وصف
Pediatric obesity management requires a comprehensive and multidisciplinary approach addressing both lifestyle and underlying factors contributing to excess weight. Interventions include promoting a balanced diet, encouraging regular physical activity, and fostering behavioral changes. Involving families, healthcare professionals, and educational institutions is crucial for creating a supportive environment. Targeted interventions, such as nutritional counseling and age-appropriate physical activities, aim to mitigate health risks and improve overall well-being in children with obesity. Regular monitoring, addressing psychosocial aspects, and fostering a positive relationship with food and exercise are integral components of effective pediatric obesity management.
ملخص
- Pediatric obesity is a significant public health concern with complications that can persist from childhood into adulthood. Obesity is now a global epidemic and is linked to more deaths than undernutrition. The global economic impact of overweight and obesity is estimated to reach $4.3 trillion annually by 2035 if prevention and treatment measures are not improved.
- BMI is used to define overweight and obesity, with different cutoffs for adults and children. The International Obesity Task Force defines overweight as a BMI of more than 23 kg/m² for Asian adults. However, age and gender-specific cutoffs are used for children, as defined by the IAP growth charts. The WHO reference charts are used for children aged 0 to 5 years, using length-for-height or BMI standard deviations.
- South Asian ethnicity requires specific BMI charts because of a unique phenotype characterized by higher visceral obesity and increased waist circumference. BMI alone has drawbacks, as it does not account for lean mass and may not be reliable during puberty. Waist circumference is a better parameter for predicting complications.
- The etiology of obesity includes CNS causes, syndromes, monogenic disorders, psychiatric conditions, and certain drugs. Metabolic programming can occur in utero due to maternal malnutrition or excessive weight gain during pregnancy. Exogenous causes, accounting for 98% of cases, are due to increased food intake and decreased activity.
- Obesity occurs when energy intake exceeds energy expenditure, involving neuroendocrine feedback loops linking adipose tissue, the gastrointestinal system, and the CNS. Early management of obesity reduces the risk of adult obesity and associated co-morbidities. The pathogenesis involves an interplay between the afferent system, central processing unit, and efferent system.
- Complications of obesity include headaches, slipped capital femoral epiphysis, daytime sleepiness, type 2 diabetes, acanthosis nigricans, and cardiovascular issues. Measuring waist circumference is vital, as it can diagnose metabolic syndrome. Evaluation should include screening for fasting blood sugar, lipid profile, liver enzymes, and co-morbidities such as fatty liver and sleep apnea.
- The key is to set treatment goals aiming to improve the quality of life. A family-based treatment plan should be implemented and customized. The initial intervention is to improve healthy eating habits, increase physical activity, and institute behavior modifications.
- Pharmacological and surgical treatment should be considered when necessary. If lifestyle modifications fail, pharmacological options include orlistat, metformin, GLP-1 receptor agonists, and setmelanotide. Bariatric surgery can be considered if the BMI is greater or equal to 40 after failure of 6 months of multi-disciplinary weight loss management program.
- Managing dyslipidemia, type 2 diabetes mellitus, hypertension, and obstructive sleep apnea in obese children is important. Treatment targets include reducing the blood pressure to less than 90th percentile in children and to less than 130/80 in children more than 13 years of age. Weight loss should be gradual and sustained, with a BMI z-score reduction of 5% over 6 months.
نموذج شهادة
حول المتحدثين
Dr. Dhanya Soodhana
Senior Specialist, Pediatric and Adolescent Endocrinology, Aster MIMS, Calicut, Kerala
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