Lecture 10 Obesity (Problems of Postnatal Growth and Development)

8/12/2019 Lecture 10 Obesity (Problems of Postnatal Growth and Development)

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Problems of postnatal growth and development

Obesity

IKG Suandi

Department of pediatrics, School of Medicine,

Udayana University/Sanglah Hospital


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Objectives

To understand the sign & symptom of

patient with obesity

To built diagnosis of patient with obesity

To understand the treatment andprevention of the obesity


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Epidemiology

The prevalenceof obesity inchildren 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


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The risk of remaining obese until adult: increases withage1

the degree of obesity2

and influenced by family history3

Children become overweight:

40%of children with 1overweight parent 80%of children with 2overweight parents

10%with nooverweight parents


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Obesity family


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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 foldthicknessmay 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 examinationdirectly

toward screening for many potential

complication noted among obese patients

type-2 diabetesin a 12-year period medical complications / the degree of

obesity

Diagnosis: measurement of excess body

fat (skinfold thicknessand BMI= kg/m2)


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In adult, BMI over 25 Is overweight, anda BMI over 30 defines obesity

In children, age-and gender-specificpercentile curve (BMI percentile); above 85th%-tileis overweight

above 95th%-tileis obese


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Complications of obesity

Complication Effects

Psychosocial Peer discrimination, teasing, reduce college

acceptance, isolation, reduce job promotion

Growth Advance bone age, increase height, early menarche

C N S Pseudo-tumor cerebri

Respiratory Sleep apnea, pickwikian syndrome

Cardiovascular Hypertension, cardiac hypertrophy, ischemic hearth

disease, sudden deathOrthopedic Slipped capital femoral epiphysis, Blount disease

Metabolic Insulin resistance, type II DM, hypertriglyceridemia,

hypercholesterolemia, gout, hepatic steatosis,

polycystic ovary disease, cholelithiasis


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Diseases associated with childhood

obesitySyndrome Manifestation

Alstrom syndrome Hypogonadism, retinal degeneration, deafness, DMCarpenter syndrome Polydactyly, syndactyly, cranial synostosis, mental

retardation (MR)

Cushing syndrome Adrenal hyperplasia or pituitary tumor

Frohlich syndrome Hypothalamic tumor

Hyperinsulinism Nesidioblastosis, pancreatic adenoma, hypoglycemia,Mauriac syndrome (poor diabetic control)

Laurence-Moon-Bardet-Biedl

syndrome

Retinal regeneration, syndactyly, hypogonadism, mental -

retardation; autosomal recessive

Musculas dystrophy Late onset of obesity

Myelodysplasia Spina bifidaPrader-Willi syndrome Neonatal hypotonia, normal growth immediately after birth,

small hands and feet, MR, hypogonadism; some have partial

deletion of chromosome 15

Pseudohypoparathyroidism Variable hypocalcemia, cutaneous calcifications

Turner syndrome Ovarian dysgenesis, lymphedema, web neck; XO

chromosome


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Treatment

Managementincludes a combinationof education1, behavior modification2,exercise3, and diet4.

Balance diet: + 30% decrease in caloricintake(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 modifiedfastmay be needed when a life threateningcomplication (alveolar hypoventilation, sleepapnea, or significant hypertension) is present

Pharmacotherapyis currently not approvedfor use in children

Surgical therapyfor morbid obesity includesgastric stapling or ileal bypass; this is rarelyindicated 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 exercise1and decreasingfat2intake may be helpful and constantenergy intake per unit weight3

Dietary and exercise recommendations,should be based on decreasing the rate of

weight gain while maintaining an appropriaterate of growth in heightis an acceptable goalfor children and adolescents in manysituation


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Happy and

healthy family


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Documents

Lecture 10 Obesity (Problems of Postnatal Growth and Development)