OBESITY DEFINITION
Under5 years
based on weight for height
- >+3SD obese >+2SD to +3SD overweight
- Above 5years
- Based BMI for age
- >+2SD obese +1SD to +2SD overweight
- Gender based charts used
- All of above based on WHO standards
- >97th centile skin fold thickness
Triceps / subscapular skin folds
BMI > 95th centile for age & sex
MUST KNOW WHAT THE INSTRUMENT IS
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Prevalance of Childhood Obesity MRIÂ (2002)
n - 4876
5 - 10 Years
Wt / Ht > 2 SD 1.1%
10-15 Years
BMI for age and sex > 95th 5.0%
‘Global Epidemic’ WHO 1998
IOTF estimates of global prevalence
155 million of 5-17 year olds - overweight
30-45 million of 5-17 year olds - obese
22 million <5 year olds - overweight
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Social trends contributing to childhood obesity
–h in motor transport
–iin safe venues for outdoor recreation
–i time in front of TVs and computers
–Easy access to cheap energy dense foods
–h consumption of fast foods
–Soft drinks replacing water
Âincreased calorie intake
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Factors Predisposing to Obesity
- Familial / Hereditary
- Consumption of energy dense foods
- Reduced physical activity
- --------------------------------------------------------
Childhood Obesity
Aetiology
1 Simple obesity
decreased activity
emotional
familial
- 2 Endocrine
Cushing
Hypothyrodism
Hyper insulinism
- 3 Syndromes  Prader-Willi
Laurence-Moon-Biedel
Pseudo hypo parathyroidism
- ----------------------------------------------------- Evaluation 1. history 2 exam 3 investigation -----------------------------------
History
Onset
Diet
Eating patterns
Exercise
CNS injury
Intellect
Emotional
Steroid Rx
Examination
Wt
Ht
Waist Circumference
BMI
Skin fold thickness
Dysmorphic features
Features of Cushing Hypothyroidism
Hepatomegaly
Cortisol / single dose dexamethasone suppression
Investigations
- Bone age
- TSH/T4
- Cortisol
- Single dose dexamethasone suppression
- Dysmorphic database
- FBS
- Lipid Profile
- ALT/AST
- OGTT
- USS Abdomen
- --------------------------------------Complications
- Â Respiratory infections (infants)
- Pseudotumor cerebri
- Sleep apnoea
- Obesity hypoventilation syndrome
- Slipped femoral epiphysis
- Poly cystic ovary syndrome
- Gall bladder disease
- Emotional problems
Long term sequelae
Adult obesity
Metabolic syndrome
NIDDM
Hypertension
Dyslipidemias
Non alcoholic fatty liver disease
 Risk of cardiovascular disease
- -----------------------------------------------Management
Motivation
Calorie restriction
Reducing portion sizes
Increasing variety in the diet
 exercise / activity
long term support /emotional support
family involvement
- ---------------------------------------------
Prevention
- Breast feeding
- Growth monitoring
- Healthy family eating habits
- Less consumption of sugar and fat
- Â physical activity
- Special focus on at risk groups
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gynecomastia can be irreversible in child hood obesity unless with surgery
childhood => blount disease bent bones
Slipped capital femoral = adolescence
acnthosis early sign of diabetis
Tall fat - simple
short and fat = patholgocial
simple vs pathologogical obesity
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Add from the madame's childhood obesity lecture did jan 18th as well
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