Download - Chldhood obesity
Obesity
Definition
A chronic condition characterised by excess adipose tissue, causally
related to serious medical illness
Obesity Diagnostic Tools
• Percentile on Growth Charts
• Body Mass Index (BMI)
• Triceps Skin fold Thickness (TST)
• Waist-hip ratio
Diagnosis of Obesity
• Weight for height >120%
• Age specific growth charts
• Skin fold thickness: >85%centile for sex and age
• Waist : >40” in males & 35” in females
• WHR : >0.8 women & 0.9 in males
Percentage Wt. for Ht.
= ------------------------------------- X 100
Weight for Height
Actual Weight
Expected weight for actual height
< 90 % : PEM> 90 % : Normal> 120-130 : Obesity
Body Mass Index or BMIin Adolescents
Weight in kilograms is divided by the square of the height in meters
• Normal : 19 to 24.9 kg/m2
• Overweight : 25 - 26.9• Obese : 27 to 29.9• Severe Obesity : Over 30 (Over the 95th Percentile)
• Morbid Obesity : Over 40
Skin fold thickness
Skin thickness is an index of body fatSFT Taken at
Triceps (most common site) Subscapular Suprailiac Abdomen Upper thigh
Lange’sHarpenden’sSkin fold calipersSkin fold calipers
Adolescent Growth Chart
Measure of Height Weight and BMI in single graph
Types of Obesity
• Simple obesity
• Pathologic obesity– Dysmorphic syndromes– Endocrine– CNS – Drugs– Leptin deficiency
Prevalence: The National Health and Nutrition Examination
Surveys
• 75% relative increase in obesity in adolescents is noted since 1970
• 25% of American adolescents are identified as being obese
• 50% increase in morbid obesity (a BMI of 30 or more) over the past decade
• Indian studies 7-21 % prevalence
Factors Contributing to the Obesity Epidemic
• Increase – in intake of regular soda drinks– In intake of fast foods – in portion size of fast foods– highcarb snacks
• Decrease – in physical activity
• Increase – in physical inactivity (TV, video, computer time)
Why is it important?
• WHO has declared obesity as a “global epidemic”
• Childhood & adolescent obesity is a risk factor for adult obesity “Tracking”
• Life style diseases like NIDDM,Coronary artery disease Hypertension, dyslipidemia, cancers are linked with obesity
• Psychosocial problems
Obesity: Complications
• Psychological– Disturbed body image– Poor self-image/self-esteem– Poor family relations: scapegoat and source
of embarrassment– Poor peer relations and social isolation– Exclusion from activities, especially dating– Acting out and depression
Obesity: Complications
• Medical– Coronary artery disease– Cerebrovascular disease– Gallstones– Orthopedic problems– Sleep apnoea– Increased cancer risks (colon, rectum, prostate)– Diabetes mellitus
Overweight Screening Procedure
Screening includes evaluation for:– Family history– Blood pressure– Total Cholesterol ( 200 mg/dl)– Large change in BMI ( 2 points in previous
year)– Concern about weight– Smoking history
Family History
• Positive Family History includes history of:– Cardiovascular Disease– Parental hypercholesterolemia– Hypertension– Diabetes – Parental Obesity
Physical Exam
• Eyes– Peripheral view– Fundi
• Skin– Acanthosis
nigricans– Purple stria– Texture– Hirsutism, acne
• Endocrine\- Hypopituitarism- Hypercortisolism- Hyperinsulinemia- Hyperandrogenism in
females
Lab Work-Up
• T4, TSH
• Free testosterone (in females)
• Fasting insulin and glucose
• Lipid profile
• 24 hour urine for free cortisol
• DHEA-S
• Sleep studies
• Chest x-ray; EKG
Management Strategies of Obesity
Prevent weight gain
Promote weight maintenance
Manage co morbidities
Promote weight loss
Rule out treatable medical causes
Underlying Medical Conditions
• Hypothyroidism– Initiate treatment with
levothyroxin
• Cushing’s syndrome– Identify source of excess
cortisol– Surgically remove source of
excess ACTH or cortisol
Treatment Content
Diet / Nutrition Plan Physical Activity Controlling the environment Self-monitoring Goal setting and contacting Parenting skills Managing high-risk situations Maintenance and relapse
prevention
General Management Principles
Can start with weight stabilization Eventually a 10% weight reduction Can decrease by 500 calories/day
with low fat/high fiber diet Set realistic goals 2% decrease in 2500 calories: 5 lb
to drop in one year (use skim milk)
Physical Activity
Providing and choice of activities appears to be superior to providing a specific exercise prescription
Recent research suggests that reducing sedentary behaviors may be more effective than promoting physical activity in promoting weight loss
Exercise Exercise also plays
very vital role in the management of obesity.
The more exercise one takes, greater is the daily energy expenditure and more rapidly the obesity reduces.
Energy expenditure in different activities
At rest 1Kcal /min Walking, gardening 5 Kcal/ min Cycling, swimming 7 Kcal /min Squash, jogging, hill climbing 10 Kcal/ min
Benefits of exercise
• Obese people with a heavier body to move, spend more energy for same amount of work.
• It is valuable as a diversion from sitting indoors and being tempted to eat.
• Exercise reduces appetite.
• After exercise the resting B.M.R. may increase for some hours.
Controlling the Environment
Help reduce cues (e.g., taking TV out of bedroom)
Limit access to high calorie foods Encourage family activities (e.g.,
family walks)
Parenting Skills
Parents often need practice in general parenting skills to implement many of the behavioral methods including: Being consistent Being observant so they can reward behavior
change Effectively using rewards Modeling desired behavior Limit setting (saying “no” when necessary)
Parental Problems
Child’s Attitude
What was wrong? Why were these kids such picky eaters?
Management Options
Behavioural interventions
Mealtime suggestions
Tactics for ToddlersTactics for Toddlers
To tempt little To tempt little taste buds taste buds
& & minimize minimize mealtime mealtime
hassles.hassles.
1. Offer a nibble tray
Toddlers like to graze their way through Toddlers like to graze their way through a variety of foods, so why not offer them a a variety of foods, so why not offer them a
customized smorgasbord? customized smorgasbord?
Use an ice-cube tray, a muffin tin, or a compartmentalized dish, and put bite-size portions of colorful and nutritious foods in each section.
Call these finger foods playful names that a two-year-old can appreciate
2. Spread it
Toddlers like spreading, or more
accurately, smearing.
Show them how to use a table knife to spread cheese, peanut butter, and fruit concentrate
onto crackers, toast, or rice cakes.
What and how much they are willing to eat may vary daily.
Don't be surprised if
"The only thing consistent about children’s feeding is "The only thing consistent about children’s feeding is inconsistency."inconsistency."
•your child eats a heaping plateful of food one day and practically nothing the next,
•adores spinach on Tuesday and refuses it on Thursday
• wants to feed herself at one meal and be totally catered to at another.
3. Count on inconsistency
Toddlers are into
toppings.
4. Top itPutting nutritious, familiar
favorites on top of new and less-desirable foods is a way
to broaden the finicky toddler's menu
Make a smoothie – together. Milk and fruit – along with supplements such as juice, egg powder, wheat germ, yogurt, honey, and peanut butter – can be the basis of very healthy meals.
5. Drink it..
If your youngster would rather drink than eat, don't despair
So what if they are consumed through a straw?
One note of caution: Avoid any drinks with raw eggs or you'll risk salmonella poisoning.
How much a child will eat often depends on how you cut it.
6. Cut it up
Cut sandwiches, pancakes, waffles, etc. into various shapes using cookie cutters.
7. Package it
Our kids enjoy the unexpected and fanciful when it comes to serving dishes – anything from plastic measuring cups to
ice-cream cones.
"Doctor, he won't eat his vegetables"
8. Become a veggie vendor
So if you aren't the proud parent of a veggie lover, try the following tricks
•Plant a garden with your child.
•Slip grated or diced vegetables into favorite foods
•Use vegetables as finger foods and dip them in a favorite sauce or dip.
•Concoct creative camouflages.
•Cut the vegetables into interesting shapes (Make veggie art).
9. Share it
If your child is going through a picky-
eater stage, invite over a friend who is
the same age or slightly older whom you know “likes to
eat.”
Your child will catch on. Group feeding lets the other kids set the example.
10. Respect tiny tummies
This less-is-more meal plan is not only more successful with picky eaters, it also has the added benefit of stabilizing blood-sugar levels, which in turn minimizes mood swings.
Dole out small portions at first
and refill the plate when your
child asks for more.
11. Make it accessible
Reserve a low shelf in the refrigerator for a variety of your toddler's favorite (nutritious) foods and drinks.
This tactic also enables children to eat when they are hungry, an important step in acquiring a healthy attitude about food.
Give your child shelf space.
12. Use sit-still strategies
One reason why toddlers don't like to sit still at the family table is that their feet dangle. Try sitting on a stool while eating.
Children are likely to sit and eat longer at a child-size table and chair where their feet touch the ground.
13. Turn meals upside downThe distinctions between The distinctions between
breakfast, lunch, and dinner breakfast, lunch, and dinner have little meaning to a have little meaning to a child. child.
If your youngster insists on If your youngster insists on eating chapathi in the eating chapathi in the morning or fruit and cereal morning or fruit and cereal in the evening, go with it – in the evening, go with it – better than her not eating at better than her not eating at all. all.
This is not to say that you should become a short-order
cook, filling lots of special requests,
but why not let your toddler set the menu sometimes?
14. Let them cook
Let your child help prepare the food.
Use cookie cutters to create edible designs out of foods.
Give your assistant such jobs as tearing and washing lettuce, scrubbing potatoes, or stirring batter.
15. Make every calorie countOffer your child foods that pack lots of nutrition into
small doses.
Nutrient-dense foods that most children are willing to eat include:
•Pasta,Brown rice and other grains, Potatoes,Cheese, Poultry, Eggs, Squash, Fish, Sweet potatoes, Kidney beans,Yogurt, etc.
Behaviour Modification - Adolescents
Aimed at changing behaviour
useful while treating obesity
Flash Card Technique
• Increases motivation• involves writing
reasons for wanting to lose weight
• I will look better• I will feel better• I will be be healthier• I will fit into my
favourite pair of jeans
Food DiaryTime Food Or Liquid
consumed Place Circumstances
7.50 pm
1 pack of chips 1 piece of cake 1 cola
bedroom watching TV
• Identifies triggers• Useful in understanding eating patterns• Logs exact amount of food or liquid consumed
Setting diets & goals
• Identifying and sticking to – a specific diet– food to be consumed– Place– time
• Setting reasonable goals like – losing one or two pounds
a week likely to be achieved
Food Pyramid
Cereals Pulses
GLV Fruits
Non-Veg FoodMilk
Sweets, oily & fatty food
Ways of controlling urges
• Removal of tempting foods• Use of distractors like engaging in
another activity• Using positive self-statements like
I can do this, I must control myself, I will be fine, The urge will pass
Use of Reinforcement
• Positive reinforcement : Rewarding oneself as goals are met
e.g. going for a film with a friend
• Negative reinforcement : escape unpleasant stimulus to increase desired behaviour > missing a favourite TV programme if overeaten
Obesity Treatment Strategies NOT recommended
Surgery Drug Treatment
(including herbal treatments)
Quick Weight Loss Diets
Pharmacotherapy
Shown to be effective in the treatment of obesity in some adults
Their use in most youth is limited at this time Teens should be
at least 16 years of age with morbid obesity
Failure of Obesity Treatment
• Lack of family involvement and support
• lack of flexibility• Lack of emphasis on increasing
physical activity• Lack of a maintenance phase
Diets may produce weight loss but do not cure obesity; weight regain is
common.
Eat less; eat 2/3 or ½ the calories you have been eating
Target is to eat about 1200-2000 kcal/d, depending on the age of the child
Try to cut out empty calorie foods – fats, soft drinks, and fast foods.
Amounts of low calorie foods can be increased – fruits and vegetables
Avoid other activities while eating (except conversation)
• Meal or food should not be provided as reward.
• Make small portions of food appear as large (small plate, food cut up in small pieces)
Leave eating place as soon as you have eaten
Slow down the rate at which you eat
Chew each mouth full for long.
Reduce inactivity
Take steps to minimize hunger, loneliness, depression, boredom, anger and fatigue which lead to overeating,
Think positively
WHAT can we do to prevent obesity ?
Right from childhood into adolescence into adulthood we must encourage •Exercise, •Physical activity •Physical Fitness •Life style modification •Nutritional intervention
• v
• C.S.N.VittalC.S.N.Vittal