What is obesity and overweight? | Definition |Main points | BMI | Complications |Prevention |Diagnosis |Management

Case study :

A 12-year-old boy presents for an obesity assessment. Physical examination is normal, but his weight is 67 kg (99.6th percentile) and height is 151 cm (75th percentile), giving a BMI of 29 (obese).

◾Body Mass Index (BMI) is used as a screening tool to identify possible weight problems in children.

◾It is calculated by dividing the weight in kilograms by the square of the height in meters.

Definition:

Having too much body mass is called obesity. A BMI of 30 or more is called obesity and BMI 40 or higher is considered obese.. 

🔸A BMI (body mass index) between the 85th and 95th percentile indicates overweight.

🔸A BMI > 95th percentile indicates obesity.

Main points:

🔹Many obese children become obese adults, and the risk of remaining obese increases with age and degree of obesity.

🔹Obesity runs in families and is rarely linked to genetic influences.

🔹There is a link between obesity and television viewing and excessive dietary intake.

🔹Children born to obese mothers are three to five times more likely to be obese in childhood.

🔹Some small-for-gestational-age (SGA) infants have a higher risk of abnormal postnatal weight gain and diabetes. 

Complication:

A high BMI increases the risk of metabolic and cardiovascular diseases, some cancers and diabetes. 

Medical complications of childhood obesity

🔸Hypertension (2.9 times higher in obese children)

🔸Type 2 diabetes (2.9 times higher in obese children)

🔸Ischemic heart disease

🔸Hypercholesterolemia (2.1 times higher)

🔸Other hyperlipidemia

🔸Left ventricular hypertrophy

🔸Obstructive sleep apnea

🔸Increased severity of asthma

🔸Mechanical stress on the joints, slipping of the main epiphysis of the femur

🔸Hepatic steatosis, cholelithiasis

🔸Gastroesophageal reflux

🔸Insulin resistance, acanthosis nigricans

🔸Social stigma (depression, low self-esteem)

Diagnosis :

▪️BMI (body mass index

BMI=weight (kg) ÷ Ht 2 (m)

▪️Early recognition of excessive weight gain, overweight or obesity in children is essential.

▪️A routine assessment should include the following

◾Anthropometric data:

Anthropometric data including weight, height and BMI calculation

◾Diet and physical activity history

◾Physical Examination

Assess blood pressure, distribution of adiposity (central versus generalized), markers of comorbidities (acanthosis nigricans, hirsutism, hepatomegaly, orthopedic abnormalities), and physical stigmata of the genetic syndrome.

◾Laboratory studies:

Screening for cholesterol, hemoglobin Alc, fasting lipid profile, fasting glucose levels, liver tests and thyroid function tests (if weight gain is faster than heigα).

Prevention:

▪️Changes in dietary and physical activity patterns. should be done

▪️The importance of physical activity should be emphasized. Increasing walking, stair use and cycling to school.

▪️Avoid fast food and promote healthy eating habits.

▪️Encourage breastfeeding in infancy.

▪️Excessive juices or diet soda should be eliminated.

▪️Children should never be forced to eat when they should not willing. 

▪️Overemphasis on food as a reward should be avoided.

▪️A balanced meal to be offered regularly, including fruit, vegetables, grains, protein and dairy products.

▪️Time spent in sedentary behaviors such as watching television and playing video/computer games should be limited.

Management :

🔹 More aggressive treatment is only necessary for those who have not responded to the above preventive interventions.

🔹Treatment involves a multidisciplinary approach.