2. DEFINITION:
Excess accumulation of body fat
Varies with the parameter used for
measuring
Most common parameter:
Weight for age: >120%
Body mass index (Quetelet’s
Index):
weight (kg)/ height (m²)
Overweight Obesity
Adult 25 – 30 ≥ 30
Children 85 – 95 centile ≥ 95 centile
3. Waist circumference
Men > 40inch Women >35 inches
Waist:hip ratio
Indicator for coronary artery diseases in adults
Men >0.9 Women >0.8
6. EPIDEMIOLOGY:
In aged 0 to 5 years increased from 32 million globally in 1990
to 42 million in 2013.
In current trends globally obesity will increase to 70 million by
2025.
7. The vast majority of overweight or obese children
live in developing countries.
India have shown prevalence of overweight 10 – 14
% and obesity in 3 – 6% of pediatric population.
In Chennai > 22% HSE group, 15% from MSE
groups and only 4.5% from LSE group, children
were obese.
Diabetes Res Clin Pract 2002; 57: 185 -190.
8. In affluent schools:
Delhi
31% overweight;
7.5% obese.
Pune
24% overweight.
Chennai
22% overweight.
(Indian Pediatr 2002; 39: 449-452)
(Indian Pediatr 2004; 41: 559-575)
(Diabetes Res Clin Pract 2002; 57: 185-190)
9. OBESITY TRENDS* AMONG U.S. ADULTS
BRFSS, 1991(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19%
10. OBESITY TRENDS* AMONG U.S. ADULTS
BRFSS, 1992(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19%
11. OBESITY TRENDS* AMONG U.S. ADULTS
BRFSS, 1993(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19%
12. OBESITY TRENDS* AMONG U.S. ADULTS
BRFSS, 1994(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19%
13. OBESITY TRENDS* AMONG U.S. ADULTS
BRFSS, 1995(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19%
14. OBESITY TRENDS* AMONG U.S. ADULTS
BRFSS, 1996(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19%
15. OBESITY TRENDS* AMONG U.S. ADULTS
BRFSS, 1997(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% ≥20%
16. OBESITY TRENDS* AMONG U.S. ADULTS
BRFSS, 1998(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% ≥20%
17. OBESITY TRENDS* AMONG U.S. ADULTS
BRFSS, 1999(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% ≥20%
18. OBESITY TRENDS* AMONG U.S. ADULTS
BRFSS, 2000(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% ≥20%
19. OBESITY TRENDS* AMONG U.S. ADULTS
BRFSS, 2001(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% 20%–24% ≥25%
20. (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
OBESITY TRENDS* AMONG U.S. ADULTS
BRFSS, 2002
No Data <10% 10%–14% 15%–19% 20%–24% ≥25%
21. OBESITY TRENDS* AMONG U.S. ADULTS
BRFSS, 2003(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% 20%–24% ≥25%
22. OBESITY TRENDS* AMONG U.S. ADULTS
BRFSS, 2004(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
23. OBESITY TRENDS* AMONG U.S. ADULTS
BRFSS, 2005(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
24. OBESITY TRENDS* AMONG U.S. ADULTS
BRFSS, 2006(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
25. OBESITY TRENDS* AMONG U.S. ADULTS
BRFSS, 2007(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
26. OBESITY TRENDS* AMONG U.S. ADULTS
BRFSS, 2008(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
27. OBESITY TRENDS* AMONG U.S. ADULTS
BRFSS, 2009(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
28. OBESITY TRENDS* AMONG U.S. ADULTS
BRFSS, 2010(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
30. RISK FACTORS:
Crucial periods
prenatal period
age 5 – 7 years
adolescence.
The point of lowest level of BMI around 6 years
after which it starts increasing is known as adiposity
rebound.
41. COMPLICATIONS:
System In Childhood In adulthood
Metabolic Insulin Resistance,
dyslipidemia, metabolic
syndrome
Type 2 diabetes, metabolic
syndrome
Cardiovascular Hypertension Atherosclerosis, LVH,
hypertension
Respiratory Sleep abnormalities, asthma
Musculoskeletal Tibia vara, slipped capital
femoral epiphysis, flat feet
Osteopenia
Gastrointestinal GERD, NAFLD NAFLD, hernia,
cholelithiasis
Endocrine Early puberty, PCOS Type 2 Diabetes
Psychosocial Low self esteem, depression, anxiety, worsening school
performance, social isolation
Dermatological Cellulitis, acanthosis nigricans, carbuncles, intertrigo
Miscellaneous Raised CRP, pseudotumor cerebri, meralgia paresthetica
42. EVALUATION:
Main aim is to ascertain whether primary or
secondary obesity.
History:
Antenatal history
Birth weight
Weight gain
Sleep pattern
Family history
Medications
Developmental assessment
Menstrual history.
43. Examination:
General and systemic examination
Anthropometry
Blood Pressure
Acanthosis nigricans
Acne
Hirsutism
Hair fall
Dysmorphic facies
Pubertal status
Psychiatric evaluation.
44. Investigations: Routine +
Lipid profile
Glucose tolerance test
Thyroid function
Gonadal axis – serum LH, FSH, testosterone
Bone age assessment
Growth hormone
Serum Parathyroid/ Vitamin D
Serum insulin, Glycosylated Hemoglobin
(HbA1C)
45. MANAGAMENT:
Multidisciplinary approach
Non – pharmacological:
Dietary:
of total calories:
Carbohydrate 45 – 65 %
Protein 10 – 20%
Fat 30 – 40%
Weight monitoring:
≤ 11years= 0.5kg/month
>11 years 1 kg/week
47. Pharmacological:
Antiobesity drugs still being evaluated in children.
Advised only in children >16 years with obesity related
complications.
Only drug approved is Orlistat.
Can be used in ≥12 years
120 mg TDS with each meal or within 1 hour
Same as adult
52. PREVENTION:
Diet:
Exclusive breast feeding
Timely complementary feeding
Healthy feeding practices
No fat restriction to be done in infants < 2 years
For > 2yr, fat contributes 20 – 30 % of calories
Fiber in diet = age + 5g
53. Traffic light diet approach:
Green (go) - fruits and vegetables
Yellow (caution) - grains and processed meat
Red (stop) - sweetened and dried fruits, fried foods
Proper guidance for age appropriate foods
Skipping breakfast, frequent snacking and eating
out to be avoided
54.
55. Lifestyle
and
physical activity:
No TV for < 2 years
> 2 years not >2hr/day
Young child and toddler daily ½ to 1 hr of outdoor
activity
Older child vigorous exercise for 60min/day
56. Behaviour:
Parental motivation
and commitment
No stacking of unhealthy food in house
Setting realistic goals for exercise
Positive reinforcement
Timely monitoring.
57.
58.
59. ENDING CHILDHOOD OBESITY (ECHO)-
WHO COMMISSION:
Goals:
Provide policy recommendations to governments to
prevent infants, children and adolescents from
developing obesity and to identify and treat pre existing
obesity in children and adolescents.
To reduce the risk of morbidity and mortality due to non-
communicable diseases, lessen the negative
psychosocial effects of obesity both in childhood and
adulthood and reduce the risk of the next generation
developing obesity.
61. THE LOSER ?
90 kg
BMI: 33.05
Obese
60 kg
BMI: 22.03
Ideal
62. THE BIGGEST LOSER ?
230 kg
BMI: 75.1
Super Obese
75 kg
BMI: 24.48
Ideal
Thank You
63. REFERENCES:
Gahagan S. Overweight and obesity. In: Nelson textbook of pediatrics. Eds. Kliegman RM,
Stanton BF, Schor NF, Geme JWS, Behrman RE. 20th Edn. Elsevier, Philadelphia, USA. 2015: pp.
307-16.
Ravikumar KG. Acute and chronic complications of Diabetes Mellitus. In: PG Textbook of
Pediatrics. Eds. Gupta P, Menon PSN, Ramji S, Lodha R. 1st Edn. Jaypee, New Delhi, India 2015:
pp. 2384-8
Agarwal KN. Obesity and thinness. In: The Growth: infancy to adolescence. Eds. Agarwal KN. 3rd
Edn. CBS, New Delhi, India 2015: pp 53–72.
Ramachandran A, Snehalatha C, Vinitha R, Thayyil M, Kumar CK, Sheeba L, Joseph S, Vijay V.
Prevalence of overweight in urban Indian adolescent school children. Diabetes Res Clin Pract.
2002; 57(3):185-90.
Bhave S, Bavdekar A, Otiv M. IAP National Task Force for Childhood Prevention of Adult
Diseases: Childhood Obesity. Indian Pediatr. 2004; 41(6):559-75.
Kapil U, Singh P, Pathak P, Dwivedi SN, Bhasin S. Prevalence of obesity amongst affluent
adolescent school children in delhi. Indian Pediatr. 2002;39(5):449-52.
The Behavioral Risk Factor Surveillance System (BRFSS) 1991 to 2010
Fall CH. The fetal and early life origins of adult disease. Indian Pediatr. 2003; 40(5):480-502.
Lustig RH. Hypothalamic obesity after craniopharyngioma: mechanisms, diagnosis, and
treatment. Front Endocrinol 2011;2:60.
Report of the WHO commission on Ending Childhood Obesity (ECHO) published January 2016.<
http://apps.who.int/iris/bitstream/10665/204176/1/9789241510066_eng.pdf?ua=1>