Chldhood Obesity

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Childhood Obesity - Dr.C.S.N.Vittal

Obesity: 

Obesity Definition A chronic condition characterised by excess adipose tissue, causally related to serious medical illness

Obesity Diagnostic Tools: 

Obesity Diagnostic Tools Percentile on Growth Charts Body Mass Index (BMI) Triceps Skin fold Thickness (TST) Waist-hip ratio

Diagnosis of Obesity: 

Diagnosis of Obesity Weight for height >120% Age specific growth charts Skin fold thickness: >85%centile for sex and age Waist : >40” in males & 35” in females WHR : >0.8 women & 0.9 in males

Weight for Height: 

Percentage Wt. for Ht. = ------------------------------------- X 100 Weight for Height Actual Weight Expected weight for actual height < 90 % : PEM > 90 % : Normal > 120-130 : Obesity

Body Mass Index or BMI in Adolescents: 

Body Mass Index or BMI in Adolescents Weight in kilograms is divided by the square of the height in meters Normal : 19 to 24.9 kg/m 2 Overweight : 25 - 26.9 Obese : 27 to 29.9 Severe Obesity : Over 30 (Over the 95th Percentile) Morbid Obesity : Over 40

Skin fold thickness: 

Skin fold thickness Skin thickness is an index of body fat SFT Taken at Triceps (most common site) Subscapular Suprailiac Abdomen Upper thigh Lange’s Harpenden’s Skin fold calipers

Adolescent Growth Chart: 

Adolescent Growth Chart Measure of Height Weight and BMI in single graph

Types of Obesity: 

Types of Obesity Simple obesity Pathologic obesity Dysmorphic syndromes Endocrine CNS Drugs Leptin deficiency

Prevalence: The National Health and Nutrition Examination Surveys: 

Prevalence: The National Health and Nutrition Examination Surveys 75% relative increase in obesity in adolescents is noted since 1970 25% of American adolescents are identified as being obese 50% increase in morbid obesity (a BMI of 30 or more) over the past decade Indian studies 7-21 % prevalence

Factors Contributing to the Obesity Epidemic: 

Factors Contributing to the Obesity Epidemic Increase in intake of regular soda drinks In intake of fast foods in portion size of fast foods highcarb snacks Decrease in physical activity Increase in physical inactivity (TV, video, computer time)

Why is it important?: 

Why is it important? WHO has declared obesity as a “global epidemic” Childhood & adolescent obesity is a risk factor for adult obesity “ Tracking ” Life style diseases like NIDDM,Coronary artery disease Hypertension, dyslipidemia, cancers are linked with obesity Psychosocial problems

Obesity: Complications: 

Obesity: Complications Psychological Disturbed body image Poor self-image/self-esteem Poor family relations: scapegoat and source of embarrassment Poor peer relations and social isolation Exclusion from activities, especially dating Acting out and depression

Obesity: Complications: 

Obesity: Complications Medical Coronary artery disease Cerebrovascular disease Gallstones Orthopedic problems Sleep apnoea Increased cancer risks (colon, rectum, prostate) Diabetes mellitus

Overweight Screening Procedure: 

Overweight Screening Procedure Screening includes evaluation for: Family history Blood pressure Total Cholesterol (  200 mg/dl) Large change in BMI ( 2 points in previous year) Concern about weight Smoking history

Family History: 

Family History Positive Family History includes history of: Cardiovascular Disease Parental hypercholesterolemia Hypertension Diabetes Parental Obesity

Physical Exam: 

Physical Exam Eyes Peripheral view Fundi Skin Acanthosis nigricans Purple stria Texture Hirsutism, acne Endocrine\ - Hypopituitarism - Hypercortisolism - Hyperinsulinemia - Hyperandrogenism in females

Lab Work-Up: 

Lab Work-Up T 4 , TSH Free testosterone (in females) Fasting insulin and glucose Lipid profile 24 hour urine for free cortisol DHEA-S Sleep studies Chest x-ray; EKG

Management Strategies of Obesity: 

Management Strategies of Obesity Prevent weight gain Promote weight maintenance Manage co morbidities Promote weight loss Rule out treatable medical causes

Underlying Medical Conditions: 

Underlying Medical Conditions Hypothyroidism Initiate treatment with levothyroxin Cushing’s syndrome Identify source of excess cortisol Surgically remove source of excess ACTH or cortisol

Treatment Content: 

Treatment Content Diet / Nutrition Plan Physical Activity Controlling the environment Self-monitoring Goal setting and contacting Parenting skills Managing high-risk situations Maintenance and relapse prevention

General Management Principles: 

General Management Principles Can start with weight stabilization Eventually a 10% weight reduction Can decrease by 500 calories/day with low fat/high fiber diet Set realistic goals 2% decrease in 2500 calories: 5 lb to drop in one year (use skim milk)

Physical Activity: 

Physical Activity Providing and choice of activities appears to be superior to providing a specific exercise prescription Recent research suggests that reducing sedentary behaviors may be more effective than promoting physical activity in promoting weight loss

Exercise: 

Exercise Exercise also plays very vital role in the management of obesity. The more exercise one takes, greater is the daily energy expenditure and more rapidly the obesity reduces.

Energy expenditure in different activities : 

Energy expenditure in different activities At rest    1Kcal /min Walking, gardening    5 Kcal/ min Cycling, swimming    7 Kcal /min Squash, jogging, hill climbing  10 Kcal/ min

Benefits of exercise : 

Benefits of exercise Obese people with a heavier body to move, spend more energy for same amount of work. It is valuable as a diversion from sitting indoors and being tempted to eat. Exercise reduces appetite. After exercise the resting B.M.R. may increase for some hours.

Controlling the Environment: 

Controlling the Environment Help reduce cues (e.g., taking TV out of bedroom) Limit access to high calorie foods Encourage family activities (e.g., family walks)

Behaviour Modification - Adolescents: 

Behaviour Modification - Adolescents Aimed at changing behaviour useful while treating obesity

Flash Card Technique: 

Flash Card Technique Increases motivation involves writing reasons for wanting to lose weight I will look better I will feel better I will be be healthier I will fit into my favourite pair of jeans

Food Diary: 

Food Diary Identifies triggers Useful in understanding eating patterns Logs exact amount of food or liquid consumed

Setting diets & goals: 

Setting diets & goals Identifying and sticking to a specific diet food to be consumed Place time Setting reasonable goals like losing one or two pounds a week likely to be achieved

PowerPoint Presentation: 

Food Pyramid Cereals Pulses GLV Fruits Non-Veg Food Milk Sweets, oily & fatty food

Ways of controlling urges: 

Ways of controlling urges Removal of tempting foods Use of distractors like engaging in another activity Using positive self-statements like I can do this, I must control myself, I will be fine, The urge will pass

Use of Reinforcement : 

Use of Reinforcement Positive reinforcement : Rewarding oneself as goals are met e.g. going for a film with a friend Negative reinforcement : escape unpleasant stimulus to increase desired behaviour > missing a favourite TV programme if overeaten

Obesity Treatment Strategies NOT recommended: 

Obesity Treatment Strategies NOT recommended Surgery Drug Treatment (including herbal treatments) Quick Weight Loss Diets

Pharmacotherapy: 

Pharmacotherapy Shown to be effective in the treatment of obesity in some adults Their use in most youth is limited at this time Teens should be at least 16 years of age with morbid obesity

Failure of Obesity Treatment: 

Failure of Obesity Treatment Lack of family involvement and support lack of flexibility Lack of emphasis on increasing physical activity Lack of a maintenance phase

PowerPoint Presentation: 

Nutrition principles - Summary

Diets may produce weight loss but do not cure obesity; weight regain is common.: 

Diets may produce weight loss but do not cure obesity; weight regain is common.

PowerPoint Presentation: 

Eat less; eat 2/3 or ½ the calories you have been eating

PowerPoint Presentation: 

Target is to eat about 1200-2000 kcal/d, depending on the age of the child

PowerPoint Presentation: 

Try to cut out empty calorie foods – fats, soft drinks, and fast foods.

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Amounts of low calorie foods can be increased – fruits and vegetables

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Avoid other activities while eating (except conversation)

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Meal or food should not be provided as reward.

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Make small portions of food appear as large (small plate, food cut up in small pieces)

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Leave eating place as soon as you have eaten

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Slow down the rate at which you eat

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Chew each mouth full for long.

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Reduce inactivity

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WHAT can we do to prevent obesity ? Right from childhood into adolescence into adulthood we must encourage Exercise, Physical activity Physical Fitness Life style modification Nutritional intervention

PowerPoint Presentation: 

C.S.N.Vittal Thank Q