II. Epidemiology
- Overweight between age 2 to 19 in 2004: 17.1% (was 12% in 1994)
- Number of obese children and adolescents in U.S. trippled between 1980 and 2000
III. Causes: Secondary Causes of Childhood Obesity (<10% of cases)
- Hypothyroidism
- Cushing's Syndrome (Hypercortisolism)
- Primary Hyperinsulinism
- Pseudohypoparathyroidism
- Hypothalamic abnormality
-
Genetic Syndromes with Mental Retardation
- Prader-Willi Syndrome
- Laurence-Moon or Bardet-Biedl Syndrome
- Borjeson-Forssman-Lehmann Syndrome
- Cohen Syndrome
- Ruvalcaba Syndrome
- Familial Lipodystrophy
-
Genetic Syndromes without Mental Retardation
- Alstrom Syndrome
- Turner's Syndrome
- Beckwith-Wiedemann Syndrome
- Sotos' Syndrome (cognitive delay may be present)
- Weaver Syndrome
IV. Risk Factors
-
Obesity Risk increases with television viewing time
- Lowest Prevalence for <1 hour/day: 8% Obesity
- Highest Prevalence for >4 hours/day: 17% Obesity
- Crespo (2001) Arch Pediatr Adolesc Med 155:363 [PubMed]
- Obesity in child's parent
- Decreased Physical Activity
- Physical Activity is inversely related to Obesity
V. Evaluation
VI. Labs
- Lipid profile
- Indications for suspected secondary cause evaluation
- Short Stature (<5th percentile)
- Minimal to no Family History of Obesity
- Mental Retardation
- Delayed Bone Age
- Physical findings suggest secondary cause
VII. Complications
- See Obesity Risk
- Slipped Capital Femoral Epiphysis
- Tibia vara
- Adult Obesity (high risk)
VIII. Associated Conditions
IX. Management
- See Prevention measures below
- Significant Obesity (BMI>95%) is an indication for Intensive management
- Set reasonable weight loss goal
- Monthly: 1 to 4 pound loss
- Month 3 to 6: 5 to 10 pound loss
- Employ 5-2-1-0 approach to lifestyle change
- Fruits and vegetables 5 or more
- Maximum recreational Screen Time limited to 2 hours or less
- Physical Activity of 1 or more hours per day
- Sugary drinks per day 0
- Adequate sleep
- Establish Dietary Guidelines
- See Food Pyramid
- Calculate Daily Energy Allowance
- Approximate a 500 calorie deficit per day
- Establish regular Exercise
-
Behavior Modification
- Stimulus control
- Modify eating habits
- Attitude change
- Reward positive new behaviors
- Involve family in Weight Reduction program
- Parent nutritional counseling
- Family activity
- Family television viewing limited
-
Obesity Medications (age >12 years with severe, refractory Obesity)
- See Obesity Medication
- Options include Semaglutide, phenteramine/Topiramate (Qsymia), Xenical
X. Prevention
- Provide balanced diet (see Food Pyramid)
- Maximize child's Dietary Fiber intake
- Eat 5 or more fruits and vegetables per day
- Eliminate excessive fat and sugars
- Limit fat calories to <30% of total calories
- Replace whole milk with skim milk at age 2 years
- Avoid fast-food and "junk-food" (e.g. potato-chips, twinkies)
- Avoid sugar-sweetened drinks (e.g. Gatorade, soda, fruit drinks)
- Limit high calorie foods in home
- Encourage healthy eating behaviors
- Eat meals as a family at least 5 days per week
- Limit eating out (esp. fast food restaurants)
- Do not skip breakfast
- Use appropriate food portions
- Food should not be used to comfort or reward child
- Treats should not be used to reward finishing a meal
- Child does not need to "clean plate": stop with satiety
- Encourage activity
- Limit television, computer and video games to 2 hour or less per day
- Do not keep a television in the child's room
- Foster active play and family Exercise for >30-60 minutes per day
XI. Resources
- Shapedown Pediatric Obesity Program (Ages 6 to 20)
- http://www.shapedown.com
- Phone: 415-453-8886
- Children's Hospital of Pittsburgh
XII. References
- (2023) Presc Lett 30(6): 33
- Kreipe (1998) Adolescent Health Update 10(2):1-8
- Moran (1999) Am Fam Physician 59(4):861-8 [PubMed]
- Rao (2008) Am Fam Physician 78(1): 56-66 [PubMed]
- Spiotta (2008) Am Fam Physician 78(9): 1052-8 [PubMed]
- Williams (1997) Ann N Y Acad Sci 817:225-40 [PubMed]