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Outline
Review the epidemiology of childhood
obesity
Discuss risk factors for childhood
obesity
Review immediate and long term
consequences of childhood obesity
Review strategies for prevention and
treatment of obesity in children
US Population
70.0
60.0
50.0
40.0
30.0
20.0
10.0
0.0
1995
2005
2015
et al. JAMA. 2014;311(8):806-814. JAMA, 295 (13): 1549-1555 and JAMA, 288 (14): 1728-1
Statewide Prevalence of
Childhood Obesity
Data Resource Center for Child and Adolescent Health, a project of the Child
and Adolescent Health Measurement Initiative
Causes of Obesity
NUTRITIONAL
99%
Endocrine
Cushing syndrome
Hypothyroidism
Genetic
Chromosomal
syndromes
Single gene
disorders
Hypothalamic
Tumor
Radiation
Infiltrative/Autoimm
une
Drugs
Antipsychotics
Antiepileptics
Environmental Factors:
Decreased Energy Expenditure
TV
Computers
Transportation
Inadequate safe
areas for physical
activity
Sedentary lifestyle
Adverse Childhood
Experiences
Potentially traumatic events with
potential lasting impact on health
Physical, emotional or sexual abuse
Collaborative research between
Kaiser Permanente and CDC
Association with obesity
Case..
AAS (13 yr F) presents for evaluation of
obesity since age 4.
Has tried various types of diets and
exercise programs with no success
Primary amenorrhea and fatigue
Wt 114 kg BMI 54
Cyanotic ( SaO2 88%), Tachycardic (HR
120/min)
Acanthosis nigricans
Case
Blood glucose 305 mg/dL, HbA1c 11.2 %
Lipids: HDL 25, Triglycerides 522, AST/ALT
normal
Elevated androgens
Severe obstructive sleep apnea and
hypoventilation on overnight
polysomnogram
CT abdomen: Hepatosplenomegaly
Case
Medically Complicated Obesity
Type 2 Diabetes Mellitus
Central Hypoventilation
Obstructive Sleep Apnea
Cirrhosis secondary to NAFLD
Polycystic Ovarian Disease
Medical Complications of
Obesity
Pulmonary disease
abnormal function
obstructive sleep apnea
hypoventilation syndrome
Idiopathic intracranial
hypertension
Stroke
Cataracts
steatosis
steatohepatitis
cirrhosis
Severe pancreatitis
Gynecologic abnormalities
abnormal menses
infertility
polycystic ovarian syndrome
Osteoarthritis
Skin
Gout
Cancer
breast, uterus, cervix
colon, esophagus,
pancreas
kidney, prostate
Phlebitis
www.obesityonline.org
venous stasis
Sinha R, Fisch G,
Teague B, N Engl J Med. 2002;346(11):802.
Hypertension
Dyslipidemia
Endothelial dysfunction
Early aortic and coronary arterial
fatty streaks and fibrous plaques
Increased risk for major
cardiovascular events during
adulthood
Respiratory Diseases
Causes both restrictive and obstructive
disease
Sleep apnea 7-33%
Asthma 30%
Oligomenorrhea/Amenorrhea
Acanthosis Nigricans
Insulin Resistance
Hirsutism
Acne
Hyperandrogenism
Psychosocial Consequences
Social & psychological
problems
Discrimination
Poor self-esteem
Continues into
adulthood
Gastrointestinal Manifestations
Steatohepatitis
Fatty infiltration of the liver
Can progress to fibrosis and cirrhosis
Gall bladder disease
Increased cholesterol excretion
30% of gallstones in children
Vitamin D Deficiency
Vast majority of obese teenagers are
vitamin D deficient
Low 25(OH)D levels correlate with
cardiometabolic risk markers
Scarcity of data on effect of vitamin D
supplementation on cardiometabolic risk
markers in obese children
Johnson MD, et al. Journal of Pediatrics,
2010 Mar;156(3): 444-9
Javed A et al. Pediatric Obesity, 2015
Orthopedic Conditions
Ankle, Knee and Hip Pian
Genu varum/valgus deformities
Blount Disease
bowing of legs
tibial torsion
Neurologic Complications
Pseudotumor cerebri
Headache, vomiting, diplopia, blurred
vision
Cancer Risk
Breast, colon, endometrium, esophagus,
kidney, pancreas, gall bladder, thyroid,
ovary, cervix, prostate, multiple myeloma
and Hodgkins lymphoma
40% for some cancers, particularly
endometrial cancer and esophageal
adenocarcinoma
500,000 additional cases of cancer in the
United States by 2030
Summary
The prevalence of childhood
overweight and obesity has
increased substantially globally
Serious morbidities, short term and
long term
Prevention of obesity is extremely
crucial
Cunningham SA, Kramer MR, Narayan KM. N Engl J Med 2014; 370:403
Prevention Initiatives
Structures within government to
support policies and interventions
Leadership, dedicated funding for
health promotion
Networks and partnerships
Standards and guidelines
School Programs
Beneficial effect on physical activity
in school or outside school (APPLE
schools in Canada)
Effects may not be sustained unless
intervention continued
No consistent effect on body weight
or BMI
School Programs
New school lunch standards by USDA
Increasing fruits, vegetables and
whole grains
Effect on eating habits and BMI
known
Catch
Overweight Early
http://www.cdc.gov/growthcharts/
Staged Treatment
Stage 1- Prevention Plus
Stage 2 - Structured Weight Management
Stage 3 - Comprehensive Multidisciplinary
Intervention
Stage 4 Tertiary Care Intervention
Weight
lost
(kg)
LF group
Sondike at al:
LC group
J Pediatr, 2003
CP1286535-4
Pharmacotherapy
Orlistat
Intestinal Lumen
Mucosal Cell
SE
LIPA
LIPASE
Orlistat
MG
TG
FA
E
S
A
LIP
Bile Acids
Micelle
TG=triglyceride; MG=monoglyceride; FA=fatty acid.
Mean
change
in BMI
Placebo
Placebo
Orlistat
Orlistat
0
Chanoine,
Chanoine, JAMA
JAMA 2005
2005
12 16
20 24 28 32 36 40 44 48 52
Week
Roux-en-Y Gastric
Bypass
Inge TH, Courcoulas AP, Jenkins TM, et al. N Engl J Med 2015.
Inge TH, Courcoulas AP, Jenkins TM, et al. N Engl J Med 2015
Summary
Pediatric obesity is increasing at an
alarming rate
Pediatric obesity is associated with
significant adverse effects in childhood
and adulthood
Prevention and early diagnosis are crucial
Lifestyle modifications remain
cornerstone of therapy
Surgery and pharmacotherapy are
indicated in a small subset of patients
Thank you