Childhood Obesity Notes PDF

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Chapter 47: Alterations in Nutritional Status Overweight and Obesity -

Obesity – excess body fat accumulation with organ-specific pathologic consequences

Body Mass Index -

BMI > 25 = overweight BMI > 30 = obese Weight (kg) / height (m2) = weight (lbs) / height (in2) * 703 In children: 85th – 95th percentile = overweight; 95th + percentile = obese

Causes of Obesity -

Energy imbalance – too much calories + not enough physical activity Also, genetics, metabolism, environment, culture, SES, health, family (parental eating patterns), media, access to food, etc. As a coping mechanism for stress, boredom, anxiety

Types of Obesity -

Upper body obesity = central, abdominal, visceral, male, apple Lower body obesity = peripheral, gluteal-femoral, female, pear Waist-to-Hip ratio > 1.0 in men or > 0.8 in women = upper body obesity o Waist circumference > 88 cm in women or > 102 cm in men = increased health risk Visceral fat release adipokines and fatty acids = greater impact on hepatic function

Health Risks Associated with Obesity -

Cardiac diseases – hypertension, hypertriglyceridemia, decreased HDL cholesterol Increased risk of T2DM, obstructive sleep apnea, gastric reflux, urinary stress incontinence, gallbladder disease Limited mobility and joint disorders Infertility in women, gestational diabetes, high risk pregnancy, difficulty in labor Cancer – endometrial, colon, gallbladder, prostate, kidney, and postmenopausal breast Non-alcoholic steatohepatitis and fatty liver disease Negative stereotypes and differential treatment in health care

Prevention and Treatment of Obesity Prevention - Modify lifestyle behaviors  healthy food choices and more physical activity - Policies  regulate availability of junk food Treatment - For people BMI > 30 and BMI > 25 with risk factors - Reduced caloric intake, increased physical activity, and behavior therapy - Pharmacotherapy and surgery - Determine person’s barriers and readiness to lose weight - Dietary Therapy

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o Caloric restriction o Diet composition Physical Activity o Decreases risk of overweight and obesity o Reduce cardiovascular and diabetes rusk Behavior Therapy o Lifestyle modifications o Setting realistic weight goals Pharmacotherapy o For BMI > 30 and > 27 with risk factors o Reduction of food intake via the CNS o Action outside the brain e.g. block lipase absorption o Antiepileptic and antidepressants Surgery (Bariatric) o For BMI > 40 and > 35 with previous failed attempts to lose weight o Restrictive procedures – reduce amount of food that can be taken in o Malabsorptive – bypass sections of the intestine = less nutrients absorbed o Combined restrictive and Malabsorptive o Results in resolution of comorbid disease states...