Obesity in Peds & Metobolic syndrome

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Obesity in Peds & Metobolic syndrome by Mind Map: Obesity in Peds & Metobolic syndrome

1. association b/w catch-up growth or rapid growth in infancy or early childhood & subsequent obesity

1.1. suggests that mechanisms that signal & regulate catch up growth in postnatal period may play a role in development of obesity????

2. Increasing age=increasing obesity prevalence

3. childhood obesity more common in certain populations:

3.1. hispanics>non-hispanic blacks>non-hispanic whites>non-hispanic asians

4. Why worry?

4.1. Peds obesity is of epidemic proportions

4.2. peds obesity is the most common chronic dx of childhood

4.3. the epidemic is worldwide

5. Obesity & Socioeconomic Status

5.1. obesity decreases w/ increasing education of the head of household among children aged 2-19 years

5.2. middle income>lowest income>highest income

6. Etiology of obesity

6.1. genetic/heritability

6.1.1. survival advantage-conserve energy as fat thru human evolution

6.1.2. humans enriched for genes that promote energy intake & storage & minimize expenditure

6.1.3. enhance female fertility & ability to breastfeed offspring

6.2. Molecular

6.2.1. Leptin=regulate fat storage & how many calories one eats & burns

6.2.1.1. "satiety hormone"/"starvation hormone"

6.2.1.2. hormone produced by body's fat cells-primary target is hypothalamus. supposed to tell brain when you have enough fat stored=don't need to eat & can burn cals @normal rate

6.2.1.3. other functions=fertility,immunity,&brain function

6.2.1.4. leptin resistance can cause hunger & reduced the number of cals burned

6.3. syndromes

6.3.1. spina bifida

6.3.2. Down syndrome

6.3.3. Bardet-Biedl

6.3.4. Prader Willi

6.4. environmental

6.5. MULTI-FACTORIAL CONDITION

7. only 21% 6-9y/o eat 5or> fruits/veggies a day

8. nearly 40%kids'diets come from added sugars & unhealthy fats

9. consumption of sugar sweetened drinks increased 500% in past 50years

10. shifts in dietary patterns

10.1. prices higher in healthy foods vs less healthful

10.2. increased portion size

10.3. increased consumption of processed foods/higher in sodium

10.4. increased schools vending & a la carte foods

11. little evidence that metabolic rate is different in obese kids vs not obese kids

12. energy intake>energy expenditure

12.1. eating more away from home,more fast food & snacks & drinking more sodas.

12.2. 100cals/day above needs=10lb weight gain/year

12.3. increased sedentary activity

12.3.1. excessive TV watching

12.3.1.1. encourages overeating while viewing

12.3.1.2. 70% KIDS 8-18 & 30% KIDS < 3 Y/O HAVE TVS IN THEIR ROOMS!!!

13. BMI

13.1. underweight=<5%ile

13.2. healthy weight=5-85%ile

13.3. overweight=85-95%ile

13.4. [email protected] or above 95%ile

13.5. BMI IS A SCREEN NOT A DIAGNOSTIC TOOL.

13.5.1. BMI interpreted diff. for children and teens even though calculated weight / height squared

14. GOAL for obese kids

14.1. reduce rate of weight gain while allowing NORMAL growth and development

15. 60% of overweight kids have 1 or more CVD risk factors

15.1. OBTAIN FASTING LIPID PROFILE and BP on all overweight children

16. ACANTHOSIS NIGRICANS

17. ortho conditions

17.1. Blount disease

17.2. Slipped Capital Femoral Epiphysis

18. acute complications that require immediate Med. attn:

18.1. Sleep apnea

18.2. Obesity hypo-ventilation syndrome

19. Psychological & Economic consequences of Ped/Adolescent obesity

19.1. Discrimination,rejection,&low self esteem,particularly females

19.2. Less participation in PE & sports activites

19.3. Difficult to quantitate

19.4. stigmatization

19.5. low self esteem

19.6. depression

19.7. discrimination

20. Obesity Metabolic syndrome:

20.1. clustering of CV risk factors related to insulin resistance

20.2. NOT well defined in Peds

20.2.1. insulin resistance

20.2.2. dyslipidemia

20.2.3. HTN

20.2.4. obesity

20.3. Steatohepatitis

20.3.1. fatty infiltration of the liver

20.3.2. abnormal insulin metabolism

20.3.3. 10% obese teens increased LFTs

20.3.4. can progress to fibrosis & cirrhosis

20.4. Gall bladder disease

20.4.1. increased cholesterol excretion

20.4.2. ~30% of gallstones in children

20.5. oligomenorrhea/amenorrhea, acanthosis nigricans, insulin resistance, obesity, hirsutism, acne, hyperandrogenism

21. TREATMENT

21.1. prevention easier than cure

21.2. lifelong weight control

21.3. decrease energy intake

21.4. increase energy expenditure

21.5. must maintain normal growth

21.6. 55%carbs; 30%fat; 15%protein

21.7. physical activity essential for weight loss(physical activity decreases 50% during adolescent-girls>boys)

21.8. FOOD DIARIES

21.9. surgeries

21.9.1. gastric bypass/gastric plication/gastric banding--- not routine for children

22. Pharmacotherapy

22.1. anti obesity pills not approved for peds

22.2. drug options

22.2.1. appetite suppressants

22.2.2. serotonin agonists

22.2.3. inhibitors of fat absorption

22.2.4. antihyperglycemic agents

23. Management

23.1. small reduction in cals allows gradual decline in BMI

23.2. weight loss of 0.5-1 kg/week is the goal

23.3. rapid weight loss can lead to electrolyte disturbance

23.4. special diets like protein rich diet not recommended

23.5. GET UP & MOVE