Obesity in children

Madarina JuliaDept of Child HealthFaculty of MedicineGadjah Mada University

Why discuss obesity in children?

An important public health concern

obesity in children is related to obesity in

adulthood

related to “syndrome X” or “metabolic

syndrome”:

– obesity, insulin resistance, hypertension

and their consequences (CVD)

its prevalence is increasing

The World Health Organization

the effects of obesity

Approximate Prevalence of Obesity-associated conditions

•Slipped capital femoral epiphyses and Blount’s

disease: 1/3300

•DM type 2: 1/1400 children age 10-19 y

•Hypertension: ¼ obese children 5-11 y (BP >

P90)

•Dyslipidemia: 1-2/5 children

•Sleep apnea: 1/100 children

•PCOS:1-3/4 adolescents with amenorrhoea/

oligomenorrhea

Control of body fat

The primary control of body fat is the balance

between dietary intake and energy expenditure

In normal circumstances, the amount of body

fat is tightly regulated by a control of appetite

and satiety by hypothalamic centers

Leptin is a feedback hormone secreted by

adipose tissue

Most of the time….

Energy intake & Food composition (254 obese elementary school, Jakarta 2002)

Energy intake (%

RDA)

≥120% :64 %

90-119% :24 %

<90% :12 %

Fat intake (% RDA)

30% :28%

>30% :72%

School Canteen & westernized food

Physical activity(254 obese elementary school children, Jakarta

2002)

Routine exercise (3x/week) : 10,6% Routine exercise (1x/week) : 39.4% Not routinely exercise : 50%

Lack of sidewalks

How do we quantify obesity?

overweight: BMI>25, obesity BMI>30,

standard BMI for age (IOTF 2000)

overweight/ obesity: BMI> P95, risk for

overweight/ obesity BMI>P95 standard BMI

for age (CDC 2000)

mild obesity: 120% standard weight/height,

severe obesity: 130% (WHO-NCHS)

…they do not always suggest adiposity

BMI-for-age Centiles

Direct measurement of body adiposity

skinfold thickness

bioelectric impedance

underwater weighing

imaging techniques: USG, CT-scan, MRI

… all have certain weaknesses, and may be

not very practical to be used in everyday

clinics

Other causes of obesity Endocrine

Hypothyroidism, GHD, Steroid excess

Hypothalamic disturbance

Syndromes:

Chromosomal defect

Genetic defects

pathological obesity

vs. simple obesity

Simple vs. pathological obesity

The most important clinical clue is: height

In simple obesity:

almost all have height > P50

most have height > P75

Other clues for simple obesity

family history of overweight

slightly advanced bone age

early onset of puberty

Pathological obesity If the obese child is of below average

stature, particularly if there is evidence of

decreased growth rate, the pathological

cause of obesity must be considered.

The endocrine causes of obesity are:

hypothyroidism, GHD and steroid excess

The endocrine causes of obesity, although

small, are important to recognize because

they are diagnosable and treatable

Management of obesity

Simple obesity: environmental intervention

related to diet and physical activities

Endocrine related: causative therapy

Chromosomal and Genetic defect: so far no

therapy is known

for simple obesity…