Overweight Mngmt Pediatric

8/3/2019 Overweight Mngmt Pediatric

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Management of Overweight

Children

By: Hazwani Md NoorSupervisor: Dr. dr. Aryono Hendarto


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Clinical Scenario 8-years-old, Female

Came to RSCM for Chemotherapy follow-up

Diagnosed with ALL since 2 months ago

High-dose dexamethasone therapy Increased appetite, Ate 5x/day meal, Sleep

Increased 10 kg BW


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Clinical Scenario Normal vital signs

Moon face

Central Obesity

Purple Striae

BMI 20.1 (89th %) = Overweight

Parents concerned about weight problems

How to manage?


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Overview Increasing rates of overweight & obesity in

Indonesia

Associated with higher social status

Increase cardiovascular risk factors,chronic diseases (e.g. T2DM, HT, stroke)

Current management: lifestyle,pharmacotherapy, surgical intervention

Effective management still uncertainUsfar A, Lebenthal E. Obesity as a poverty related emerging nutrition problems: the case of Indonesia. Obesity Reviews.2010;11(12):924-8.


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Clinical Question

Population : Overweight children

Intervention : Overweight management

Comparator : -

Outcome : Weight reduction

Question: What is the management ofoverweight problem in children?


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Methods

Literature search conducted using

Pubmed, EMBASE and National GuidelineClearinghouse on 19thSeptember 2011.

Articles obtained using children,overweight, management and theirsynonyms as the entry terms.


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MethodsEngine Search Terms Hits

PubMed ((children OR pediatric) AND overweight AND

management

2546

EMBASE (('child':ab,ti) OR ('pediatric':ab,ti)) ANDoverweight:ab,ti AND management:ab,ti

194

NationalGuideline

Clearinghouse(NGC)

(children OR pediatric) AND overweight ANDmanagement

1393


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Pediatric

OR

Children

Overweight ManagementA

N

D

A

N

D

2546

Screening title/abstract

83

Screening full-text and duplicates

Useful articles: 2

Exclusion criteria

-Diagnostic, Etiologic &

Prognostic Study

-Animal study

-Text not in English

-Publication before year 2000

Inclusion criteria

-Therapeutic study

-English language

-Full-text available

Pubmed EMBASE NGC

194 1393

252 428

Screening title/abstract

206 16 112

5

Selection criteria

-Overweight management in

children

Date of search: 19th September 2011


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Articles August GP, Caprio S, Fennoy I, Freemark M, Kaufman

FR, Lustig RH, et al. Prevention and treatment of

pediatric obesity: an endocrine society clinical practiceguideline based on expert opinion. Journal of ClinicalEndocrinology & Metabolism. 2008;93(12):4576. [TES]

Logue J, Thompson L, Romanes F, Wilson DC,Thompson J, Sattar N. Management of obesity:summary of Scottish Intercollegiate Guidelines Network(SIGN) guideline. Bmj. 2010;340. [SIGN]


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Critical Appraisal Appraisal of Guidelines for Research &

Evaluation II (AGREE II)Domains Score

SIGN Guideline TES Guideline

1.Scope & Purpose 66.7% 60%

2.Stakeholder & Involvement 66.7% 50%

3.Rigour of Development 47.5% 55%

4.Clarity of Presentation 66.7% 60%

5.Applicability 45% 37.5%

6.Editorial Independence 50% 50%


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Results Lifestyle Intervention

-most effective

-diet changes, increasing physical activity,decreasing sedentary behavior, behavioralinterventions, family involvement

Weight maintenance in overweightchildren

Logue J, Thompson L, Romanes F, Wilson DC, Thompson J, Sattar N. Management of obesity: summary of Scottish IntercollegiateGuidelines Network (SIGN) guideline. Bmj. 2010;340.

August GP, Caprio S, Fennoy I, Freemark M, Kaufman FR, Lustig RH, et al. Prevention and treatment of pediatric obesity: an endocrinesociety clinical practice guideline based on expert opinion. Journal of Clinical Endocrinology & Metabolism. 2008;93(12):4576.


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Results Pharmacological Treatment

-If intensive lifestyle modification fails andsevere comorbidity

-Only prescribed if doctor familiar with drugspotential side-effects

(E.g.: Orlistat gastrointestinal side effects)




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Results Surgical Intervention (Bariatric Surgery)-Only in adolescents with extreme obesity

and severe comorbidities despite lifestyleintervention with or without pharmacologicalmanagement

-Discuss with parents and children(readiness for long-term follow-up andlifestyle intervention)




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Discussion Weight maintenance-Decrease BMI as Increase height

Dr. should prescribe lifestyle intervention Problems with pharmacological

intervention

Lack of FDA approval Reduced efficacy over time

Limited studies on efficacy and safety

Risk of severe side-effects & long-termotential morbidit & mortalit


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Discussion Oct 2010, FDA voluntarily withdrawn

Sibutramine increase risk of heart

attack and stroke Surgical intervention not recommended in

young children

-long term side-effects and complicationsfor growing child still unknown.


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Conclusion &

Recommendations

Intensive lifestyle intervention most

effective, safe, cost-saving Patient should undergo lifestyle

intervention

Improve diet calorie, fat, fast food,fibers, fruits, veg

sugared beverages


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Prescribe at least 60 min of daily moderate

to vigorous physical activity Limit screen time (watch tv, play

videogames) 1 2 hr per day

Maintain weight

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Overweight Mngmt Pediatric