Obesity in Children

1. See Also
   1. Obesity
2. Epidemiology
   1. Overweight between age 2 to 19 in 2004: 17.1% (was 12% in 1994)
   2. Number of obese children and adolescents in U.S. trippled between 1980 and 2000
3. Causes: Secondary Causes of Childhood Obesity (<10% of cases)
   1. Hypothyroidism
   2. Cushing's Syndrome (Hypercortisolism)
   3. Primary Hyperinsulinism
   4. Pseudohypoparathyroidism
   5. Hypothalamic abnormality
   6. Genetic Syndromes with Mental Retardation
      1. Prader-Willi Syndrome
      2. Laurence-Moon or Bardet-Biedl Syndrome
      3. Borjeson-Forssman-Lehmann Syndrome
      4. Cohen Syndrome
      5. Ruvalcaba Syndrome
      6. Familial Lipodystrophy
   7. Genetic Syndromes without Mental Retardation
      1. Alstrom Syndrome
      2. Turner's Syndrome
      3. Beckwith-Wiedemann Syndrome
      4. Sotos' Syndrome (cognitive delay may be present)
      5. Weaver Syndrome
4. Risk Factors
   1. Obesity Risk increases with television viewing time
      1. Lowest Prevalence for <1 hour/day: 8% Obesity
      2. Highest Prevalence for >4 hours/day: 17% Obesity
      3. Crespo (2001) Arch Pediatr Adolesc Med 155:363
   2. Obesity in child's parent
   3. Decreased Physical Activity
      1. Physical Activity is inversely related to Obesity
5. Evaluation
   1. See Cardiac Risk Factors
   2. See Body Mass Index
   3. See Daily Energy Allowance
   4. Blood Pressure
6. Labs
   1. Lipid profile
   2. Indications for suspected secondary cause evaluation
      1. Short Stature (<5th percentile)
      2. Minimal to no Family History of Obesity
      3. Mental Retardation
      4. Delayed bone age
      5. Physical findings suggest secondary cause
7. Complications
   1. See Obesity Risk
   2. Slipped Capital Femoral Epiphysis
   3. Tibia vara
   4. Adult Obesity (high risk)
      1. Kvaavik (2003) Arch Pediatr Adolesc Med 157:1212-18
8. Associated Conditions
   1. Hypertension
   2. Diabetes Mellitus
   3. Metabolic Syndrome
   4. Hyperlipidemia
9. Management
   1. See Prevention measures below
   2. Set reasonable weight loss goal
      1. Monthly: 1 to 4 pound loss
      2. Month 3 to 6: 5 to 10 pound loss
   3. Establish dietary guidelines
      1. See Food Pyramid
      2. Calculate Daily Energy Allowance
      3. Approximate a 500 calorie deficit per day
   4. Establish regular Exercise
      1. Exercise in addition to school physical education
      2. Home Exercise for more than 30 minutes/day
   5. Behavior Modification
      1. Stimulus control
      2. Modify eating habits
      3. Attitude change
      4. Reward positive new behaviors
   6. Involve family in Weight Reduction program
      1. Parent nutritional counseling
      2. Family activity
      3. Family television viewing limited
10. Prevention
    1. Provide balanced diet (see Food Pyramid)
       1. Maximize child's Dietary Fiber intake
       2. Eat 5 or more fruits and vegetables per day
    2. Eliminate excessive fat and sugars
       1. Limit fat calories to <30% of total calories
       2. Replace whole milk with skim milk at age 2 years
       3. Avoid fast-food and "junk-food" (e.g. potato-chips, twinkies)
       4. Avoid sugar-sweetened drinks (e.g. Gatorade, soda, fruit drinks)
       5. Limit high calorie foods in home
    3. Encourage healthy eating behaviors
       1. Eat meals as a family at least 5 days per week
       2. Limit eating out (esp. fast food restaurants)
       3. Do not skip breakfast
       4. Use appropriate food portions
       5. Food should not be used to comfort or reward child
       6. Treats should not be used to reward finishing a meal
       7. Child does not need to "clean plate": stop with satiety
    4. Encourage activity
       1. Limit television, computer and video games to 2 hour or less per day
       2. Do not keep a television in the child's room
       3. Foster active play and family Exercise for >30-60 minutes per day
11. Resources
    1. Shapedown Pediatric Obesity Program (Ages 6 to 20)
       1. http://www.shapedown.com
       2. Phone: 415-453-8886
    2. Children's Hospital of Pittsburgh
       1. http://www.chp.edu/clinical/03a_weightmanage.php
12. References
    1. Kreipe (1998) Adolescent Health Update 10(2):1-8
    2. Moran (1999) Am Fam Physician 59(4):861-8
    3. Rao (2008) Am Fam Physician 78(1): 56-66
    4. Spiotta (2008) Am Fam Physician 78(9): 1052-8
    5. Williams (1997) Ann N Y Acad Sci 817:225-40