Lancaster Physician Summer 2017 - 15
SPRING 2017
Childhood Obesity
Definition of Obesity
In adults, overweight and obese classifications are based on the body mass index
(BMI). In children, the BMI is calculated
using the same formula as adults. However,
given the variation that occurs in weight
and height and that relation to body fatness, the numbers are age and sex specific.
Once the BMI is calculated, it is expressed
in relation to other children of the same
age and sex. The CDC has growth charts
based on national survey data collected
in the 1960s and late 1980s - 1990s. The
percentiles that the BMI falls into define
whether a child is underweight, healthy
weight, overweight, or obese.
Causes and Risks of
Pediatric Obesity
The causes of excess weight gain are
multifactorial-from genetics to behaviors
(for example, sedentary lifestyle coupled
with high calorie meals) to the community
in which a child is growing up. There
are short- and long-term implications of
obesity. Children who are obese are more
likely to be obese as adults, which increases
the risk of cardiovascular-related disease.
According to various studies published
in pediatric journals, obese children are
at higher risk for conditions like asthma,
type 2 diabetes, bone and joint problems.
They are also more likely to be bullied than
their peers who have a normal weight.
Evaluation
Once diagnosed, the evaluation of the
obese child includes a thorough history and
physical exam as well as laboratory studies as
indicated by the initial assessment. The goal
of this evaluation is to attempt to identify
treatable causes of obesity and comorbidities. Families should be questioned about
the child's diet, activity, and past medical
history. The child's family and psychosocial history should also be assessed. The
physical exam should include measurement
of blood pressure (with an appropriately
sized cuff), evaluation for any dysmorphic
features suggestive of a genetic syndrome,
UNDERWEIGHT
NORMAL OR HEALTHY WEIGHT
OVERWEIGHT
OBESE
assessment of affect, and assessment of
fat distribution. In terms of laboratory
studies, a fasting lipid profile (timing of
starting screening is based on child's age
and risk factors for cardiovascular disease),
type 2 diabetes screening (if additional
risk factors present), and serum alanine
aminotransferase (starting at age 10 years)
should be obtained. Additional testing for
conditions associated with obesity is based
on clinical findings (e.g., hormone levels
with polycystic ovary syndrome, sleep study
with obstructive sleep apnea, TSH with
hypothyroidism, cortisol with Cushing
syndrome, and vitamin D deficiency).
Management
According to the American Academy
of Pediatrics (AAP), the key to addressing
childhood obesity is prevention. Primary care
providers play an important role in obesity
prevention because they are in a unique
position to partner with families and patients.
A recent report from the Institute of Medicine "Early Childhood Obesity Prevention
Policies," made specific recommendations
for health care providers as follows:
LANCASTER
15
PHYSICIAN
BMI < 5th percentile
BMI >/= 5th percentile to < 85th percentile
BMI >/= 85th percentile to < 95th percentile
BMI >/= 95th percentile
ASSESS, MONITOR, AND TRACK
A CHILD'S GROWTH FROM BIRTH
TO AGE 5 AS PART OF EVERY WELL
CHILD VISIT
Concurrently, providers should keep in
mind the rate of weight gain and parental
weight status as risk factors for obesity and
its adverse consequences.
HELP PARENTS OR GUARDIANS
INCREASE PHYSICAL ACTIVITY
AND DECREASE SEDENTARY
BEHAVIOR IN YOUNG
CHILDREN.
This can be achieved by encouraging
families to participate in physical activities together to meet the recommended
60 minutes of activity a day as well as
removing televisions, computers, and other
media devices from the child's bedroom.
Continued on page 16
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