Childhood Obesity Pediatrics: October In-Service Employee Training Presentation by: Lillian Nelson

Childhood Obesity and Physical Therapy Number of pediatric PT patients with obesity has increased in recent years.  According to the CDC, the childhood obesity rate has tripled in the last 30 years.  In 2010, 17% of American children and adolescents 2-19 years of age were reported to be obese.(1) This is due to:  Shifting dietary patterns  Sedentary activities instead of active play.  Childhood orthopedic injuries due to excess weight.

Etiology  Obesity is the accumulation of excess body fat.  BMI greater than 30 kg/m^2  >25kg/m^2 is considered overweight  Positive energy balance is typically the cause.  More calories taken in than are expended (2)

Biological Factors A child’s genetics “load the gun” but their environment “pulls the trigger”. The patient’s past medical history should include these information points to help determine the cause of excessive weight gain:  “Obesogenic”  A new term for certain genetic traits that predispose someone to gain weight. (4)  Birth Weight  Infant Feeding:  Formula vs Breast Milk  Adiposity Rebound:  Lowest BMI should be at 5-6 years old before gaining body fat again into adulthood.  If the child did not have an adiposity rebound or it was not at age 5-6 this may point to other homeostatic imbalances.  Sexual Maturation:  Body fat total, distribution, and percentage are associated with maturation.  Heavier female children have earlier onset of menarche. (5)

Environmental Factors Environment is the more important, and easier to manipulate, factor when treating childhood obesity.  Intake:  Energy Density  Glycemic Index  Vegetables and Fruits  Soft Drinks  Serving Sizes  Meal Frequency, Snacking Habits  Physical Activity:  Average amount of time spent walking and bicycling in ages 5-15 dropped 40% from , mostly due to less children walking/biking to school.(3)  Sports  PE at School  Free Time:  Television Viewing and Computer Games  Parental Obesity and Family Environment:  Genetic and Shared Lifestyle  SES:  Urban poor at highest risk.  Self Esteem and Quality of Life

Weight Management in Children- Critical Measurements  BMI  Body Composition  Waist Circumference  Physiology:  ICF Model  Comorbidities  Physical Disabilities  Cognitive Disabilities  Psychology:  Depressed or Happy  Relationships (Children and Parents)

Treatment- What Determines Need for Intervention?  It is our job as PTs to recognize the need for weight loss and educate our patients of potential benefits of weight loss.  Increased Energy  Less Functional Limitations  Less Orthopedic Problems  Improved Self Esteem

Treatment Each patient’s treatment will be slightly different based off of:  BMI: Use Standard Growth Chart  95 th percentile OR 85 th percentile and presence of Co-morbidities.  Presence of co-morbidities:  Diabetes Mellitus  Dyslipidemia  Hypertension  High triglycerides  Asthma  Menstrual Problems  Sleep Apnea  Age: infancy, childhood, adolescence  Different energy needs depending on stage of life  Parent’s Weight and Lifestyle:  Parent’s play a large role in the success of the intervention (4)

Treatment (4)

Treatment  Exercise Prescription:  Based off initial evaluation  Results of submaximal exercise testing and strength testing  Goals should be to improve cardiovascular endurance and strength as appropriate.  Focus on fun activities  Weight maintenance in combination with growth in height will lead to decreased BMI over time. (2)  Maintain current weight and not gain  Supervised exercise first, then home exercise or maintenance program

Lifestyle Modifications  Teach positive lifestyle modifications that will last beyond the PT intervention!  Decrease severity of obesity related diseases, functional impairments, and limitations.  Increase self esteem and quality of life  60 Minutes of physical activity per day:  Outdoor play  Sports team  Referral to a dietician  Educate the parents:  Ways to change the family’s diet and activity level.  Limit “inactivity” such as TV watching and computer games.  Positive reinforcement and goal setting techniques appropriate for weight loss goals.  Example- As a reward for good grades, let the child have an hour at a batting cage or roller skating rink instead of candy or a new video game. (5)

Discussing the Topic of Weight  Use “people first” language  Stress that childhood obesity, if untreated, can lead to:  Life Long Obesity  Metabolic Syndrome  Cardiovascular Disease  Diabetes  Renal Failure

Family Education The family needs to be taught how to create positive changes for the child so their weight loss is maintained after they are discharged from PT.  Dietary:  Meal Planning  Availability of healthy snacks  Portions  Physical Activity:  Encourage active play  Limit sedentary activities  Behavioral:  Goal Setting  Self Monitoring  Positive Reinforcement Techniques

Works Cited 1.Han, Lawlor and Kimm. Childhood Obesity. The Lancet. May :9727, 15–21:1737– Accessed 13 October Available at 2.Racette, Susan. Obesity: Overview of Prevalence, Etiology and Treatment. Journal of The American Physical Therapy Association. March : Accessed 14 October Available at: 4e50-b086-c9cf4a1473e2http://ptjournal.apta.org/content/83/3/276.full?sid=99f5772b-187e- 4e50-b086-c9cf4a1473e2 3.Stewart, Laura. Childhood Obesity. Journal of Medicine. January :1: Available at: 4.Stanford, Breckon and Copeland. Treatment of Childhood Obesity: A Systematic Review. Journal of Child and Family Studies :545–564. Accessed 13 October Available at: content/ a045x772h054406r /fulltext.pdfhttp://0- content/ a045x772h054406r /fulltext.pdf 5.Wang, Y. Child Obesity and Health. International Encyclopedia of Public Health Accessed 14 October Available at