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Childhood

Obesity
Linda Moody & Allison Rogers
King University
Childhood Obesity: Etiology and
Pathophysiology
Excessive fat (adipose tissue) is the hallmark sign of obesity.
This may be caused by increased size of fat cells (hypertrophy) or increased
number of fat cells (hyperplasia) in the body.
Some risk factors that may cause obesity in children:
Smoking while pregnant with the child
Gaining weight too fast as a baby or small child
Bottle feeding or eating solid foods too early
Eating and drinking high-glycemic foods (sugars, sodas, and processed or prepackaged
foods)
Not eating enough high-fiber foods (whole grains, fruits, and vegetables)
Using food as a reward or comfort during stressful times
Not getting enough exercise (too much television, or screen time with electronics such as
video games, computer, or phone)

(Filkins & Dunn, 2017)


Childhood Obesity: Ediology and
Pathophysiology
Body mass index (BMI) is used to define boundaries for children 2 years old or
older. This is based on the normal average depending on how old they are and
being a boy or girl (age and gender).
BMI is measured in percentiles for the specific group, and shows if the child is
considered overweight, obese, or severely obese.

(Filkins & Dunn, 2017)


Almost 1 in 3 children/ teenagers in the United States are overweight or
obese.
Obese children have an 80% chance of staying obese their whole life. Which
means if you are obese now, you have a greater chance of being obese when
you grow up.

(American Heart Association, 2015)


Childhood Obesity: Usual Presentation &
Course of Condition
Excessive rate of weight gain

BMI Upward change in BMI percentiles


Class (according to
percentiles) BMI greater than 95th percentile is
Overweight 85th to 95th associated with increased risk of
secondary complications
Obesity > 95th
Severe BMI greater than 99th percentile is
> 99th associated with greatly increased risk
obesity
of co-morbidities

(American Heart Association, 2015; Haemer,


Primak, & Krebs, 2016)
Cardiovascular disease
Hypertension
Type 2 Diabetes Mellitus
Some
Orthopedic problems
Complicatio

Obstructive sleep apnea


Obesity-hypoventilation syndrome
ns
Dyslipidemia Associated
Non-alcoholic fatty liver disease with
Gallstones Childhood
Gastroesophageal reflux disease Obesity
Depression/ anxiety
Eating disorders
(American Heart Association, 2015; Haemer, Primak, & Krebs, 2016)
Childhood Obesity: Standard Testing &
Diagnostics
Routine evaluation at well-child visits should include:
Measurement of height and weight, as well as calculation of BMI (and
plotting on growth chart)
Blood pressure measurement
History regarding diet and physical activity
Physical exam should include distribution of adipose tissue (central versus
generalized)
Physical exam should also include assessing for clues of co-morbidities,
such as acanthosis nigricans, hirsutism, hepatomegaly, and orthopedic
abnormalities.

(Haemer, Primak, & Krebs, 2016)


Childhood Obesity: Standard Testing &
Diagnostics
Lab tests beginning at age 10 (may consider younger with severe obesity) include:
Fasting lipid profile
Fasting glucose and/or hemoglobin A1C
Alanine aminotransferase (ALT)
(Haemer, Primak, & Krebs, 2016; Smaldone, Steiner, & Whittemore, 2017)

Conditions to screen for if BMI is > 85th percentile for age and gender:
Nonalcoholic steatohepatits: ALT and aminotransferase (AST)
Thyroid function: thyroid panel
Sleep apnea: history of snoring or daytime somnolence
Polycystic ovary syndrome: free and total testosterone level
Psychological issues (low self-esteem, behavioral problems, depression): thorough history
(Smaldone, Steiner, & Whittemore, 2017)
Childhood Obesity: Standard Treatment
Regimens (Haemer, Primak, & Krebs, 2016)

Step 4:
Tertiary care
intervention
Step 3: (Not been successful
Comprehensive with previous steps.
multidisciplinary Multidisciplinary team
develops a plan that
Step 2: (Involves may include intensive
Structured weight multidisciplinary team behavior therapy,
management and may involve weekly specialized diets,
group meetings.) medications, and
(More specific and
Step 1: surgery.)
structured plan. Meal
Prevention
planning, exercise
(Emphasis on lifestyle prescription, and
changes: healthy eating behavioral changes with
and physical activity.) assistance of health
care professional.)
Resources For More Information (books,
websites, etc.)
Bright Futures

Bright Futures is a national health promotion and prevention initiative, led by the American Academy
of Pediatrics. Bright Futures provides theory-based and evidence-driven guidance for professionals
and families (American Academy of Pediatrics, 2017).
Rethink your Drink

Rethink your Drink is a campaign supported by the American Heart Association. The Rethink your
drink program has been developed to reduce the consumption of sugary beverages by Americans,
especially children by creating and implementing policies designed to improve access to affordable,
nutritious foods and beverages, thereby making it easier for Americans to choose healthier foods
consistent with the Dietary Guidelines for Americans (American Heart Association, 2017 para 2).
Kick the Can

Kick the Can is a program initiated by the Public Health Advocates (PHAdvocates). PHAdvocates is an
advocacy program whose mission is to solve the obesity and diabetes epidemics by promoting
policies that build healthier communities (Public Health Advocates, 2017).
Financial and/or Community Resources
Available to Manage Condition
Healthy Kingsport and the #LiveSugarfreed movement
Healthy Kingsport is a non-profit organization that promotes healthy
living and wellness in the community. Healthy Kingsport has initiated
the #LiveSugarfreed movement to encourage the reduction of
sugary drink consumption.
#LiveSugarfreed is taking on the epidemics of obesity and diabetes
by encouraging people to drink water or other healthier beverages
instead of beverages that contain sugar (Public Goods Project, 2015,
para2).
Financial and/or Community Resources
cont.
According to Healthy Kingsport (2015), the #LiveSugarfreed initiative
has encouraged numerous businesses in the Kingsport area to
pledge against the consumption of sugary beverages in their
establishments. The 3 levels of pledges are
Gold Level: Organizations who do not sell, provide, or promote
sugary beverages.
Silver Level: Organizations who discourage sugary beverages.
Bronze Level: Organizations who promote and encourage water.
Financial and/or Community Resources
cont.
To date, 80 organizations have pledged in the Gold level, 74 in the Silver level, and
96 in the Bronze. Of the organizations that have made pledges, 13 schools including
Kingsport City Schools have also pledged to reduce sugary drink consumption.

St. Paul Day School and Kindergarten Appalachia Elementary School

Blountville Middle School Rogersville City Schools

Sevier Middle School Special Education Kennedy Elementary School

Church Hill Intermediate School Kingsport City Schools

DB Excel Alternative School Elydale Elementary School

Chuckey-Doak High School Wellness Dept. Lighthouse Christian School

Sullivan North High School


What did we do to help?

Re-Think Your Drink


Presentation
YMCA After School Program in Kingsport, TN
Many people consume more sugar than they realize,
therefore it is important to be aware of how much sugar
you are taking in.
Sugars can be naturally occurring in foods, such as in
fruit (fructose) or milk (lactose). Added sugars and
syrups are often used in many foods and drinks.
(American Heart Association [AHA], 2017) Step 1:
Added sugars contribute zero nutrients but many added Prevention
calories that can lead to extra pounds or even obesity
(AHA, 2017, para 3)
The American Heart Association (2017) recommends
(Emphasis on
limiting the amount of added sugars to approximately 9 lifestyle
teaspoons (36 grams) for men and 6 teaspoons (25 changes)
grams) for women each day.
Anticipatory guidance early in childhood, before weight (Haemer, Primak, & Krebs,
becomes a significant problem, is more likely to have 2016)
successful outcomes than intervention after the fact.
(Haemer, Primak, & Krebs, 2016)
Re-think Your Drink Interactive
Presentation
Re-think Your Drink Presentation at YMCA
Re-think Your Drink Presentation at YMCA
Re-think Your Drink Presentation at YMCA
References

American Academy of Pediatrics. (2017). Bright futures prevention and health promotion for infants, children, adolescents, and
their families. Retrieved from: https://brightfutures.aap.org/Pages/default.aspx

American Heart Association [Internet]. (Updated February 01, 2017). Added sugars. Retrieved from:
http://www.heart.org/HEARTORG/HealthyLiving/HealthyEating/Nutrition/Added-Sugars_UCM_305858_Article.jsp#.WNvRCoWcHmJ

American Heart Association [Internet]. (Updated August 17, 2015). BMI in children. Retrieved from:
http://www.heart.org/HEARTORG/HealthyLiving/HealthyKids/ChildhoodObesity/BMI-in-
Children_UCM_308993_Article.jsp#.WNvRiYWcHmJ

American Heart Association. (2017). Rethink your drink. Retrieved from:


http://www.heart.org/HEARTORG/Affiliate/ReThink-Your-Drink_UCM484504_SubHomePage.jsp

Filikins, S. & Dunn, A. M. (2017). Nutrition. In C. E. Burns, A. M. Dunn, M. A. Brady, N. B. Starr, C. G. Blosser, & D. L. Garzon (Eds.),
Pediatric Primary Care, 6th (ed.), (pp. 158-197). St. Louis, MO: Elsevier.

Haemer, M. A., Primak, L. E., & Krebs, N. F. (2016). Normal childhood nutrition & its disorders. In W. W. Hay, M. J. Levin, R. R.
Deterding, & M. J. Abjung (Eds.), Current Diagnosis & Treatment: Pediatrics, 23rd (ed.), (pp. 281- 307). New York, NY:
McGraw Hill Education.
References cont.

Healthy Kingsport. (N.D.) Take the pledge. Retrieved from:


http://www.healthykingsport.org/livesugarfreed-pledges/

Public Goods Project. (2015). #LiveSugarfreed. Retrieved from: http://livesugarfreed.org/about/

Public Health Advocates. (2017). Kick the can: Giving the boot to sugary drinks. Retrieved from:
http://www.kickthecan.info/

Smaldone, A., Steiner, R. D., & Whittemore, B. J. (2017). In C. E. Burns, A. M. Dunn, M. A. Brady, N. B. Starr, C. G. Blosser, & D. L.
Garzon (Eds.), Pediatric Primary Care, 6th (ed.), (pp. 596-625). St. Louis, MO: Elsevier.