Dr Ira Shah
How is An Obese Child Managed?
The child is first assessed for the degree of obesity. Although measurement of skin fold thickness may be unreliable, at triceps skin fold thickness higher than 95th percentile suggests that child is overweight. ( triceps skin fold thickness is measured at the midpoint between the acromion and olecranon process on the posterior surface of the right arm, with the arm relaxed and measured with a caliper). Visceral obesity is measured directly by CTScan or MRI to find out the risk of cardiovascular disease. After calculating the BMI, the child is evaluated for the cause of obesity. Usually, children with endogenous obesity are short and have delayed done age whereas those with exogenous cause are tall and have advanced bone age. It is always imperative to rule out hypothyroidism in every case of obesity and a T3, T4, TSH level may be useful. If Cushing's syndrome is suspected, urine free cortisol or Dexamethasone suppression test may be indicated. Genetic disease may require karyotyping including high resolution banding.

Complications like pseudotumor cerebri, sleep apnea, obesity hypoventilation syndrome and orthopedic problems may require referral to the pediatric obesity treatment centres. Children younger than 2 years of age with severe obesity require evaluation in a pediatric obesity center before treatment is considered.

A lipid profile should be done if there is a family history of myocardial infarction before 50 years of age, hypertension and dyslipidemias to rule out dyslipidemias.

Once, the child has been evaluated for the cause and complications of obesity, the treatment is initiated. The main criteria of treatment is weight control in all overweight children of 2 years of age. i.e. maintenance of baseline weight. It allows a gradual decrease in BMI as the child grows in height. For children more than 7 years of age, weight maintenance may be continued if there are no secondary complications and BMI is between 85th and 95th percentile. However if the BMI is above 95th percentile, or associated with complications, then weight loss is recommended. It is recommended to have a weight loss of 0.5 kg per month. The goal should be to achieve a BMI below the 85th percentile.

To achieve the above goals, intervention should begin early. The most important aspect is that the family should be ready to accept change. The family should be informed about the complications of obesity. The family and all caregivers should participate in the treatment program. The family should be taught to monitor eating and activity in the child. The treatment programs should be directed towards a permanent change. The best way to achieve all this is diet modification and increase the activity level of the child. Instead of calculating the amount of calories consumed in a day, reduction or elimination of specific food may reduce the calories without making the patient feel hungry or deprived. The patient can be refrain from eating one or two high caloric food such as biscuits, ice-cream, fried foods etc. Even a 100 kcal deficit per day could lead to a 5 kg loss of weight in a year. Another way to maintain weight is to reduce inactivity. The best way to do that would be to limit television viewing to 1 to 2 hours per day.

The goal of therapy is healthy eating and activity and not attainment of ideal body weight.

Obesity Obesity 02/23/2001
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