Childhood Obesity

GDS K49

Subdiv. of Nutrition and Metabolic Disease

Dept. of Child Health
Medical Faculty, Univ. of Sumatera Utara

Definitions
• Obesity
– Excessive deposition of adipose tissue

• Overweight
– Weight in excess of the average for
height
– ↑ lean body mass or adipose tissue or
both

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 Clinical Manifestations
• Round face, double chin
• Increased truncal fat deposition
• Gynecomastia
• Pendulous abdomen and white/purple striae
• Buried penis
• Tall for age & Early menarche
• Genu valgum

Clinical manifestations

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 Clinical manifestations

Anthropometric Measurement

• BMI ≥ 95th percentile

• % Ideal Body Weight (IBW) ≥ 120%
• Triceps Skinfold ≥ 85th percentile
• Fat distribution patterns (waist-hip-
ratio)
– < 0.8 gynecoid type (feminine type)
– > 0.8 android type (masculine type)

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 Causes
• Positive energy • Medical causes
balance (± 95%) (<5%)
– Excessive caloric – Endocrinology
intake
• Cushing syndr.
– Decreased
physical activity • Growth hormone
– Decreased deficiency, etc
resting metabolic – Genetics
rate
• Prader Willi, etc

4
 Complications
• Endocrine : Insulin resistance, NIDDM
– Impaired glucose tolerance, acanthosis nigricans
• Cardiovascular: dyslipidemia,hypertension
– Altered lipid profiles
• Respiratory : obstructive sleep apnea,
Pickwickian syndrome
– Snoring and restless sleep, abnormal lung function
tests
• Orthopedic : Blount disease, slipped capital
femoral epiphysis, gout

Complications
• Gastrointestinal : Cholelithiasis, NASH
– Hepatomegaly, altered serum transaminases

• Sexual development & growth : abnormal

growth acceleration, early onset of menarche,
pubertal gynecomastia

• Psychiatric : psychosocial dysfunction

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 Goals of treatment program

• Appropriate for the child’s age and

developmental status

• Result in significant weight reduction

to within 20% of the IBW

• Long-term appropriate eating and

physical activity that result in weight
maintenance but do not hinder growth
& development

Principles of treatment

• Dietary management
• Physical activity (exercise)
• Behaviour modification
• Family involvement
• Alternative therapy

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 Dietary management
• Hypocaloric balance diet
– Reduces caloric intake 200-500 kcal/day of
usual intake
– 50% carbohydrate, 30% fat, and 20% protein

• Protein Sparing Modified Fast Diet

(4-12 weeks)
– 600-800 kcal/day
– 1.5-2 g protein/kg ideal body weight/day
– No carbohydrate. Low starch vegetables
– Water or calorie-free fluid at least 2 L/day
– Daily supplements : multivitamins & mineral

Principle of exercise
• Frequency 3-5 x/week
• Intensity 50-60% maximal ability
• Duration 15 min initially, building to 30-40 min
• Mode : use large muscles walking, jogging,
swimming, cycling
• Interest : patient dependent tennis, dancing,
martial arts, skating
• Enjoyment : important factor
• Incorporation into functional activities
walking to school, taking stairs vs elevator,
bicycles vs cars
• Reducing passive activities TV watching,
videogames

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 Behaviour modification
• Diet and activity self monitoring
• Set weekly goal
• Stimulus control
– Eat meals and snacks at scheduled times, etc
• Cue elimination
– Store all food out of sight, leave the table
immediately after eating, etc
• Behaviour substitution
– Substitute exercise for snacking, etc
• Parental support

Alternative (aggressive) therapy

(for morbid obesity)
• BMI ≥ 95th percentile
– Very Low Caloric Diet (PSMF)
• Pharmacotherapy
– at this time no drugs approved for
use in children
• BMI ≥ 97th percentile (rarely used)
– Bariatric surgery (reduced caloric &
nutrient absorption)
• jejunoileal bypass
• Roux-en-Y gastric bypass

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 Recommended Treatment Algorithm

2-7 years of age

BMI BMI
85th –95th > 95th

Complications + :
Complications - mild hypertension,
insulin resistance,
dyslipidemia

Weight
maintenance
Weight loss

Recommended Treatment Algorithm

7 years of age / older

BMI BMI
85th – 95th
95th

Complications - Complications +

Weight maintenance Weight loss

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 Preventing Obesity:
Tips for Parents
Respect your child's appetite: children do not need to finish every bottle or
meal.
Avoid pre-prepared and sugared foods when possible.
Limit the amount of high-calorie foods kept in the home.
Provide a healthy diet, with 30 percent or fewer calories derived from fat.
Provide ample fiber in the child's diet.
Skim milk may safely replace whole milk at 2 years of age.
Do not provide food for comfort or as a reward.
Do not offer sweets in exchange for a finished meal.
Limit amount of television viewing.
Encourage active play.
Establish regular family activities such as walks, ball games and other
outdoor activities.

Components of a Successful
Weight Loss Plan
Component Comment
Reasonable weight- Initially, 5 to 10 lb, or a rate of 1 to 4 lb per month.
loss goal
Dietary management Provide dietary prescription specifying total number
of calories per day and recommended percentage of
calories from fat, protein and carbohydrates.
Physical activity Begin according to child's fitness level, with
ultimate goal of 20 to 30 minutes per day (in
addition to any school activity).
Behavior Self-monitoring, nutritional education, stimulus
modification control, modification of eating habits, physical
activity, attitude change, reinforcements and
rewards.
Family involvement Review family activity and television viewing
patterns; involve parents in nutrition counseling.

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 The Pickwickian syndrome
• Severe cardiorespiratory distress &
alveolar hypoventilation

• Decreased pulmonary tidal &

expiratory reserve volume

• Clinical manifestation : polycytaemia,

hypoxemia, cyanosis, cardiac
enlargement, congestive cardiac
failure, somnolence

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