Dr. P. RAGHUPATHY, B.Sc., MD, DCH, FRCP *
Former Professor & Head of the Department of Child Health, Christian Medical College, Vellore.
Senior Consultant in Pediatric Endocrinology, Sagar Apollo Hospital, Tilak Nagar, Bangalore.*
Childhood obesity is a significant public health problem. There is a significant increase in the prevalence of obesity in childhood and adolescence both in the developed and developing world.
Methods of Measuring Obesity:
BMI is defined as weight in kilograms divided by height in meters squared (kg/m2). Other methods of obesity measurement (skin fold thickness, body circumferences, dual energy x-ray absorptiometry, bioelectric impedance analysis, densitometry, computerized tomography and magnetic resonance imaging) are used on a smaller scale.
Obesity is defined as a BM I> / = 95th percentile for age and gender. Children with a BMI between the 85th to 95th percentile for age and gender are defined as being at risk of obesity.
Genetic and environmental factors are present in the majority of cases of obesity.
- Genetic factors
- Environmental factors: Increased caloric intake and decreased physical activity.
- Endocrine causes: Hypothyroidism, Cushing's syndrome, Growth Hormone deficiency.
- Genetic Syndromes : Prader-Willi, Cohen, etc.,
- Insulin resistance and type II Diabetes Mellitus
- Hypertensionli>Hepatic disease
- Cholecystitis and cholelithiasis
- Polycystic ovary syndrome
- Orthopedic complications : Blount's disease, Perthes' diseaseli>Sleep apnea or hypoventilation syndrome
- Pseudotumour cerebri
- Psychosocial complications
- Type II diabetes
- Atherosclerosis and coronary heart disease
- Liver fibrosis / cirrhosis
- Colorectal cancer
- Obese adolescent girls tend to have lower household income and less education when they are adults (Dietz, 1998).
- A doubling of the relative risk of mortality in adults who had childhood obesity (Must and Strauss, 1999).
- If the obese child is not short for his / her specific age and sex and is not developmentally delayed and does not have dysmorphic features, obesity is very unlikely to be secondary to an endocrine disorder or a genetic syndrome.
- Assess for the possible complications
- Assess the family members
- Assess psychological problems
- Encourage healthy dietary practices
- Establish healthy physical activity program
- Assess patient's and family's routine daily activities, pay particular attention to the amount of TV viewing.
- Develop plan for increasing activities, such as family outings
- Management is a long-term process
- Pediatric obesity management programs are often multidisciplinary
- Family involvement is an essential component
Behaviour Modification forms an important part of management of obesity.
Goals of Therapy:
- Medical goals: resolution or improvement of obesity sequelae, e.g., hypertension, dyslipidemia.
- Weight maintenance: for children with BMI between 85th and 95th percentile and no complications of obesity.
- Weight loss: for children with BMI>95th percentile or for children with BMI>85th percentile and who have at least one complication of obesity; weight loss should not be more than 0.5 kg per week.
- Behavioural: acquiring and maintaining healthy weight-management behaviours.
|Follow up |
duration of follow-up and the frequency of visits will vary depending on the individual patient; in general; initial follow-up should be 1 to 2 weeks following the initial visit.
- Follow-up visits should be frequent with short intervals initially, e.g., 2 weeks apart, then the interval between visits can be increased.
- Laboratory tests can be repeated in 6 months.
Currently, a few drugs are undergoing testing for their efficacy and safety in obese children and adolescents, but currently no such drugs are approved for pediatric use.
|How to Cite URL :|
|FRCP D M B R P D.. Available From : http://www.pediatriconcall.com/fordoctor/ Conference_abstracts/report.aspx?reportid=21|