Pediatric obesity

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Pediatric Obesity

Childhood obesity needs treated as soon as possible.
Age matched Weight to Length is crucial

Approach To Childhood Obesity

Pregestational & gestational period (epigenetic risk)

Bariatric Surgery reduced obesity risk in half for children(2nd gen effects)
Most women gain >rec weight amt
Critical to interrupt the inter-generational cycle of obesity

Birth to 3 yrs period

Time when habits develop
Time when demands become stronger
Time to train parents on healthy eating and growth
Weight gain during first 4 mos of life is critical
Parental Smoking, obesity. Maternal Stress. Misconception about normal infant growth.
Home environment
Breast vs formula (may protect from obesity) Lower Protein formula in future!
Reduces risk by 13-20%
4% decrease per month. >7 mos ideal.
Family eating habits
Child rearing practies / feeding style

Parental Concern:

  1. Do you think your child is too thin, too heavy or just right? Do you worry #when your child doesnt eat?
  2. Do you make your child eat whene he/she refuses?
  3. Do you sometimes give your child junk food when he doesnt eat?
Provide specific counseling, growth chart, tripling of weight, hunger cues
Discuss '3-day eating cycle' for toddlers
Introduce 1-2oz of water per day at 2 months
Discourage juice at any age
Ellyn Satter Eating

Preschool & elementary age period

Can prevent and break BMI increase without weight loss!
Time to strongly encourage physical activity and less sedentary life style
Adiposity Rebound = if goes up past age 6, no problems, if never goes down then need to slow down 25x! Low point before 5.5yo risk = 4x

Adiposityreb.gif

Davis 15 min obesityDavis Obesity
  1. Assess Concern
  2. Develop 3 targets for change (2 dietary (1pos, 1neg) 1 physical activity)
  3. Follow up q3mos.

Middle School and adolescence period

Children have control over what they eat
Weight loss becomes necessary to achieve healthy BMI
Obesity is very difficult to treat
Screen for Insulin Resistance Consider Fasting glucose & Insulin, FLP, HGBA1c.

Weight Loss Surgery in Adolescents

~1million obese teens.
11x greater weight loss in surgery, 25 of 25 had resolution of metabolic syndrome
ASMBS - Best Practice Guidelines
~99% BMI + (Strong indiciation in morbidly obese: T2DM, Mod-Sev OSA, NASH, Psuedotumor Cerebri)
RYGB recommended
LAGB possibly
GS possible
Success 10pt decrease in BMI, 30% decrease in weight, 50% decrease in EBW, improve health/self image.
References
  1. Dinkevich, E. "Obesity Mgmt in Pediatric Population."
  2. Early Adiposity Rebound, M F Rolland-Cachera
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