CHILDHOOD OBESITY

Prof.(Dr) Maniruzzaman Bhuiyan Prof.(Dr) Durdana A. Bhuiyan

 Childhood Obesity - Overview
 For Children Between 2 & 20 Years of Age
 Underweight – BMI < 5th percentile for age & sex
 Normal weight – BMI between the 5th & 85th percentile
 Overweight - BMI between the 85th & 95th
 Obese – BMI > 95th percentile
 Severe obesity – BMI > 120% of the 95th percentile values

Obesity, overweight, normal, underweight are assessed by measuring the body mass index (BMI)
(From weight in kg & height in m2)
Ways to Measure Obesity -Obesity is Measured by BMI (From weight in kg & height in m2)
Skin Fold Thickness
Measurement of triceps & sub-scapular skin fold thickness by Harpenden Calipers.
 Measurement of Waist Circumference
Measured at a point midway between the 10th rib and the iliac crest
A. From Measuring Body Mass Index (BMI)
Interpretation

 underweight <5%

 normal weight 5th - 85th

 Overweight 85th - 95th

Obesity > 95th

B. Skin Fold Thickness or Caliper’s Test

Measured by thickness of skin over triceps or over the calf muscle or sub scapular skin fold

C. Waist Circumference Measurement

Measured at a point midway between the 10th rib and the iliac crest
Pathophysiology of Childhood Obesity

Excess fat accumulates in children &

adolescents when there is an increase in
energy consumption & a decrease in
energy expenditure due to a secondary
lifestyle such as watching television or
computer & video game use.

Viscous cycle of childhood obesity

 Etiology of Childhood Obesity
 Constitutional
 Activity Related
 Due to an imbalance between energy
 Less physical activity
consumption energy expenditure
 Indoor activity ( watching TV, playing video games
 Gap between physical activity & choice of food
 Obesity runs in families - obese parents tend to
 Other Causes of Obesity
have obese children
 Hormonal causes (hypothyroidism, cushions syndrome,
 An obese child tends to become an obese adult
hyper - insulinism , growth hormone deficiency)
 Environmental
 Hypothalamic damage (trauma, post- encephalitis,
 Socio economic deprivation
craniotharyngiona)
 Single child , single parent
 Syndrome (downs, prader - willi , laurance - moon, biedo)
Diet related
 Drugs ( insulin, steroids, anti -thyroid drugs, sodium proate)
 Bottle fed in infancy
 Immobility ( spina bifida, cerebral palsy)
 High fat diet ; Bad eating practices
Complications

 Psychosocial

Poor self-esteem

Depression

Eating disorders

Neurological

Pseudotumour cerebri

Pulmonary

Sleep apnoea

Asthma

Exercise intolerance
 Musculoskeletal
Cardiovascular
 Slipped capital femoral epiphysis
 Dyslipidaemia
 Blount’s disease
 Hypertension
 Forearm fracture
 Coagulopathy
 Flat feet
Gastrointestinal
Endocrine
Fatty liver
Steatohepatitis  Type 2 diabetes
Gallstones  Precocious puberty
Renal
 Polycystic ovary syndrome (girls)
Glomerulosclerosis
 Hypogonadism (boys)
Investigations

Assessment of sugar profile Lipid profile

Fasting blood sugar Thyroid function test (T4 and TSH )

Glucose tolerance test  Three 24 hour urinary cortisol estimation

Urine for glycosuria  X- Ray for bone age

Fasting serum insulin

 Sex hormone binding globulin concentration
 To detect the presence of insulin resistance
 Treatment (Mainly Preventive)

A. Counseling

B. Supportive

 Behavior modifications to control feeding habits and appetite (at least 5 or more vegetables & fruits everyday)

 water should be the only drink avoid soft drinks & junk foods as much a as possible (choose healthy zero
sugar sweetened drinks)

 Power down (not more than 2 hours of screen time a day /watching TV/playing video games)

 Play actively (at least 1 hour each day)

 Avoid stress

 Family time should be spent more often together

C. Treatment of cause if any

Vicious Cycle of Obesity Must be Corrected