Obesity in Kids! Assessment

Childhood obesity has made headlines, most recently this month on Malaysian newspaper, 1 and was a dsitinction viva question in IIUM's latest professional exam as well. Malaysia is becoming a fatter nation with fat children. This is all linked to the standard of living and the way we live our lives.

http://mthago.com/2011/05/14/obesity-among-school-children-causes-and-treatment/

As for kids becoming fat, most are not 100% their own fault. Parental styles contribute, family and cultural lifestyle, as well as peer pressure play roles in this 'disease' of fatness. Some (a lot) take offense to public comments on fatness as well.

Understanding the risks and complications may help in creating awareness in the general public. Only then can an effective counter-measure be implemented.

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Diagnosis and Assessment of Obesity

Diagnosis is based on the BMI centile charts in children and adolescence. This is in contrast to adults where the absolute value of BMI determine whether a person is obese.

Calculation of BMI is the same = Weight (kg) / [ Height (cm) ] square root.

Centile charts here.

Boys

Girls

Anything above 95% is considered OBESE.

What to do when you see a really fat kid in your clinic?

History Taking:

Family History:

- Fat parents and siblings

- Metabolic syndrome or cardiovascular disease in family

Antenatal and Postnatal History:

- GDM mother

- High birth weight

- Non-exclusive breastfeed

- Early introduction to sweetened fluids and food

Monster 5 kg.

Social History:

- Diet history: frequency of snacks, carbonated or sweet drinks, eating as a family, eating outside.

- Physical activity: frequency, types of activities, 'screen' time ie. TV, internet, playstation.

- Attitude towards obesity, and losing weight. 

- School and peer: Bullying, bully, taunting.

Symptoms (related to Complications or Comorbids, see later)

Physical Examination

Short statured (Cushing syndrome)

Acne (PCOS, Cushing syndrome) 

Acanthosis nigricans (Metabolic syndrome, PCOS)

Blood pressure

Abducent nerve palsy, papilloedema (Pseudoumor cerebri)

Striae (Cushing syndrome)

Abdominal pain (Gallstone)

Hepatomegaly (Non-alcoholic fatty liver disease)

Limited range of movement of hips (Slipped capital femoral epiphysis)

Bowing of legs (Blounts disease)

Investigations

Fasting lipid profile

Fasting sugar profile

Liver function test

Imaging as indicated according to complications.

Hip and lower limb x-ray

Abdominal ultrasound

Complications and Comorbids

 

 Respiratory System

• Asthma
• Obstructive sleep apnea

 Cardiovascular System

• Hypertension

Endocrine System

• Metabolic syndrome
• Diabetes mellitus

GIT System

• GERD
• Non-alcoholic fatty liver disease
• Gallstone

Musculoskeletal System

• Blount disease
• Slipped capital femoral epiphysis

Neurological

• Pseudotumor cerebri

Psychological

• Depression
• Worsening school performance
• Eating disorders

TO BE CONTINUED... Management and Prevention

References:

1. http://www2.aap.org/obesity/pdf/COANImplementationGuide62607FINAL.pdf

2. CPG, Obesity, Ministry of Health Malaysia

3. Kliegman, Robert M., et al., Nelson Textbook of Pediatrics, 18th ed., Elsevier Saunders.

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