Endocrinology Book

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Obesity in Children

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  1. See Also
    1. Obesity
  2. Epidemiology
    1. Childhood Obesity Prevalence: 25-30%
  3. Secondary Causes of Childhood Obesity (<10% of cases)
    1. Hypothyroidism
    2. Cushing's Syndrome (Hypercortisolism)
    3. Primary Hyperinsulinism
    4. Pseudohypoparathyroidism
    5. Hypothalamic abnormality
    6. Genetic Syndromes with Mental Retardation
      1. Prader-Willi Syndrome
      2. Laurence-Moon or Bardet-Biedl Syndrome
      3. Borjeson-Forssman-Lehmann Syndrome
      4. Cohen Syndrome
      5. Ruvalcaba Syndrome
      6. Familial Lipodystrophy
    7. Genetic Syndromes without Mental Retardation
      1. Alstrom Syndrome
      2. Turner's Syndrome
      3. Beckwith-Wiedemann Syndrome
      4. Sotos' Syndrome (cognitive delay may be present)
      5. Weaver Syndrome
  4. Risk Factors
    1. Obesity Risk increases with television viewing time
      1. Lowest Prevalence for <1 hour/day: 8% Obesity
      2. Highest Prevalence for >4 hours/day: 17% Obesity
      3. Crespo (2001) Arch Pediatr Adolesc Med 155:363
    2. Obesity in child's parent
    3. Decreased Physical Activity
      1. Physical Activity is inversely related to Obesity
  5. Evaluation
    1. See Cardiac Risk Factors
    2. See Body Mass Index
    3. See Daily Energy Allowance
    4. Blood Pressure
  6. Labs
    1. Lipid profile
    2. Indications for suspected secondary cause evaluation
      1. Short stature (<5th percentile)
      2. Minimal to no Family History of Obesity
      3. Mental retardation
      4. Delayed bone age
      5. Physical findings suggest secondary cause
  7. Complications
    1. See Obesity Risk
    2. Slipped Capital Femoral Epiphysis
    3. Tibia vara
    4. Adult Obesity (high risk)
      1. Kvaavik (2003) Arch Pediatr Adolesc Med 157:1212
  8. Management
    1. Set reasonable weight loss goal
      1. Monthly: 1 to 4 pound loss
      2. Month 3 to 6: 5 to 10 pound loss
    2. Establish dietary guidelines
      1. See Food Pyramid
      2. Calculate Daily Energy Allowance
      3. Approximate a 500 calorie deficit per day
    3. Establish regular Exercise
      1. Exercise in addition to school physical education
      2. Home Exercise for more than 20 to 30 minutes/day
    4. Behavior Modification
      1. Stimulus control
      2. Modify eating habits
      3. Attitude change
      4. Reward positive new behaviors
    5. Involve family in Weight Reduction program
      1. Parent nutritional counseling
      2. Family activity
      3. Family television viewing
  9. Prevention
    1. Provide balanced diet (see Food Pyramid)
      1. Maximize child's Dietary Fiber intake
    2. Eliminate excessive fat and sugars
      1. Limit fat calories to <30% of total calories
      2. Replace whole milk with skim milk at age 2 years
      3. Avoid fast-food and "junk-food" (e.g. potato-chips, twinkies)
      4. Limit high calorie foods in home
    3. Encourage healthy eating behaviors
      1. Use appropriate food portions
      2. Food should not be used to comfort or reward child
      3. Treats should not be used to reward finishing a meal
      4. Child does not need to "clean plate": stop with satiety
    4. Encourage activity
      1. Limit television and video games to 1 hour or less per day
      2. Foster active play and family Exercise for >30-60 minutes per day
  10. Resources
    1. Shapedown Pediatric Obesity Program (Ages 6 to 20)
      1. http://www.shapedown.com
      2. Phone: 415-453-8886
  11. References
    1. Kreipe (1998) Adolescent Health Update 10(2):1-8
    2. Moran (1999) Am Fam Physician 59(4):861
    3. Williams (1997) Ann N Y Acad Sci 817:225

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