Problems of postnatal growth and development

Obesity

IKG Suandi Department of pediatrics, School of Medicine, Udayana University/Sanglah Hospital

Objectives
To understand the sign & symptom of patient with obesity To built diagnosis of patient with obesity To understand the treatment and prevention of the obesity
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Epidemiology
The prevalence of obesity in children has increased in the last 2-3 decades:
as young as 4-5 years African-American and Mexican-American Also in children of South-East Asia

 The risk of remaining obese until adult:

increases with age1 the degree of obesity2 and influenced by family history3

Children become overweight:

40% of children with 1 overweight parent 80% of children with 2 overweight parents 10% with no overweight parents
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Obesity family

Genetic and environment influences

Obesity runs in families; could be related to genetic influences or environment
studies of adopted twin pairs: up to 80% of variance in weight for height or skin fold thickness may be explained on the basis of genetics the association between obesity and television watching and dietary intake the different rates observed in urban vs. rural areas
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snack

Watching TV and dietary intake

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Clinical manifestation
History and physical examination directly toward screening for many potential complication noted among obese patients type-2 diabetes in a 12-year period medical complications / the degree of obesity

Diagnosis: measurement of excess body fat (skinfold thickness and BMI = kg/m2)
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 In adult, BMI over 25 Is overweight, and a BMI over 30 defines obesity In children, age-and gender-specific percentile curve (BMI percentile);
above 85th %-tile is overweight above 95th %-tile is obese

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Complications of obesity
Complication Effects

Psychosocial
Growth

Peer discrimination, teasing, reduce college acceptance, isolation, reduce job promotion
Advance bone age, increase height, early menarche

CNS
Respiratory Cardiovascular Orthopedic Metabolic

Pseudo-tumor cerebri
Sleep apnea, pickwikian syndrome Hypertension, cardiac hypertrophy, ischemic hearth disease, sudden death Slipped capital femoral epiphysis, Blount disease Insulin resistance, type II DM, hypertriglyceridemia, hypercholesterolemia, gout, hepatic steatosis, polycystic ovary disease, cholelithiasis
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Diseases associated with childhood obesity

Syndrome Manifestation

Alstrom syndrome
Carpenter syndrome Cushing syndrome Frohlich syndrome Hyperinsulinism

Hypogonadism, retinal degeneration, deafness, DM

Polydactyly, syndactyly, cranial synostosis, mental retardation (MR) Adrenal hyperplasia or pituitary tumor Hypothalamic tumor Nesidioblastosis, pancreatic adenoma, hypoglycemia, Mauriac syndrome (poor diabetic control)

Laurence-Moon-Bardet-Biedl Retinal regeneration, syndactyly, hypogonadism, mental syndrome retardation; autosomal recessive
Musculas dystrophy Myelodysplasia Prader-Willi syndrome Late onset of obesity Spina bifida Neonatal hypotonia, normal growth immediately after birth, small hands and feet, MR, hypogonadism; some have partial deletion of chromosome 15 Variable hypocalcemia, cutaneous calcifications Ovarian dysgenesis, lymphedema, web neck; XO chromosome
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Pseudohypoparathyroidism Turner syndrome

Treatment
Management includes a combination of education1, behavior modification2, exercise3, and diet4.

Balance diet: + 30% decrease in caloric intake (generally 1000-1500 kcal/day); dietary fat and thus total calories are reduced

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Management of obesity: reduces food intake

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 Very low calorie diet or protein modified fast may be needed when a life threatening complication (alveolar hypoventilation, sleep apnea, or significant hypertension) is present

Pharmacotherapy is currently not approved for use in children

Surgical therapy for morbid obesity includes gastric stapling or ileal bypass; this is rarely indicated in children or adolescents
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Surgical therapy for adult

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Surgical therapy

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Prevention
There is no recognized method of prevention, although increasing exercise1 and decreasing fat2 intake may be helpful and constant energy intake per unit weight3 Dietary and exercise recommendations, should be based on decreasing the rate of weight gain while maintaining an appropriate rate of growth in height is an acceptable goal for children and adolescents in many situation
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Happy and healthy family

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