1. Advanced Nutrition
Obesity 3
MargiAnne Isaia, MD MPH

2. CHILDHOOD OBESITY
Overweight: BMI >95 percentile for age and gender
At risk for overweight 85 < BMI < 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

3. 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

4. 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…

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

6. 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

7. 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.

8. 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

9. 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

10. 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

11. 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

12. References:
Dietz WH, Robinson TN. Overweight children and adolescents N England J Med, 352:20, 2005

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