Stephanie H. Abrams, MD, MS

The Nuts & Bolts of Childhood Obesity

Objective/Content:

1)Describe the epidemiology and etiology of the obesity epidemic

  1. Review the prevalence:
  2. obesity rate more than tripled since 1970s (Will show NHANES maps/data)
  3. more than 1/3 of Texas’ children are overweight or obese (above the national average)
  4. lower socioeconomic status at risk
  5. African American teenage girls are the most obese group of children, followed by Hispanic boys & girls of all ages
  6. Etiology: Every aspect of society favors weighing too much. It is normal for adults in our nation to weigh too much (2/3 of adults are overweight or obese)
  7. Taking in too many calories
  8. Sugar-sweetened beverages
  9. Fast food/Restaurants
  10. Using less calories
  11. PE cut from school-we are sedentary
  12. Transportation-we are sedentary
  13. Electronics have made entertainment and lifestyle easier and less active (will show a slide about energy expenditure in today’s era (even down to the invention of the remote control vs. changing the channel on the television)
  14. Not safe to play outside alone/expectation of parental observation/loss of community

2)Describe the co-morbid conditions of the obese child

  1. Metabolic syndrome is prevalent
  2. Review the various co-morbid diseases, as these drive the history/ROS, physical exam and work up
  3. HTN, DM, dyslipidemia, OSA, Vitamin D deficiency

3)Explain the work-up, co-morbid diseases of obesity and understand when to refer to a specialist

  1. Review the guidelines for screening the obese child for co-morbid diseases (i.e. how often to get an ALT, AST, hemoglobin A1c vs. fasting glucose & insulin, lipid panel)
  2. Refer to specialist for treatment of co-morbid diseases outside your comfort level
  3. Dyslipidemia deserves treatment:
  4. TG>350
  5. LDL>100 for diabetics, >140 with risk factors, >190 straight up
  6. Hypertension:
  7. Aldosterone, rennin, uric acid, UA, renal ultrasound, possible EKG
  8. Liver disease:
  9. When ALT elevated for 3 months, work up is unrevealing or any other concerns
  10. Whenever concerned (ALT>350 very unusual; if PT/INR high or albumin low or imaging c/w cirrhosis)
  11. OSA (Obstructive Sleep Apnea:
  12. 90% of all severely obese children who snore nightly have some degree of sleep apnea
  13. Refer to Sleep Clinic or for PSG when suspected as treatment can improve NAFLD, energy, and quality of life

4)Identify the treatment options for childhood obesity

  1. Medication
  2. Behavior modification-Yelling at your patients or shaming them doesn’t work. Motivational interviewing techniques do.
  3. Review the 12 AAP recommendations for the prevention of obesity in children (are also treatments)
  4. 5-2-1-0 (the easy way to remember the biggest hitting changes to yield improvement in lifestyle and weight status)
  5. At least 5 servings of fruits or vegetables every day
  6. No more than 2 hours of screen time per day
  7. At least 1 hour of physical activitydaily
  8. Eliminate sugar-sweetened beverages
  9. My 5 top recommendations in clinic
  10. Reward the healthy behavior, not the pounds lost
  11. Kamp K’aana, Weigh of Life, Program for Healthy Bodies, Weight Watchers
  12. Bariatric surgery
  13. Criteria: when a patient inquires, consider referral to Dr. Brandt for evaluation. Even if the strict criteria aren’t met, there are exceptions
  14. BMI of at least 40 + 2 minor co-morbidities or 35 or more with 2 major co-morbidities

References:

- (National Health And Nutrition Examination Survey (NHANES) data) January 29, 2014.

- (NASH is third leading reason for liver transplant) April 3, 2013.

-Schwimmer, et al. Pediatrics 2006

-Biel L. Dallas Morning News 8/30/99 (the cost of modern living)

-Sarah E. Barlow, MD, MPH and the Expert Committee. Pediatrics 2007; 120: S164-192.

-American Academy of Pediatrics (bulk of talk): . January 29, 2014.