Journal of Medicine Vol 2 - Amrita Institute of Medical Sciences and ...

Amrita Journal of Medicine
Obesity in Children and Adolescents
Table 2: Medical Evaluation of a Child or an Adolescent Who Is Overweight
Evaluation of growth: Normal growth (especially height) makes metabolic or genetic form of overweight less likely
Family history of premature coronary heart disease, dyslipidemia, diabetes
Diet history, history of smoking
History of sleep-disordered breathing
Assessment of physical activity and sedentary behaviour
Psychiatric assessment
History of irregular menstrual periods, acne, and hirsutism in adolescent girls
(evidence of polycystic ovarian syndrome).
Skin disorders like intertrigo, monilial dermatitis, acne and acanthosis nigricans.
Blood pressure measurement (multiple readings with attention to proper cuff size)
Physical assessment for orthopedic abnormalities
Urine analysis, fasting lipid profile, Serum uric acid, C-Reactive Protein,
Fasting glucose, fasting insulin, HbA1c level
Liver function tests, thyroid function tests
Renal function tests (if hypertension is present)
Abdominal USG (for fatty liver, ovarian cysts)
PREVENTION OF OBESITY
The ideal preventive strategy for obesity is to prevent
children with a normal, desirable BMI from becoming
overweight or obese. Preventive strategies should start as
early as newborn period. Both initiation and duration of
breast-feeding may reduce the risk of later overweight 52 .
A reasonable goal for preschool interventions would be
to aim toward weight gain of 1.0 kg/2 cm of growth.
This rate of gain from preschool age (3 to 4 years) onward
predicted desirable weight at 8 to 9 years of age,
whereas a gain of 1.8 kg/2 cm predicted obesity at elementary
school age 53 . The important role of healthful
behaviors has increasingly been documented. Behavior
modifications should focus on increasing consumption
of fruits, vegetables and fiber-containing grain products,
avoidance of high calorie/high fat food items, increasing
daily physical activity, and limiting sedentary time.
Interventions that include classroom and physical
education sessions, changes in school meals, vending
machines, and cafeterias, and after-school programs, can
increase physical activity and improve dietary patterns in
children and adolescents 54,55 . One recent study has emphasized
reducing television, videotape/DVD, and video
game use 32 . There are also successful examples of physical
education interventions designed with higher-intensity
or more motivating activities, specifically endurance training
56 and popular dance 57 . Exposure to various media is
critical. A substantial proportion of the advertising on
children’s television promotes food, and there is a direct
relationship between television viewing and obesity 58 .
Reducing television viewing has reduced weight gain and
the prevalence of obesity in experimental trials 32,59 . It has
been hypothesized that television promotes obesity
through the consumption of food while watching television,
the consumption of foods advertised on television,
or reduced physical activity 58,60,61 .
TREATMENT OF OBESITY
In treating children with overweight and obesity, the
immediate goal is to bring down the rate of weight gain,
followed by a period of weight maintenance and finally
weight reduction to improve BMI. Children 2 to 4 years
old who are overweight or obese will achieve reductions
in BMI percentile by achieving a rate of weight gain < 1
kg/2 cm of height gain. Older Children who are obese
without comorbidities may achieve BMI percentile reductions
to below overweight cut-offs with BMI
maintenance. Children who are obese with comorbidities
require an aggressive approach to bring in weight loss in
concurrence with other treatment strategies. A gradual
weight loss is preferred because it is achievable and more
easily sustained giving long-term benefits. Older adolescents
who have completed linear growth and have a BMI
>30 kg/m 2 require more aggressive weight loss similar
to that for adults 62 . The principles for the treatment of
obesity can be summarized as follows:
1. Establish individual treatment goals and approaches
on a case-to-case basis.
2. Ensure family involvement through out the treatment
period.
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