Childhood Obesity

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Childhood Obesity
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'Timebomb' alert over child obesity
Taken from BBC News website
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Definition

• Adults obesity BMI (weight kg/hgt m2) gt 30
• Children BMI varies from birth to adulthood and
  between boys and girls.
• Interpret BMI by comparing with population data.
• Obese children BMI gt 98th centile of UK 1990
  ref chart for age and sex.
• Overwgt children BMI gt 91st centile.

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Prevalence

• Worldwide concern about increase and by 1991 1 in
  5 children in USA were overweight
• U.K. 6 recent surveys all show higher than
  expected childhood obesity c/f 1990 data.
• 11 6 yr olds and 17 15 yr old gt 95th centile
  relative to 1990 data
• Increases above expected 5 suggest a trend to
  an increase in obesity prevalence.

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Impact

• Cardiovascular Risk Factors
• Cohort/case control studies show good evidence
  of association childhood obesity and CVS RF.
• Obesity epidemic in US has led to increase I
  prevalence of adolescent type II diabetes.
• Main CVS consequences of childhood obesity
  occurring in childhood are subclinical
  atherosclerosis and coronary artery disease.
  (American post mortem studies)
• Little direct evidence for intervention but
  inferred that would be beneficial.

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Impact 2

• CVS Risk factors shown to be associated with
  childhood obesity are
• Increased BP
• Adverse lipid profiles
• Adverse changes in left ventricular mass
• - Hyperinsulinaemia
• - Clustering of risk factors i.e. a tendency to
  have more than one which also results in an
  increased risk.
• CVS RF in children also related to central
  adiposty and a family history of coronary artery
  disease.

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Impact 3

• Psychological impact
• More likely to show evidence of psychological
  distress c/f non obese.
• Associated with poor self esteem, being
  perceived as unattractive, depression, disordered
  eating, bulimia.

• Other medical
• ?chronic inflammatory condition increased CRP
  in obese children
• Increased risk of asthma
• Abnormal foot structure and function
• Increased risk of type I diabetes.

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Impact on the adult

• Evidence suggests RF present in child are carried
  into adulthood BP, lipids, insulin and glucose
  synthesis.
• Cohort in Dutch men showed an increased 32yr
  mortality if BMIgt 26 at 18yrs.
• Uk/USA studies show adverse association between
  childhood obesity, education attainment and
  income in women.
• Appears to be a tendency for child obesity to
  persist into adulthood but no evidence to show a
  direct link
• tendency more if parents obese, and increases
  with age of child and severity of obesity.

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Diagnosis

• Body mass indexwt (kg)/height (m2)
• Obese BMI 98th centile
• Overweight BMI 91st centile
• See tables
• From SIGN guidelines

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Treatment

• Consider when obese and motivated
• Aim is weight maintenance
• Components healthy eating, physical activity
  gt30 min/day, reduce inactivity , lt2hours/day

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Refer

• In those with serious obesity related morbidity
• Those with underlying medical cause (think in
  short/obese)
• BMI 99.6th centile

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Primary Prevention

• Media influences modest OFCOM survey more
  honesty in advertising needed
• Ofsted national minimum standards in schools
• Schools are very variable - lots of local
  initiatives
• Only so much can be done - eg PE only
  realisitically once a week

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