Obesity in Children

Definition

1. Obesity:
Excess deposition of adipose tissue/fat in the body, mostly the subcutaneous tissue.
2. Clinical Obesity:
when a person has a BMI 30

Description

Etiology

3. Overweight:
Sangat tinggi(BB/TB)
Rangka yang besar
Athlete(bcz ada byk otot)
Problem in WHO(1998):
A global epidemic.
Increase of the risk mortality
Increase of morbidity
Increase of health care risk
Problem In Children:
Persistence of childhood to adult obesity
o 15% :infant
o 25%:(6m/o-5y/o)
o >50%(6 y/o)
o 80%(10y/o-14 y/o) & one parent obese
Psychosocial-well-being(e.g.rendah diri)
Difficult to lose weight and to sustain weight loss long term
1. + Energy balance (= idiopathic: 90%)
2. Medical causes(< 10 %) :Cushing Syndrome, Leptin deficiency, syndromal(prader-willi)
Leptin:
Protein (hormone) berada pada chromosome 7
Produced by: white fat cells in adipose tissue, that is involved in controlling the amount of white adipose tissue laid down
in the body.
Source: adipose tissue, hepatic stellates cells, placenta gastric fundic glands
F(X): act on the brain as a signal to regulate appetite or energy expenditure(inhibit food intake& stimulation of energy)
Mutation in ob gene, which codes for leptin responsible some cases of obesity.
Example: Leptin byk pd obesity tapi masih x boleh turunkan berat badan kerna telah ada resistance leptin(mutation in
ob gene)

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Evaluation
of
obese children &
adolescent
Clinical
manifestation

Anthropometric
measurements

Management

1. History taking
2. Clinical Examination: Anthropometric evaluation
3. Investigation:
Laboratory
Radiology
dietary analysis
4. Assessment of risk factors
1. Heavier, taller &advanced bone age
2. Gynaecomastia
3. Pendulous abdomen(abdomen tergantung) & white/purple striae
4. Peripheral/trunkal obesity
5. Buried penis (embedded in the pubic fat)
6. Early puberty & advanced menarche
7. Genu valgum (seperti kaki O)
8.
BMI
o 95 th percentileobesity
o 85-95 th percentileoverweight
o IBW 120%
Triceps skin fold thickness:85 th percentile
Visceral adiposity tissue

Echocardiography, lung function etc

1. Determine the goal of treatment

Decrease the BW20% BBI
Long termappropriate diet & physical activity
Normal decrease the BW: decrease 2 kg/month(500g/week)
2. Principle
Dietary management
Exercise
Behaviour modification
Family involvement
Alternative therapy
Bayi
Fat:35%
Protein:20%
Carbohydrate:45%

Anak
Fat: 30%
Protein:10-20%
Carbohydrate:50-60%

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Recommendation < 2y/o

1.
2.

Not restrict diet

Advice appropriate feeding practice
a. React appropriate to infants crying(bored,tired)
b. No addition in infants bottle(sugar,cereal)
c.
Correct feed dilution & volume appropriate for
age
d. Weaning solids low energy density(vegetable &
fruits) & decrease milk intake
e. Introduce to a cup 7-8 m/o & 1 y/o(no drink in
bottle)
f.
Drink of water with & between meals.

Recommendation 2-7 y/o

Overweight (-complication)
Overweight(+ compl cation)
Obesity (-complication)
Obesity(+ complication)

Maintain BW & no need decrease food intake

Decrease the BW
Maintain BW
Decrease the BW

Management:
1. Individual diet
2. Decrease kg /week of BW
3. Traffic light diet

Green: vegetable & fruit

Yellow: low fat food & drink

Red: high fat food & drink

4. Step 1& 2:

Total fat 30% of total calories

Saturated fatty acid < 10% of total calories

PUFA 10% of total calories

Cholesterol < 300 mg/day

5. Exercise

3-5x/week

50-60% maximal ability

15 minutes minimally, building 30-40 minutes

Mode: use large muscle jogging, swimming, bicycle

Reduce passive activities: TV watching, playing video games

6. Behaviour modification

Diet & activity self monitoring

Set weekly goal

Stimulus control

Cue elimination

Behaviour substitution

Parental support
7. Family involvement

Parents is the most important role models for children

Creating an active environment

Creating a healthy eating environment

8. Alternative Therapy

BMI 95th percentile: very low calorie diet(Protein Spring Modified Fast
diet/PSMT) & no drug

BMI 97th percentile : bariatric surgery

*EARLY INTERVENTION IS BETTER

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