Advanced Nutrition Obesity 3 MargiAnne Isaia, MD MPH

CHILDHOOD OBESITY Overweight: BMI >95 percentile for age and gender At risk for overweight 85 < BMI < 95 Critical periods for the onset: fetal life and adolescence: - developmental stages in which physiologic alterations increase the later prevalence of obesity Early environmental factors Prenatal influences: - fetal under nutrition and impaired fetal development - long term effects on organ functions - maternal smoking and diabetes - increase the risk of being overweight as children and adults Breast feeding - could be protective against obesity Family environment - Children of obese parents have an increased risk 25-80% of overweight children remain overweight as adults

CHILDHOOD OBESITY Epidemic increase in childhood and adolescent overweight US In the last 20 years, overweight has: - doubled among children age 6-11 - tripled among adolescents 12-19 Childhood obesity Australia, Japan, Brazil, Chile, Western Samoa, Mauritius, India, China World Health Organization (WHO) Overweight – a complex condition, with serious social and psychological dimensions, that affects virtually all age and socioeconomic groups and threatens to overwhelm both developed and developing countries

CHILDHOOD OBESITY CO MORBIDITIES Cardiac risk factors blood pressure lipid level Insulin levels Childhood type 2 Diabetes Mellitus onset as early as age 6, most approx. age 10 prevalence among newly diagnosed children/adolescents (aged < 18 years) = 8% - 45% Ovarian hyper - androgenism (amenorrhea) Respiratory effects (asthma) Other…

CHILDHOOD OBESITY The eating habits you give your child can last a lifetime

OBESITY SCREENING (FOR CHILDHOOD OBESITY) Initial screen Second-level screen In-depth medical Assessment Overweight BMI At risk of Overweight + Family history Blood pressure Total cholesterol Large DBMI Concern about weight If any positive _ Not at risk of Overweight If all negative Note in the chart No therapy Return next year for screen Return next year for screen

CHILDHOOD OBESITY Clinical assessment History - age of onset of overweight, symptoms - (pregnancy: maternal Gestational Diabetes) - family history of overweight or associated diseases Dietary history 24-hour recall quantitative questions qualitative questions Physical activity level – time outdoor Secondary activity – time Review of system (headache, visual changes, snoring, dyspneea on exertion, abdominal pain, irregular menstrual periods, hip pain.

CHILDHOOD OBESITY Clinical Assessment - Physical examination Calculation of BMI (CDC charts) Inspection and measurement of the triceps skin fold thickness (helps establish excess weight, represents body fat/increased frame size) Blood pressure (appropriate size cuff & age–appropriate standards) Skin inspection Funduscopic exam ENT exam (enlarged tonsils) – sleep apnea Abdominal exam Hip flexion

LABORATORY ASSESSMENT Serum cholesterol levels Liver enzymes Urinalysis (glucosuria) Fasting Glucose and Insulin levels – may help to classify the risk of DM in a child a adolescent with Acantosis Nigricans Sex hormones, LH, FSH - for girls with signs & symptoms of Polycystic Ovary Disease

CHILDHOOD OBESITY PRIMARY CARE Basic assessment of weight status Eating patterns possible “emotional” overeating encourage family meals encourage division of responsibility in eating: -parent provides healthy food at regular meals -child decides what to eat and how much form what is offered Activity patterns encourage child activity and family activities set limits for TV, video games and computer time Psychosocial risk home, school, friends, depression, stress, risk behavior Parenting skills reframing the parental role Care planning referrals: counseling for psychosocial issues, family-based programs with behavioral component counseling with Registered Dietitian

CHILDHOOD OBESITY THE PUBLIC HEALTH APPROACH Schools increase quantity and quality physical education integrate food and nutrition education into curricula increase accessibility for healthy choices in school meals Communities advocate for convenient, safe, and adequate places for children to play and take part in physical activity support programs which enable parents to model and support healthy lifestyles for their children Media reduce or eliminate messages which promote unhealthy eating and sedentary lifestyles Food manufacturers limit marketing of high-calorie, nutrient-poor food products Policy access to health services for children insurance coverage for family-based prevention and treatment of childhood overweight promote the funding of applied research to identify successful intervention to prevent childhood overweight

References: www.brightfuture.org Dietz WH, Robinson TN. Overweight children and adolescents N England J Med, 352:20, 2005 www.pubmed.com

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