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Supervised by Dr. Najlaa Jassas
Done by Dr. Rahma ShahBahai
OUTLINE:
• Definition
• Epidemiology
• Etiology& Pathophysiology
• Approach to obese child
• Complication
• Treatment& prevention
• English formula for BMI:
703 x Weight in pounds ÷ (Height in inches)2
• Metric formula for BMI:
Weight in Kilograms ÷ (Height in meters)2
DEFINITION
for 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)
For children <2 Y.O:
Standard weight for length curves
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

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Childhood obesity

  • 1. Supervised by Dr. Najlaa Jassas Done by Dr. Rahma ShahBahai
  • 2. OUTLINE: • Definition • Epidemiology • Etiology& Pathophysiology • Approach to obese child • Complication • Treatment& prevention
  • 3. • English formula for BMI: 703 x Weight in pounds ÷ (Height in inches)2 • Metric formula for BMI: Weight in Kilograms ÷ (Height in meters)2
  • 4. DEFINITION for 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)
  • 5. For children <2 Y.O: Standard weight for length curves
  • 6. 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.
  • 7. • 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
  • 8. • Environmental factors • Genetic factors • Endocrinal diseases
  • 9. 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
  • 10. Genatic factors: • Down syndrome>>>most common • Prader-Willi syndrome • Bardet-Biedl syndrome • Cohen syndrome • Turner syndrome
  • 11. 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)
  • 12. PATHOPHYSIOLOGY 1. Genetic & environmental component. caloric intake= caloric expenditure
  • 13. 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.
  • 14. 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
  • 16. 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 >>>>
  • 17.
  • 18.
  • 19.
  • 23.
  • 24.
  • 26.
  • 27. WHEN TO REFER TO PEDIATRIC ENDOCRINOLOGY?