseling as above w / qmo f/u 3 -6 mo Stage 2: Structured weight mgmt - dietitian referral, freq monitoring q3-6 mo

Stage 3: Comprehensive multidisciplinary intervention involvement of behavioral counselor and exercise specialist, visits for 8 -1 2 wk Stage 4 : Tertiary care intervention very low-cal diets, meds, and/or bariatric surgery fo r adolescents

recommends referral to intensive weight mgmt program (dietary, physical activity, and behavioral interventions) Formal obesity clinic
Team approach
Physician Therapist Dietician Exercise therapist

Intensive program


Weight Loss Pharmacotherapy

Induces feeling of satiety

Contraindicated with CAD,CVA or uncontrolled blood pressure Once daily 8-10% weight loss
Need to monitor BP

Increases 5HT & Norepi. Caution with use in combination with SSRIs

FDA approved 1999 FDA approved 12-18 year old Reduces absorption of ~30% dietary fat
1/3 of fat passes undigested Facilitates weight loss GI side effects

3 times daily with meals containing fat Vitamin supplementation 8-10% weight loss

Diet: Limit sugar-sweetened drinks, encourage fruits and veg, eat breakfast, limit eating out, limit p ortion size, encourage family meals Physical activity: LimitTV time <2 hr/d, no TV in bedroom is >60 min mod-vigorous physical activity, i sedentary activities.

Nelson pediatrics New england journal of medicine American academic physicians Central disease control Internet sources

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