Childhood obesity

etiology,evaluation,traffic light diet plan,treatment

1. CHILDHOOD OBESITY

2. DEFINITION BMI is the most widely used parameter to define obesity. In children >2yrs,obesity is defined as BMI >/= 95 th percentile. BMI between 85 th -95 th percentile falls in the overweight range . Weight for height >120% is considered obesity.

3. It is a global public health problem sparing only dramatically poor regions with chronic food scarcity. Prevalence is 31% in age group of 2-6yrs, 16% in ages 6-19yrs. PREVALENCE

4. ETIOLOGY 1. Environmental factors : Increased consumption of high carbohydrate beverages,fast food, increased snacking between meals, d ecline in levels of physical activity, i ncrease in sedentary activities,

5. high pressure for academic performance, s ocioeconomic status,race,gender , maternal education level, parental obesity, prenatal factors like weight gain during pregnancy,high birth weight,gestational diabetes,IUGR with early infant catch up growth,

6. chronic partial sleep loss (1.>> hunger and appetite due to decreased leptin levels and increased ghrelin levels, 2.decreased glucose tolerance and insulin sensitivity due to alterations in glucocorticoids levels, 3.synthesis of orexins,peptides in lateral hypothalamus increasing feeding)

7. 2.Genetic causes :

8. 3. Endocrine causes : Monitoring of stored fats,control over appetite,satiety occurs through neuroendocrine feedback loops L inking adipose tissue,CNS and GI tract.

9. FROM THE GIT Stimulating appetite Promoting satiety Ghrelin Cholecystokinin Glucagon like peptide-1 Peptide YY FROM THE ADIPOCYTES Adiponectin (>> levels in fasting,<< in obesity) Leptin (= satiety, low levels stimulate food intake,high levels inhibit hunger)

10. FROM THE BRAIN Neuropeptide Y Agouti related peptide stimulate appetite Orexin Melanocortins Alpha melanocortin stimulating hormone satiety

11. Endocrine causes Cushing syndrome (central obesity,hirsutism,moon face,hypertension ) Growth hormone deficiency (short stature,slow linear growth) Hyperinsulinism ( nesidioblastosis,pancreatic adenoma,Mauriac syndrome)

12. Hypothyroidism (short stature,weight gain,constipation,cold intolerance) Pseudohypoparathyroidism (short metacarpals,subcutaneous calcifications,dysmorphic facies,MR,short stature,hypocalcemia,hyperphosphatemia )

13. 4.CONSTITUTIONAL OBESITY No organic cause. Due to imbalance between energy intake and expenditure. These children are tall for age -> differentiating factor from pathological obesity. Normal development,obesity is proportional. Unnecessary investigations to be avoided.

14. 5.HYPOTHALAMIC OBESITY Following surgery,radiation,tumors,trauma,infection . Rapid onset obesity sets in. 6.DRUGS Anti epileptic drugs,steroids,estrogen,atypical antipsychotics.

15. COMORBIDITIES 1.Type-2 diabetes (>> insulin resistance) 2.Hypertension 3.Hyperlipidemia 4.Non alcoholic fatty liver disease,cirrhosis 5.Risk of chronic inflammation (low levels of adiponectin - anti-inflammatory peptide, h igh levels of proinflammatory peptides IL-6,TNF-a )

16. 6.Obstructive sleep apnea 7.Orthopedic complications like Blount disease,slipped femoral capital epiphysis 8.Mental health problems like low self esteem,depression,eating disorders 9.Metabolic syndrome 10.PCOS

17. EVALUATION Identified as a part of routine medical checkup. Perform detailed physical examination. Charting growth charts for weight,height,BMI . Consider possible medical causes for obesity (poor linear growth,rapid changes in weight gain). Detailed history of family eating and activity patterns ( description of regular meal,snacking,physical and sedentary activities).

18. Family history of adiposity and obesity related disorders. Laboratory testing to identify comorbid conditions.

19. INTERVENTION Nutritional advice + exercise + cognitive behavioral therapy. Meals should be based on fruits,vegetables,whole grains,lean meat,fish and poultry. Gradual approach to cut down calories. Family support is crucial.

20. RECOMMENDED CALORIC INTAKE DESIGNATED BY AGE AND GENDER

21. “TRAFFIC LIGHT” DIET PLAN Groups foods into those which can be consumed without any limitation (green), in moderation (yellow), reserved for infrequent treats (red). Can be adapted to any ethnic group/regional cuisine.

22. Increasing physical activity contributes to weight loss,decreases risk for cardiovascular disease. Restriction of screen time to no more than 2hrs/day in children >2yrs old,no television for children less than 2yrs (AAP).

23. Pharmacological therapy : Adjunctive,>> rate of weight loss

24. Bariatric surgery : For adolescents with a BMI >/= 40, a fter attaining complete skeletal maturity, s uffering from medical problems associated with obesity, after they have failed 6 months of multidisciplinary weight management program (Roux-en- Y ,adjustable gastric band)

25. PREVENTION Improved food choices+increased physical activity+reduced screen time. Promotion of breast feeding(exclusive for 6 months,total BF for 12months). Introduction of infant foods at 6 months with focus on cereals,fruits,vegetables . Introduction of lean meat,poultry,fish later in first year of life. Avoiding highly sugared beverages and foods.

26. Family approach , scheduled meals. Frequent snacking to be avoided. Limiting screen time for children. 60min/day of activity for children. Encourage walking to school. Use of mass media.

27. THANK YOU