Childhood Obesity

Childhood Obesity

is a condition where excess body fat negatively affects a child's health or well being.

Epidemiology• The prevalence has increased at

an alarming rate.• Globally, in 2013 the number of

overweight children under the age of five, is estimated to be over 42 million.

• In 1996, Egypt had the highest average BMI in the world at 26.3.

•  In 1998, 1.6% of 2- to 6-year-olds, 4.9% of 6- to 10-year-olds, 14.7% of 10- to 14-year-olds, and 13.4% of 14- to 18-year-olds were obese.

Diagnosis of childhood obesity

• Body mass index (BMI) is acceptable for determining obesity for children two years of age and older.Formula: weight (kg) / [height

(m)]2

• The normal range for BMI in children

vary with age and gender.

• While a BMI above the 85th percentile is defined as overweight, a BMI greater than or equal to the 95th percentile is defined as obesity by CDC.

• References:- Haemer MA, Daniels SR. Special issues in treatment of pediatric obesity. In: Gray GA,

Bouchard C, editors. Handbook of obesity, volume 2: clinical applications. 4th ed. Boca Raton: CRC Press; 2014.

Public Health Agency of Canada (2012). Curbing Childhood Obesity: A Federal, Provincial and Territorial Framework for Action to Promote Healthy Weights. http://www.phac-aspc.gc.ca/hp-ps/hl-mvs/framework-cadre/index-eng.php

http://www.ncbi.nlm.nih.gov/pmc/articles/ http://www.who.int/countries/egy/en/ http://www.cdc.gov/healthyschools/obesity/facts.htm

• Name :- Mostafa Mohamed Mostafa Abdelkader

• ID :- • 897

Thank you

Causes of childhood obesity

• By: Mustapha Mansour Ahmed • No.: 898

• Genetics and early life factors.– Leptin encoding gene mutation.– Syndromes with certain genetic

mutations. (Prader-Willi).• Neuroendocrinal causes.

– Hypothyroidism.– Cushing’s $.– 1ry hyperinsulinism.

Diet and Energy input.

Physical activity and

Life style.

Thank you

METABOLIC SYNDROME

ابراهيم حلمي معتز يونس

900

Metabolic syndrome

High blood glucose level

Visceral obesity

Reduced HDL

Raised triglycerides

High arterial blood

pressure

High arterial blood pressurepathophysiology

obesity insulin resistance

hyperinsulinemia

increases the

sympathetic activity

Increases the activity in the renin-angiotensin

system

hypertension

Classification Systolic or diastolic blood pressure*Normal < 90th percentile

Prehypertension 90th to < 95th percentile or ≥ 120/80 mm Hg†

Stage 1 hypertension 95th to < 99th percentile plus 5 mm Hg

Stage 2 hypertension > 99th percentile plus 5 mm Hg

Diagnosis

NHBPEP Classification of Prehypertension and Hypertension in Children and Adolescents

Management :

If blood pressure < normal

Lifestyle modification for several weeks

BP not on goal : add ACEI or ARB

BP not on goal : add CCB

BP not on goal : add carvedilol or nebivolol

mechanismHyperglycemia

• Impaired fasting glucose (IFG): IFG is 100-125 mg/dL

• Impaired glucose tolerance (IGT): A plasma glucose level (obtained 2 hours after a 75-g oral glucose challenge) > 140 mg/dL but < 200 mg/dL

• Hemoglobin A1c (A1c): A1c level of 5.7%-6.4% as an indicator of prediabetes. The advantage of A1c measurement is that it reflects plasma glucose levels over time and does not require fasting

Prediabetes

Criteria for diagnosing diabetes in childhood are based on glucose levels and the presence of symptoms :

1. Fasting glycemia > 126 mg/dl 2. Post-overload glucose levels with 1.75 g/kg of anhydrous glucose up to 75 g dissolved in water, ≥ 200 mg/dl3. Classic symptoms of diabetes and casual glycemia ≥ 200 mg/dl, where ‘casual’ is defined as any time of day, not related to the last meal, and ‘classic symptoms’ include polyuria, polydipsia and unexplainable weight loss.

Plasma C peptide levels over 1 ng/mL one year after diagnosis are highly suggestive of T2D

Diet

Exercise

pharmacotherapy

Management

By: Manar SabryNo.: 902

Prevention and treatment of child obesity

• OFFICE-BASED MANAGEMENT.

• MULTIDISCIPLINARY AND COMMUNITY-BASED MANAGEMENT.

OFFICE-BASED MANAGEMENT. Anticipatory Guidance: Establishing Healthy Eating Habits in Children

•Do not punish a child during mealtimes with regard to eating. The emotional atmosphere of a meal is very important. Interactions during meals should be pleasant and happy

• Do not use foods as rewards.

•Parents, siblings, and peers should model healthy eating, tasting new foods, and eating a well-balanced meal.

• Children should be exposed to a wide range of foods, tastes, and textures.

• Foods should be offered multiple times. Repeated exposure to initially disliked foods will break down resistance.

• Offering a range of foods with low energy density helps children balance energy intake.

• Restricting access to foods will increase rather than decrease a child's preference for that food.

• Forcing a child to eat a certain food will decrease his or her preference for that food. Children's wariness of new foods is normal and should be expected.

• Children tend to be more aware of satiety than adults, so allow children to respond to satiety, and let that dictate servings. Do not force children to “clean their plate”.

MULTIDISCIPLINARY AND COMMUNITY-BASED MANAGEMENT.

• Community-based programs to inform families regarding age-appropriate healthy eating choices, meal and portion size planning, decreasing “screen time,” and approaches to increasing physical activity provide an important service for families with children at risk for becoming overweight or mildly to moderately overweight without comorbidities.

• Teams may include a physician, a psychologist, a dietitian, an exercise specialist (physical therapist, exercise physiologist, educator), a nurse, and counselors.

  Proposed Suggestions for the Prevention of obesityPREGNAN

CY

POSTPARTUM

AND INFANC

Y

FAMILIES SCHOOLS

COMMUNITIE

S

HEALTH CARE

PROVIDERSINDUSTR

Y

GOVERNMENT AND

REGULATORY AGENCIES

MEDICATIONS.

Pharmacologic treatment is sometimes

indicated as an adjunct to diet

and physical activity in

overweight adults with

obesity -related complications.

sibutramine

Orlistat

Topiramate

Metformin

octreotide

Rimonabant