Obesity

What is the importance of portion sizes?

Age-appropriate portion sizes for meals and snacks should be encouraged. Children should be taught to recognize hunger and satiety cues, guided by reasonable portions and healthy food choices by parents. Smaller bowls should be used; children should never eat directly from a bag or box. No juices or soda should be the rule.

What is BMI?

BMI age-specific and gender-specific percentile curves (for 2-20 year olds) allow an assessment of BMI percentile. Cons: BMI may be an imperfect measure of body fat and real health risk. There are racial and ethnic differences in body fat at the same BMI level. Pros: BMI is a convenient screening tool that correlates fairly strongly with body fatness in children and adults.

How can obesity be prevented?

Behavioral and lifestyle modifications are the primary tools for reducing obesity. There are three levels of prevention in dealing with childhood obesity: 1) Primordial prevention as it deals with keeping a healthy weight and a normal BMI through childhood and into teens. 2) Primary prevention aiming to prevent overweight children from becoming obese. 3) Secondary prevention directed toward the treatment of obesity so as to reduce the comorbidities and reverse overweight and obesity if possible. The goal for all children with uncomplicated obesity and fast-rising weight-for-height is to achieve a health balance of energy consumption as a caloric intake, health eating, with the number of calories used with the activities and activity patterns.

What is overweight?

Child and adolescent overweight was defined as a BMI between the 85th and 95th percentile on the CDC BMI-for-age growth charts.

What is obesity?

Childhood and adolescent obesity was defined as a body mass index (BMI) at or above the gender-specific 95th percentile on the CDC BMI-for-age growth charts. Childhood extreme obesity was defined as a BMI at or above 120% of the gender-specific 95th percentile on the CDC BMI-for-age growth chart.

What is the epidemiology of obesity?

Childhood obesity is an epidemic in the US. According to the CDC in 1990, no state in the US had a prevalence of obesity of 15% or more, but by 2010, no state had a prevalence of obesity of less than 20% and a third of the states had a prevalence of 30% or higher.

What are prevention strategies in infancy?

During infancy, early initiation of breast feeding, exclusive breast feeding for 6 months followed by inclusion of solid foods, providing a balanced diet with avoidance of unhealthy calorie-rich snacks, and close monitoring of weight gain should be emphasized. The transition to complementary and table foods and the importance regularly scheduled meals and snacks, versus grazing behavior, should be emphasized.

What are prevention strategies in childhood?

During the preschool age period, putting these strategies into practice includes providing nutritional education and guidance to parents and children so as to develop healthy eating practices, offering healthy food preferences by giving early experiences of different food and flavors, and following closely the rate of weight gain to prevent early adiposity rebound. In school-aged children, this includes monitoring both weight and height, preventing excessive prepubertal adiposity, providing nutritional counseling, and emphasizing daily physical activity. Preschool children require unstructured activities and thus will benefit from outdoor play and games. On the other hand, school children and adolescents require at least 60 minutes of daily physical activities.

How is obesity assessed?

Early recognition of excessive rates of weight gain, overweight or obesity in children is essential because the earlier the interventions, the more likely they are to be successful. Routine evaluation at well child visits should include the following: 1) Anthropometric data, including weight, height, and calculation of BMI. Data should be plotted on age-appropriate and gender-appropriate growth charts and assessed for BMI trends. 2) Dietary and physical activity history. Assess patterns and potential targets for behavioral change. 3) Physical examination. Assess blood pressure, adiposity distribution (central versus generalized), markers of comorbidities (acanthosis nigricans, hirsutism, hepatomegaly, orthopedic abnormalities), and physical stigmata of a genetic syndrome. 4) Laboratory studies. These are generally reserved for children who are obese (BMI >95th percentile), who have evidence of comorbidities, or both. All 9-11 year olds should be screened for high cholesterol levels. Other useful laboratory tests may include hemoglobin A1c, fasting lipid profile, fasting glucose levels, liver function tests, and thyroid function tests.

What BMI percentiles are indicative of overweight or obesity?

For children younger than 2 years of age, weight-for-length measurements greater than 95th percentile may indicate overweight and warrant further assessment. Child and adolescent obesity was defined as a BMI at or above the gender-specific 95th percentile on the CDC BMI-for-age growth charts. A BMI for age and gender above the 95th percentile is strongly associated with excessive body fat and comorbidities. Extreme obesity was defined as a BMI at or above 120% of the gender-specific 95th percentile on the CDC BMI-for-age growth chart.

What are the 5 criteria for metabolic syndrome?

HDL <40 men and <50 women BP >135/85 Triglycerides >150 Fasting glucose >100 Waist >40 inches in men and >35 inches in women

What are prevention strategies in adolescence?

In adolescence preventing the increase in weight after a growth spurt, maintaining health eating behavior, and reinforcing the need for daily exercise are most important. Furthermore, advocate for specific and attainable goal settings and positive reinforcement of target behavior. Adolescents require at least 60 minutes of daily physical activities.

When is surgical treatment for obesity indicated?

In the context of a general lack of effective tools for primary prevention or behavioral treatment of obesity, surgical treatment may be advocated as a preferred and cost-effective solution for certain children and adolescents. However, the role of bariatric surgery in the treatment of obese children or adolescents is controversial. There is very limited evidence available to adequately estimate long-term safety, effectiveness, cost-effectiveness, or durability of bariatric surgery in growing children. Although based on methodologically limited and underpowered studies, the existing evidence suggests that bariatric surgery in severely obese adolescents results in significant weight loss and improvements in comorbidities and quality of life.

What are prevention strategies in the perinatal period?

In the perinatal period this includes adequate prenatal nutrition with optimal maternal weight gain, good blood sugar control in diabetes, and postpartum weight loss with healthy nutrition and exercises.

What is the etiology of obesity?

Many obese children become obese adults, and the risk of remaining obese increases with age of onset and the degree of obesity. Obesity may run in families. The main causes of excess weight in youth are similar to those in adults; they include individual cases such as behavior and rarely genetics. Behavior causes may include dietary patterns, physical activity, inactivity, medication use, and other exposures. Obese children may exercise too little and consume too many calories.

When are more aggressive therapies for weight loss indicated?

More aggressive therapies are considered only for those who have not responded to other interventions. The initial interventions include a systemic approach that promotes multidisciplinary brief, office-based interventions for obese children and promotes reducing weight. Before enrolling any patient in a weight-loss program, the clinician must have a clear idea of that individual's expectations. Using the mnemonic described, the clinician should guide the patient who seeks weight reduction to create SMART goals: Specific, Measurable, Attainable, Realistic, and Timely.

What are complications of obesity?

Obesity during childhood can have a harmful effect in a variety of ways. Complications of obesity in children and adolescents can affect every major organ system. High BMI increases the risk of metabolic and CVDs and some cancers; it is the most important modifiable risk factor for hyperglycemia and diabetes. Children who are obese are at higher risk for (1) high blood pressure and high cholesterol, which are risk factors for CVD; (2) impaired glucose intolerance, insulin resistance, type 2 diabetes; (3) respiratory problems such as sleep apnea and asthma; (4) joint problems and musculoskeletal discomfort; (5) fatty liver disease, gallstones, and gastroesophageal reflux; (6) psychologic stress such as depression, behavioral problems, and bullying issues at school; (7) low self-esteem and low self-reported quality of life; and (8) impaired social, physical and emotional functioning. Children who are obese are more likely to become obese adults. Adult obesity is associated with a number of serious health conditions including heart disease, metabolic syndrome, and cancer.

What are risk factors for obesity?

One early major risk factor is maternal obesity during pregnancy. Children born to obese mothers are 3-5 times more likely to be obese in childhood. Women who gain much more weight than recommended during pregnancy have children who have a higher BMI than normal in adolescence. High BMI increases the risk of metabolic and CVDs and some cancers; it is the most important modifiable risk factor for diabetes.

How is obesity diagnosed?

The diagnosis of obesity depends on the measurement of excess body fat. Actual measurement of body composition is not practical in most clinical situations. BMI may be an imperfect measure of body fat and real health risk. There are racial and ethnic differences in body fat at the same BMI level.

What are the categorizations for weight status in children?

The following definitions are used to categorize weight status for children between 2 and 20 years of age: Underweight - BMI <5th percentile for age and sex. Normal weight - BMI between the 5th and <85th percentile for age and sex. Overweight - BMI ≥85th to <95th percentile for age and sex. Obese - BMI ≥95th percentile for age and sex. Severe obesity - BMI ≥ 120 percent of the 95th percentile values or a BMI ≥35 kg/m2 (whichever is lower)

What is the importance of physical activity?

The importance of physical activity should be emphasized. For some children, organized sports and school-based activities provide opportunities for vigorous activity and fun, whereas for others a focus on activities of daily living, such as increased walking, using stairs, and more active play may be better received. Children should have an hour of activity a day. Time spent in sedentary behavior, such as television viewing and video/computer games, should be limited.

Who is at risk of becoming obese?

The most significant prevalence of obesity in race is in African-American (19.5%) and Hispanic children (21.9%). Individuals with lower income and/or education levels are disproportionately more likely to be obese.