Management of Pediatric Obesity

Christina K Nugrahani

Obesity is a health problems in Developed & Developing countries

Approximately 310 millions people faced with chronic excessive energy & obesity

WHO (2000) : big threatening to health in western countries

Background

Obesity : Accumulation of excessive fat tissue in

the body

Overweight : Excess body weight due to

increase muscle mass

Definition

Physical findings

BMI (BW/H2) : > 95th

> 97th : super obese

Diagnosis

Idiopathic

- > 90% cases- tall stature

- Family history of obesity

- Normal mental status

- Normal/advanced bone age

- Normal physical appearance

Endogenous

- < 10% cases

- Short stature

- Family history of obesity (-)

- Often MR

- Delayed bone age

- Stigmata on PE

Idiopathic & Endogenous Obesity

Organs

Psychology

Economic

Complication of Obesity

Jakarta : 21 % Semarang : 12.1% Jogyakarta : 10% Manado : 5.3% Sumbar : 2,5-25,6%

Indonesian’s childhood obesity multi center study(school children aged 6-12 years)

( Sjarif DR et al, 2005 )

Prevalens

Energy Balance

Energy Production and Energy Balance

Carbohydrate

Fat

Basal metabolism

Thermic effectof food

Protein

Physicalactivity

Adaptivethermogenesis

1. Dietary management

2. Physical activity/Exercise

3. Behavior Therapy & Family involvement

4. Medical treatment : drugs & surgery

5. Prevention

Management

1. Diet is the mainstay for the treatment of pediatric obesity

2. Approx 20 % weight loss can be achieve by a decrease in sodas, juices & excess milk in the diet

3. Two main types diet programs- Balance hypocaloric diet- Protein sparing modified fast

Dietary Management

1. Consist of 1200 – 2000 calories

2. Deficit 30 – 40 % usual intake

3. Lose weight 0.5 kg/week & grow normal

4. Recommended diet:- fat : 25-30%- CHO : 50-55%- Protein : 20-25%

Balance hypocaloric diet

Traffic light diet/stop light

Green light- free consumption- low density foods

Yellow light- Moderate consumption- Moderate density protein containing foods

Red light- very limited consumption

High caloric density &/ high sugar & fat content

Calory content of the diet 900 - 1300 kcal/day

(Epstein LH et al. JAMA 1990)

1. Should only be used for more severe cases of obesity

2. 600-800 kcal/day

3. 1.5-2 g/ideal bw protein/day; 2 liters water, 2-4 cups low starch vegetables & multivitamin

4. Lose weight 1.0 kg/week

5. Reported associated with nitrogen loss, orthostatic hypotension, cardiac arrhythmias, impaired growth, hair lost & gallstones

6. Not suitable for children

Protein sparing modified diet

The goal of dietary intervention : to reach healthy

weight without affecting linear growth

Balance Diet : 10% over ideal weight

Food pyramid, food exchange, portion size is

important

Summary