Supervised by Dr. Najlaa Jassas

Done by Dr. Rahma ShahBahai

OUTLINE:

•Definition• Epidemiology• Etiology& Pathophysiology• Approach to obese child• Complication• Treatment& prevention

Remember…

• English formula for BMI:

703 x Weight in pounds ÷ (Height in inches)2

• Metric formula for BMI:

Weight in Kilograms ÷ (Height in meters)2

DEFINITIONfor children between 2 and 20 years of age:

●Underweigh – BMI <5th percentile for age and sex

●Normal weight – BMI between the 5th and 85th percentile

●Overweight – BMI between the 85th and 95th

●Obese – BMI ≥95th percentile

●Severe obesity – BMI ≥120 percent of the 95th percentile values, or a BMI ≥35 kg/m2 (whichever is lower)

صورة إلضافة األيقونة فوق انقر

For children <2 Y.O:

Standard weight for length curves

Epidemiology

Currently, almost one third of children and adolescents in the United States are either overweight or obese.

●Overweight or obese (body mass index [BMI] ≥85th percentile)

        22.8 percent of preschool children (2 to 5 years)        34.2 percent of school-aged children (6 to 11 years)        34.5 percent of adolescents (12 to 19 years)

●Obese (BMI ≥95th percentile)

        8.4 percent of preschool children        17.7 percent of school-aged children        20.5 percent of adolescents

●Severe obesity (BMI that is either ≥120 percent of the 95th percentile or ≥35 kg/m2)

        1.7 percent of school children         6.8 percent of school-aged children        7.7 percent of adolescent girls and 6.8 percent of adolescent boys

National Center for Health Statistics, Centers for Disease Control and Prevention, 2012.

• 19 317 healthy children and adolescents

• 5 to 18 years of age

• The overall prevalence of: • Overweight 23.1%• obesity 9.3%• severe obesity 2% Over weight obesity severe obesity

• Environmental factors

• Genetic factors

• Endocrinal diseases

Environmental factors:

• Sugar

• Sweetened beverage

• Television

• Video games

• Sleep

• Medications

• psychoactive drugs

(particularly olanzapine and

risperidone)

• antiepileptic drugs

• Glucocorticoids

• Virus: Adenovirus 36

• Gut microbes

• Toxins: BPA(bisphenol A), DDT

Genatic factors:

• Down syndrome>>>most common

• Prader-Willi syndrome

• Bardet-Biedl syndrome

• Cohen syndrome

• Turner syndrome

Endocrine diseases:

• Growth hormone deficiency

• Growth hormone resistance

• Hypothyroidism

• Leptin deficiency or resistance to leptin action

• Glucocorticoid excess (Cushing syndrome)

• Precocious puberty

• Polycystic ovary syndrome (PCOS)

PATHOPHYSIOLOGY

1. Genetic & environmental component.

caloric intake= caloric expenditure

2.THE (THRIFTY) GENE HYPOTHESIS.

• (thrifty) phenotype gene:• Storage calories in adipose tissues ^• Protect energy store during starvation• More intense food-seeking behavior.

• (wasteful) phenotype gene:• Store less calories as adipose tissues• Less intense food-seeking behavior.

3.WEIGHT SET POINT& REGULATION OF ENERGY HOMEOSTASIS

• Weight set point is maintained by adjustment to metabolic rate in response to changes in body mass.

Dec. caloric intake=dec. leptin

4.THE

NEUROENDOCRINOLOGY OF

WEIGHT REGULATION

4 HORMONES:

• Leptin: • Inhibit NPY/AgRP

• Appetite• Metabolic rate

• Stimulate POMC• Inhibit appetite• Metabolic rate

• Secreted from >>>>

• insuline: • Post prandial• May act to feed intake• Secreted from >>>>

• Ghrelin: • in fasting • Stim. NPY/AgRP

• Appetite• Metabolic rate

• Secreted from >>>>

• Peptide yy: • With feeding• NPY/AgRP• stimulate POMC• Secreted from >>>>

HISTORY

EXAMINATION

INVESTIGATION?

?

TREATMENT

WHEN TO REFER TO PEDIATRIC ENDOCRINOLOGY?

PREVENTION

REFERENCES