Overweight
26.2.2015 thu NAWAL
EPIDEMIOLOGY
The predictor of overweight
high birth weight,
Children who are overweight are more likely to be over weight as adults.
The strongest predictor is parental obesity.
PATHOGENESIS
Overweight results from a dysregulation of caloric intake and energy expenditure.
, “thrifty genotype” that maximized energy storage in adipose tissue, improving survival
during periodic famines.
In industrialized countries, thrifty genotype become detrimental instead of beneficial.
Multifactorial Causes of Obesity
Increased eating
Decreased activity
Family history
Etiology
ENVIRONMENTAL CHANGES:-
1-The type and cost of food. high levels of calories, fat, simple carbohydrates, and sodium, and
low levels of fiber and micronutrients. Snacking .
2- An increase in sedentary activity and a lack of exercise. watchTV, video games, Internet
computer use, telephone use, and home viewing of movie
3-decrease amount of time spent sleeping,decrease leptin& increase ghrelin
2-Genetic determinant may be impor for individual susceptibilities. More than 200 genes or
gene markers are associated with obesity.
Stress
Drugs Glucocorticoids, Antidepressants,
Anticonvulsants:
Genetics
Genetic &endocrine causes of Obesity
cushing syndrome,
Hyperinsulinism :Nesidioblastosis.
Growth h deficiency
Hypothyroidism
ENDOGENOUS WEIGHT CONTROL MECHANISMS
. (appetite and satiety) occur through neuroendocrine feedback to the central nervous system
from:-
Gastrointestinal hormones, including cholecystokinin, glucagon-like peptide-1, and vagal
neuronal feedback promote satiety, whereas ghrelin stimulates appetite.
Adipose tissue provides feedback regarding energy storage levels to the brain through hormonal
release of leptin and adiponectin which act on the hypothalamus and on the the brainstem.
DIAGNOSTIC CRITERIA FOR OVERWEIGHT
calculation of the BMI by dividing the weight in kilograms by the height in meters squared
(kg/m2). most reliable method to determine healthy and unhealthy adiposity.
BMI +clinical assessment is sufficient to make the diagnosis.
Body Mass Index (BMI) Classification of Children>2y and Adolescents
Underweight <5th percentile
5th- 84th Normal weight
85th–94th percentile overweight
≥95th percentile pediatric obesity
EVALUATION OF THE OVERWEIGHT CHILD.
exploring dietary practices.
family structure, and habits.
FH of obesity
Pseudohypoparathyroidism
Prader-Willi syndrome
Turner syndrome
Down syndrome
*
<5%
determine if there may be an underlying secondary cause of obesity
if there are current comorbidities from being overweight
Comorbidities of Obesity:
Pulmonary:- Asthma, Obstructive sleep apnea
endocrine:- Type 2 diabetes mellitus
Polycystic ovary syndrome
CVS:- Dyslipidemia, Hypertension
GIT :- Gallstones, Nonalcoholic fatty liver disease
orthopedic :-Musculoskeletal problems
slipped capital femoral epiphysis
psycologic:- Behavioral complications
CNS :- Pseudotumor cerebri
Lab
Initial
F.glucose
Cholesterol& triglyceride.
Liver function test.
TREATMENT
1-age of the child.
2- the severity of complications from being overweight.
points consider in the ttt:-
-severe caloric restriction & weight loss may be detrimental.
-Weight maintenance rather than weight loss is initial goal..
-Weight loss should be attempted only in skeletally mature children or in those with serious
complications.
-Weight loss should be slow (1 lb or 0.5 kg or less/wk),.
-substantial lifestyle changes.
Multidisciplinary and community-based approaches to overweight management
-Severely overweight children and
- adolescents with complications from obesity
a multidisciplinary team may include a physician, a psychologist, a dietitian, an exercise
specialist (physical therapist, exercise physiologist, educator), a nurse, and counselors
DIETARY COUNSELING
A successful approach used in preschool and preadolescent children is the traffic light or
stoplight diet.
Stoplight Diet Plan
1-
GREEN LIGHT FOOD
Low-calorie, high-fiber, low-fat, nutrient-dense , Fruits, vegetables,
Unlimited
2-YELLOW LIGHT FOODS
Nutrient-dense, but higher in calories and fat
Lean meats, dairy, starches, grains, Limited
3-RED LIGHT FOODS
High in calories, sugar, and fat
Fatty meats, sugar, fried foods
Infrequent or avoided
PHYSICAL ACTIVITY.
1-Decreasing sedentary activity.
2- Increased activity → increases calorie expenditure & decrease appetite..
Simple measures, such as daily walks, In the severely overweight child, problems of exercise
tolerance may warrant referral to an experienced physical or exercise therapist..
MEDICATIONS.
-severe medical complications.
-It is of marginal value, with unclear risks, and it is best reserved for use in clinical trials.
Dietary supplements and herbal therapies are heavily marketed for weight loss
BARIATRIC SURGERY
The American Pediatric Surgical Association Guidelines recommend that surgery be considered
only in children with a BMI > 40 and a medical complication of obesity after they have failed 6
mo of a multidisciplinary weight management program
DIAA