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2 Peds Obesity
| Question | Answer |
|---|---|
| BMI note in kids | While absolute BMI defines body weight in adults, percentiles specific for age and gender define body weight for children |
| BMI 85th-94.9 percentile | Overweight |
| BMI>/= 95th percentile | Obesity |
| BMI>99th percentile | Severe Obesity |
| Endocrine causes of childhood obesity | hypothyroidism, Cushing syndrome, Growth Hormone deficiency, Acquired hypothalamic lesions. These account for <1% of causes of peds obesity and usually are associated with height and growth deficits |
| Genetic Disease/Causes of obesity | Single gene defects: Prader-Wili, Bardet-Biedl, Cohen Syndrome. Account for <3% of causes of obesity. Typically also have dysmorphic features, short stature and/or developmental delay |
| If 1 parents is obese, child has a ____ % chance of obesity | 40%. If both parents, then 80% chance of obesity |
| TV guidelines from american pediatrics | no tv under age 2 |
| 5-3-2-1-0 | 5 fresh fruits/veggies a day, 3 structured family meals, 2 hours or less of screen time, 1 hour of physical activity a day, almost none sugar-sweetened beverages |
| Core principle of motivational interviewing: | Core principle: human behavior change results from motivation, not information |
| How often should BMI be screened in kids ages 2-19 | annually. Use recumbent length-weight for children</= 2 years |
| Medical Risk Screening: Inheritable Risk | DM II, CVD, Ethnicity (non-European origin at higher risk) |
| Comorbidities of obesity | sleep problems, respiratory, GI: Nonalcoholic Fatty LIver Disease, Gallstones, GERD, Constipation; Endocrine, Nervous System Problems, CV (BP and lipids), Orthopedic, mental health |
| Endocrine Comorbities with Obesity | DM II, Insulin resistance, PCOS, Irregular menses, Advanced puberty |
| Nervous System Comorbidity of Obesity | Pseudotumor cerebri extremely rare, but obesity is a risk factor. If untreated, can lead to vision loss. ROS: severe HA w/ photophobia |
| Blount Disease | Tibia Vara. Visible bowing of lower extremities due to weight. Tx is surgery. Generally occurs after age 8 |
| Slipped Capital femoral epiphysis | more common in obese, as additional shear forces around the proximal growth plate in the hip at risk.Tx: surgery with internal fixation |
| Selection criteria for weight control surgery | BMI>/= 40with type 2 diabetes mellitus, obstructive sleep apnea, pseudotumor cerebri, or severe steatohepatitis), or a BMI of ≥50 with more minor comorbidities (hypertension, dyslipidemia, mild steatohepatitis, significant impairment in quality of life) |
| Meridia | serotonin reuptake inhibitor (appetite suppression). BMI>99% or BMI>97% with co-morbidities. 16 years or older. May cause htn and tachycardia |
| alli, xenical | Causes fat malabsorption through inhibition of enteric lipase. 12 years or older. AE: abdominal pain/discomfort, flatus, oily spotting, etc. |
| Stage 1 (prevention plus) pts should be assessed every | 3-6 months at their PCP office. Risk assessment. 5-3-2-1-0 teachign |
| Stage 2 (Structured weight management) pts should be assessed | monthly. PCP office, dietition or trained provider. Structured meal planning. Small amts of energy dense foods, reduce screen time to <1hr. 60min of supervised play, referral to dietition.Motivational interviewing |
| Stage 3 (comprehensive multidisciplinary) pts should be assessed... | weekly for 8-12 weeks, monthly follow up. Multi-practice group, community program, commercial program (MD, RD, PT, LCSW). Structured meal planning, formal monitoring, beh tx, family involvement |
| Stage 4 (tertiary care) pts should be assessed... | as per protocol. Components: structured meal planning, formal monitoring, beh. tx, family involvement, pharmacotherapy, bariatric surgery, consider meal replacement |
| Acanthosis Nigricans | Is a cutaneous finding characterized by velvety hyperpigmentation (neck, axilla, groin). More common in dark skinned people and is a marker for insulin resistance. |
| At risk for overweight is defined as | BMI greater than the 85th percentile for age |
| Currently in the US, ___% of 6-19 year olds are overweight | 34% (in 2004) |
| Environmental Risk factors that can lead to obesity: | Absence of family meals, excessive consumption of sweetened beverages, large portion sizes, frequent consumption of foods prepared outside the home, excessive tv watching, and sedentary lifestyle |
| For children older than 7 years with BMI between 85th-95th percentile, with secondary complications present, then weight loss is recommended. An appropriate goal is | 1lbweight loss/month until BMI is less than 85% |
| Name the two meds approved for obesity treatment in adolsecents | sibutramine - an SSRI approved for pts over 16 y/o (tx approved for 2 years). Orlistat - a lipase inhibitor approved for patients over 12 y/o |
| Comorbidities seen with childhood obesity | increased serum glucose, insulin, triglyceride levels, systolic htn and impaired glucose tolerance |
| large amounts of 100% fruit juice is quantified as | >12oz/day. Fruit juice does not seem to be linked to obesity unless ingested in large quantities |
| American Academy of Pediatrics recommendation on fruit juice intake | limit to 4-5 oz/day for children 1-6, and 8-12oz/day for children 7-18 |
| Low calcium intake is related to | higher adiposity |
| How much fiber should a child have each day? | "age + 5" rule for dietary fiber intake is recommended. Adult levels = 20-25g/day |
| How much exercise is recommended daily for children and adolescents? | 60 min of mod-intensity, 30 min of which should be accomplished in school |
| Which has a greater impact? Physical activity or dietary change? | Physical activity has less impact on weight loss than dietary intervention |
| Major AE of Sibutramine | Vasoconstriction, leading to increased HR and BP. This effect persists even after significant weight loss, limiting the usefulness of this drug for obese individuals with concomitant htn |
| Orlistat AE's | oily bowel movements, flatus with discharge, and oily spotting on the underwear casued by unabsorbed fat in the feces |
| Types of Bariatric Surgery: | Malabsorptive, Restrictive and combination |
| Combination Bariatric Surgery | Roux-en-Y gastric bypass: restricts food intake and the amounts of energy and nutrients the body absorbs |
| Only bariatric surgery approved by the FDA for use in adolescents | Gastric bypass procedures b/c they are the most extensively studied |
| Weight loss surgery may be considered for kids with | BMI>/= 50 or >/=40 with significant comorbidities, have experienced a failure of a formal, 6-month weight loss program, and be capable of adhering to the long-term lifestyle changes required after surgery |
| The appropriate initial treatment for overweight and obese children 2-18 years of age | Prevention plus stage. Obese children and adolescents with severe comorbidities may be immediately enrolled in a more advanced state of treatment if such services are readily available and child shows motivation for change |
| If a child is in stage 2, how many months are they given to improve before being advanced to stage 3? | 3-6months (improvement of BMI/weight status) |
| Healthy weight loss | Weight loss should not exceed 1lb/month for children 2-5 years of age or 2lb/week for older obese children and adolescents |
Created by:
ltm12