child obesity treatment - cgdrc.mui.ac.ir · prevalence of bmi> 85th percentile in 6-year-old...
TRANSCRIPT
![Page 1: Child obesity treatment - cgdrc.mui.ac.ir · Prevalence of BMI> 85th percentile in 6-year-old children at school entry (n=899,035) in Iran, 2007 • Meta-analysis](https://reader036.vdocuments.us/reader036/viewer/2022081616/6018ce563bd11276b01d18dd/html5/thumbnails/1.jpg)
![Page 2: Child obesity treatment - cgdrc.mui.ac.ir · Prevalence of BMI> 85th percentile in 6-year-old children at school entry (n=899,035) in Iran, 2007 • Meta-analysis](https://reader036.vdocuments.us/reader036/viewer/2022081616/6018ce563bd11276b01d18dd/html5/thumbnails/2.jpg)
Treatment of Childhood ObesityTreatment of Childhood Obesity
Roya Kelishadi, MDProfessor of Pediatrics
Child Growth and Development Research CenterResearch Institute for Primary Prevention of Non-communicable Disease
Isfahan University of Medical Sciences
Oct2014
![Page 3: Child obesity treatment - cgdrc.mui.ac.ir · Prevalence of BMI> 85th percentile in 6-year-old children at school entry (n=899,035) in Iran, 2007 • Meta-analysis](https://reader036.vdocuments.us/reader036/viewer/2022081616/6018ce563bd11276b01d18dd/html5/thumbnails/3.jpg)
www.cgdrc.mui.ac.ir
![Page 4: Child obesity treatment - cgdrc.mui.ac.ir · Prevalence of BMI> 85th percentile in 6-year-old children at school entry (n=899,035) in Iran, 2007 • Meta-analysis](https://reader036.vdocuments.us/reader036/viewer/2022081616/6018ce563bd11276b01d18dd/html5/thumbnails/4.jpg)
GLOBAL WARNING
GLOBESITY
![Page 5: Child obesity treatment - cgdrc.mui.ac.ir · Prevalence of BMI> 85th percentile in 6-year-old children at school entry (n=899,035) in Iran, 2007 • Meta-analysis](https://reader036.vdocuments.us/reader036/viewer/2022081616/6018ce563bd11276b01d18dd/html5/thumbnails/5.jpg)
IS PEDIATRIC OBESITY•A Problem in Iranian Children &AdolescentsOR•JUST A Problem of WesternPopulations?
5
![Page 6: Child obesity treatment - cgdrc.mui.ac.ir · Prevalence of BMI> 85th percentile in 6-year-old children at school entry (n=899,035) in Iran, 2007 • Meta-analysis](https://reader036.vdocuments.us/reader036/viewer/2022081616/6018ce563bd11276b01d18dd/html5/thumbnails/6.jpg)
6
![Page 7: Child obesity treatment - cgdrc.mui.ac.ir · Prevalence of BMI> 85th percentile in 6-year-old children at school entry (n=899,035) in Iran, 2007 • Meta-analysis](https://reader036.vdocuments.us/reader036/viewer/2022081616/6018ce563bd11276b01d18dd/html5/thumbnails/7.jpg)
Prevalence of BMI> 85th percentile in 6-year-oldchildren at school entry (n=899,035) in Iran, 2007
![Page 8: Child obesity treatment - cgdrc.mui.ac.ir · Prevalence of BMI> 85th percentile in 6-year-old children at school entry (n=899,035) in Iran, 2007 • Meta-analysis](https://reader036.vdocuments.us/reader036/viewer/2022081616/6018ce563bd11276b01d18dd/html5/thumbnails/8.jpg)
• Meta-analysis• Trend in the prevalence of obesity and overweight among
Iranian children and adolescents: a systematic review andmeta-analysis.
• Kelishadi R, Haghdoost AA, Sadeghirad B,Khajehkazemi R.N t iti 2014 A 30(4) 393 400 d i• Nutrition. 2014 Apr;30(4):393-400. doi:10.1016/j.nut.2013.08.011. Epub 2013 Dec 12.
• PMID: 24332523 [PubMed - in process]
Metaanalysis
![Page 9: Child obesity treatment - cgdrc.mui.ac.ir · Prevalence of BMI> 85th percentile in 6-year-old children at school entry (n=899,035) in Iran, 2007 • Meta-analysis](https://reader036.vdocuments.us/reader036/viewer/2022081616/6018ce563bd11276b01d18dd/html5/thumbnails/9.jpg)
Complications ofchildhood obesity
![Page 10: Child obesity treatment - cgdrc.mui.ac.ir · Prevalence of BMI> 85th percentile in 6-year-old children at school entry (n=899,035) in Iran, 2007 • Meta-analysis](https://reader036.vdocuments.us/reader036/viewer/2022081616/6018ce563bd11276b01d18dd/html5/thumbnails/10.jpg)
Objectives
� Increase awareness on childhood obesityamong pediatricians so they can workwith their patients and parents to identifywith their patients and parents to identifyat-risk patients and take preventive orcorrective action.
![Page 11: Child obesity treatment - cgdrc.mui.ac.ir · Prevalence of BMI> 85th percentile in 6-year-old children at school entry (n=899,035) in Iran, 2007 • Meta-analysis](https://reader036.vdocuments.us/reader036/viewer/2022081616/6018ce563bd11276b01d18dd/html5/thumbnails/11.jpg)
Childhood Obesity
� Epidemic – Widespread in population(adults and children)
�Progressive – Childhood obesity becomesadult obesity
�Alters Development – Physically�Alters Development – Physically,emotionally, psychosocially
�Chronic disease – Lifelong morbidityaccelerates “adult” disease into childhood
� Increases morbidity/mortality – Firstgeneration to have shorter lifespan thanparents
![Page 12: Child obesity treatment - cgdrc.mui.ac.ir · Prevalence of BMI> 85th percentile in 6-year-old children at school entry (n=899,035) in Iran, 2007 • Meta-analysis](https://reader036.vdocuments.us/reader036/viewer/2022081616/6018ce563bd11276b01d18dd/html5/thumbnails/12.jpg)
Obesity Trajectory
� Phase I – Steady increase in childhood obesity� Phase II – Emergence of serious obesity related
comorbidities� Phase III – Medical complications lead to life
threatening disease death in middle agethreatening disease—death in middle age� Phase IV – Acceleration of obesity epidemic by
transgenerational transmission
Ludwig DS. Childhood obesity—the shape of things to come. N Engl J Med. ����;���(��):����-����.
![Page 13: Child obesity treatment - cgdrc.mui.ac.ir · Prevalence of BMI> 85th percentile in 6-year-old children at school entry (n=899,035) in Iran, 2007 • Meta-analysis](https://reader036.vdocuments.us/reader036/viewer/2022081616/6018ce563bd11276b01d18dd/html5/thumbnails/13.jpg)
![Page 14: Child obesity treatment - cgdrc.mui.ac.ir · Prevalence of BMI> 85th percentile in 6-year-old children at school entry (n=899,035) in Iran, 2007 • Meta-analysis](https://reader036.vdocuments.us/reader036/viewer/2022081616/6018ce563bd11276b01d18dd/html5/thumbnails/14.jpg)
Expert Committee Recommendations
� Purpose: Update pediatric obesity prevention andtreatment recommendations
� Focus• Pediatric practice change• “Universal prevention”• Parents/families as partners in lifestyle change• Obesity in the context of the Chronic Disease model• Connections to the community
� Medical Home
Assessment of Child and Adolescent Overweight and Obesity. Pediatrics. ����;���(Supplement �):���-���.
![Page 15: Child obesity treatment - cgdrc.mui.ac.ir · Prevalence of BMI> 85th percentile in 6-year-old children at school entry (n=899,035) in Iran, 2007 • Meta-analysis](https://reader036.vdocuments.us/reader036/viewer/2022081616/6018ce563bd11276b01d18dd/html5/thumbnails/15.jpg)
Expert Committee Recommendations
� Assessment – BMI/nutrition/activity/readiness tochange
� Evidence based/evidence informed/expert opinion onhigh risk behavior for obesity
� Stepwise approach to prevention and treatment� Addressed obesity management in primary and tertiary
care� Multidisciplinary approach� Family centered/parenting/motivational interviewing
Assessment of Child and Adolescent Overweight and Obesity. Pediatrics. ����;���(Supplement �):���-���.
![Page 16: Child obesity treatment - cgdrc.mui.ac.ir · Prevalence of BMI> 85th percentile in 6-year-old children at school entry (n=899,035) in Iran, 2007 • Meta-analysis](https://reader036.vdocuments.us/reader036/viewer/2022081616/6018ce563bd11276b01d18dd/html5/thumbnails/16.jpg)
Expert Committee Recommendations
� Assessment
� Prevention
� Prevention Plus
� Structured Weight ManagementStructured Weight Management
� Comprehensive Multidisciplinary Protocol
� Tertiary Care Protocol
Assessment of Child and Adolescent Overweight and Obesity. Pediatrics. ����;���(Supplement �):���-���.
![Page 17: Child obesity treatment - cgdrc.mui.ac.ir · Prevalence of BMI> 85th percentile in 6-year-old children at school entry (n=899,035) in Iran, 2007 • Meta-analysis](https://reader036.vdocuments.us/reader036/viewer/2022081616/6018ce563bd11276b01d18dd/html5/thumbnails/17.jpg)
Universal Assessment of Obesity Risk: Steps to Prevention and Treatment
American Academy of Pediatrics. Pediatric Obesity Clinical Decision Support Chart.Elk Grove Village, IL: American Academy of Pediatrics; ����.
![Page 18: Child obesity treatment - cgdrc.mui.ac.ir · Prevalence of BMI> 85th percentile in 6-year-old children at school entry (n=899,035) in Iran, 2007 • Meta-analysis](https://reader036.vdocuments.us/reader036/viewer/2022081616/6018ce563bd11276b01d18dd/html5/thumbnails/18.jpg)
Recommendations with Consistent Evidence
� Multiple studies show consistent association betweenrecommended behavior and either obesity risk orenergy balance.• Limit consumption of sugar sweetened beverages.
Li i TV (� h � � h � ld)• Limit TV (� hours <� years, <� hours >� years old).• Remove TV from primary sleeping area.• Eat breakfast daily.• Limit eating out.• Encourage family meals.• Limit portion size.
![Page 19: Child obesity treatment - cgdrc.mui.ac.ir · Prevalence of BMI> 85th percentile in 6-year-old children at school entry (n=899,035) in Iran, 2007 • Meta-analysis](https://reader036.vdocuments.us/reader036/viewer/2022081616/6018ce563bd11276b01d18dd/html5/thumbnails/19.jpg)
Recommendations with Mixed Evidence
� Some studies demonstrated evidence for weight orenergy balance benefit but others did not or thestudies were too few or too small.• � or more fruits and vegetable servings/day ( age
appropriate servings recommended)
![Page 20: Child obesity treatment - cgdrc.mui.ac.ir · Prevalence of BMI> 85th percentile in 6-year-old children at school entry (n=899,035) in Iran, 2007 • Meta-analysis](https://reader036.vdocuments.us/reader036/viewer/2022081616/6018ce563bd11276b01d18dd/html5/thumbnails/20.jpg)
Recommendations Where Evidence Suggests
� Studies have not examined association with weight orenergy balance, or the studies were too few or toosmall, but expert committee thinks it could supporthealthy weight and would not be harmful• Eat a diet rich in calcium.• Eat a diet high in fiber.• Eat a diet with balanced macronutrients (food groups).• Breastfeeding• Promote moderate-vigorous activity �� minutes a day.• Limit consumption of energy dense foods.
![Page 21: Child obesity treatment - cgdrc.mui.ac.ir · Prevalence of BMI> 85th percentile in 6-year-old children at school entry (n=899,035) in Iran, 2007 • Meta-analysis](https://reader036.vdocuments.us/reader036/viewer/2022081616/6018ce563bd11276b01d18dd/html5/thumbnails/21.jpg)
Assessment of Obesity
� Calculate, chart, and classify BMI for all children �–��years of age at least yearly.
� Assess dietary patterns.
� Assess activity/inactivity.
� Assess readiness for change.
� Assess obesity related comorbidities.
� Assess ongoing progress.
![Page 22: Child obesity treatment - cgdrc.mui.ac.ir · Prevalence of BMI> 85th percentile in 6-year-old children at school entry (n=899,035) in Iran, 2007 • Meta-analysis](https://reader036.vdocuments.us/reader036/viewer/2022081616/6018ce563bd11276b01d18dd/html5/thumbnails/22.jpg)
BMI – Calculate, Chart, Classify
• BMI is a screening measure, determines furtherevaluation
• BMI based on age and gender and is a populationbased reference
• Underweight BMI <�%• “Normal weight” BMI �%–��%• Overweight BMI >��%–��%• Obese BMI ��%–��%• Morbid (severe) obesity BMI >��%
Freedman DS, Mei Z, Srinivasan SR, et al. Cardiovascular Risk Factors and Excess Adiposity Among Overweight Children and Adolescents: The Bogalusa Heart Study.J Pediatr. ����;���(�):��-��.
![Page 23: Child obesity treatment - cgdrc.mui.ac.ir · Prevalence of BMI> 85th percentile in 6-year-old children at school entry (n=899,035) in Iran, 2007 • Meta-analysis](https://reader036.vdocuments.us/reader036/viewer/2022081616/6018ce563bd11276b01d18dd/html5/thumbnails/23.jpg)
Prevention
� All children are considered “at risk for obesity.”� Message at well visits
• Simplep
• Consistent
• Cumulative prevention
� “Gateway message” to nutrition, activity, and high riskbehavior
![Page 24: Child obesity treatment - cgdrc.mui.ac.ir · Prevalence of BMI> 85th percentile in 6-year-old children at school entry (n=899,035) in Iran, 2007 • Meta-analysis](https://reader036.vdocuments.us/reader036/viewer/2022081616/6018ce563bd11276b01d18dd/html5/thumbnails/24.jpg)
BMI ��th Percentile Cut-Points (kg/m�)
American Academy of Pediatrics. Pediatric Obesity Clinical Decision Support Chart. Elk Grove Village, IL: American Academy of Pediatrics; ����.
![Page 25: Child obesity treatment - cgdrc.mui.ac.ir · Prevalence of BMI> 85th percentile in 6-year-old children at school entry (n=899,035) in Iran, 2007 • Meta-analysis](https://reader036.vdocuments.us/reader036/viewer/2022081616/6018ce563bd11276b01d18dd/html5/thumbnails/25.jpg)
Weight Loss Targets
American Academy of Pediatrics. Pediatric Obesity Clinical Decision Support Chart. Elk Grove Village, IL: American Academy of Pediatrics; ����.
![Page 26: Child obesity treatment - cgdrc.mui.ac.ir · Prevalence of BMI> 85th percentile in 6-year-old children at school entry (n=899,035) in Iran, 2007 • Meta-analysis](https://reader036.vdocuments.us/reader036/viewer/2022081616/6018ce563bd11276b01d18dd/html5/thumbnails/26.jpg)
BMI
� Children with a BMI >��% have a greater rate ofcardiovascular risk factors.
� Children (age ��) with a BMI >��% followed intoadulthood (age ��).• ���% BMI >��• ���% BMI >��
• ��% with BMI >��
• ��% with BMI >��
Freedman DS, Mei Z, Srinivasan SR, et al. Cardiovascular Risk Factors and Excess Adiposity Among Overweight Children and Adolescents: The Bogalusa Heart Study.J Pediatr. ����;���(�):��-��.
![Page 27: Child obesity treatment - cgdrc.mui.ac.ir · Prevalence of BMI> 85th percentile in 6-year-old children at school entry (n=899,035) in Iran, 2007 • Meta-analysis](https://reader036.vdocuments.us/reader036/viewer/2022081616/6018ce563bd11276b01d18dd/html5/thumbnails/27.jpg)
� Promote breastfeeding.� Diet and physical activity
• � or more servings of fruits and vegetables per day• � or fewer hours of screen time per day, and no television in
the room where the child sleeps• � hour or more of daily physical activity
Prevention of BMI 5%–84%
• � hour or more of daily physical activity• No sugar-sweetened beverages
![Page 28: Child obesity treatment - cgdrc.mui.ac.ir · Prevalence of BMI> 85th percentile in 6-year-old children at school entry (n=899,035) in Iran, 2007 • Meta-analysis](https://reader036.vdocuments.us/reader036/viewer/2022081616/6018ce563bd11276b01d18dd/html5/thumbnails/28.jpg)
www.aap.org/bookstore
![Page 29: Child obesity treatment - cgdrc.mui.ac.ir · Prevalence of BMI> 85th percentile in 6-year-old children at school entry (n=899,035) in Iran, 2007 • Meta-analysis](https://reader036.vdocuments.us/reader036/viewer/2022081616/6018ce563bd11276b01d18dd/html5/thumbnails/29.jpg)
Prevention BMI �%–��%
� Portions• Age appropriate• “Parents provide, child decides”• ��–�� minute increments of exercise
� Structure• Breakfast• Family dinners, no TV• Limit fast food• Outdoor time
� Balance• Food groups• Limit refined sugar• Screen time alternatives
![Page 30: Child obesity treatment - cgdrc.mui.ac.ir · Prevalence of BMI> 85th percentile in 6-year-old children at school entry (n=899,035) in Iran, 2007 • Meta-analysis](https://reader036.vdocuments.us/reader036/viewer/2022081616/6018ce563bd11276b01d18dd/html5/thumbnails/30.jpg)
PreventionMinimum Once a Year at Well Visits
� Self-efficacy and readiness to change� Small incremental steps for change� Family support� Positive� Self monitoring� Setbacks are normal, trouble shoot, support return
to plan� Identify high risk nutritional/activity behaviors
![Page 31: Child obesity treatment - cgdrc.mui.ac.ir · Prevalence of BMI> 85th percentile in 6-year-old children at school entry (n=899,035) in Iran, 2007 • Meta-analysis](https://reader036.vdocuments.us/reader036/viewer/2022081616/6018ce563bd11276b01d18dd/html5/thumbnails/31.jpg)
Universal Assessment of Obesity Risk: Steps to Prevention and Treatment
American Academy of Pediatrics. Pediatric Obesity Clinical Decision Support Chart.Elk Grove Village, IL: American Academy of Pediatrics; ����.
![Page 32: Child obesity treatment - cgdrc.mui.ac.ir · Prevalence of BMI> 85th percentile in 6-year-old children at school entry (n=899,035) in Iran, 2007 • Meta-analysis](https://reader036.vdocuments.us/reader036/viewer/2022081616/6018ce563bd11276b01d18dd/html5/thumbnails/32.jpg)
Prevention Plus BMI >��%
� Build on prevention.
� Eating behaviors• Family meals should happen at least � to � times per
week.
• Allow the child to self-regulate his or her meals and avoidoverly restrictive behaviors—“Parents provide, childdecides.”
• Structure activity.
![Page 33: Child obesity treatment - cgdrc.mui.ac.ir · Prevalence of BMI> 85th percentile in 6-year-old children at school entry (n=899,035) in Iran, 2007 • Meta-analysis](https://reader036.vdocuments.us/reader036/viewer/2022081616/6018ce563bd11276b01d18dd/html5/thumbnails/33.jpg)
Prevention Plus BMI >��%
� Within this category, the goal should be weightmaintenance with growth that results in a decreasingBMI as age increases.
� Monthly follow-up for � to � months; if noMonthly follow up for � to � months; if noimprovement go to Stage �.
![Page 34: Child obesity treatment - cgdrc.mui.ac.ir · Prevalence of BMI> 85th percentile in 6-year-old children at school entry (n=899,035) in Iran, 2007 • Meta-analysis](https://reader036.vdocuments.us/reader036/viewer/2022081616/6018ce563bd11276b01d18dd/html5/thumbnails/34.jpg)
Assess Dietary Patterns
� Additional practices to be considered for evaluationduring the qualitative dietary assessment include:• Excessive consumption of foods that are high in energy
density
• Meal frequency and snacking patterns (including quality)
![Page 35: Child obesity treatment - cgdrc.mui.ac.ir · Prevalence of BMI> 85th percentile in 6-year-old children at school entry (n=899,035) in Iran, 2007 • Meta-analysis](https://reader036.vdocuments.us/reader036/viewer/2022081616/6018ce563bd11276b01d18dd/html5/thumbnails/35.jpg)
Dietary Assessment
� Consumption of sugar sweetened beverages� Daily breakfast� Eating out� Family meals� Portion size� � or more servings of fruits and vegetables
C l i� Calcium� Fiber� Balanced macronutrients (food groups)� Energy dense foods� Readiness to change
![Page 36: Child obesity treatment - cgdrc.mui.ac.ir · Prevalence of BMI> 85th percentile in 6-year-old children at school entry (n=899,035) in Iran, 2007 • Meta-analysis](https://reader036.vdocuments.us/reader036/viewer/2022081616/6018ce563bd11276b01d18dd/html5/thumbnails/36.jpg)
Assess Physical Activity/Inactivity
� Screen time� TV in room� Daily activity� Self-efficacy and readiness to change� Physical (built) environment� Social/community support for activity� Barriers to physical activity� Assess patient’s and family’s activity and exercise habits.� Assess outdoor activity
![Page 37: Child obesity treatment - cgdrc.mui.ac.ir · Prevalence of BMI> 85th percentile in 6-year-old children at school entry (n=899,035) in Iran, 2007 • Meta-analysis](https://reader036.vdocuments.us/reader036/viewer/2022081616/6018ce563bd11276b01d18dd/html5/thumbnails/37.jpg)
Physical Activity/Inactivity
� Advise �� minutes of at least moderate physicalactivity per day and �� minutes of vigorous activity� times a week.• Refer to community activity programs.• Encourage development of family activities.• Consider pedometer useConsider pedometer use.
� Decrease level of sedentary behavior.� Limit screen time to <� hours per day.� No TV/computer in bedroom
![Page 38: Child obesity treatment - cgdrc.mui.ac.ir · Prevalence of BMI> 85th percentile in 6-year-old children at school entry (n=899,035) in Iran, 2007 • Meta-analysis](https://reader036.vdocuments.us/reader036/viewer/2022081616/6018ce563bd11276b01d18dd/html5/thumbnails/38.jpg)
Structured Weight Management
� Dietary and physical activity behaviors• Development of a plan for utilization of a balanced
macronutrient diet emphasizing low amounts ofenergy-dense foods
• Increased structured daily meals and snacks• Supervised active play of at least �� minutes a day• Screen time of � hour or less a day
![Page 39: Child obesity treatment - cgdrc.mui.ac.ir · Prevalence of BMI> 85th percentile in 6-year-old children at school entry (n=899,035) in Iran, 2007 • Meta-analysis](https://reader036.vdocuments.us/reader036/viewer/2022081616/6018ce563bd11276b01d18dd/html5/thumbnails/39.jpg)
Structured Weight Management
� Weight maintenance that• Decreases BMI as age and height increases
� Weight loss should not exceed• ���g/month in children aged �–�� yearsor• An average of �Kg/week in older overweight/obeseAn average of �Kg/week in older overweight/obese
children and adolescents
� If no improvement in BMI/weight after � to �months, patient should be advanced to Stage �.
![Page 40: Child obesity treatment - cgdrc.mui.ac.ir · Prevalence of BMI> 85th percentile in 6-year-old children at school entry (n=899,035) in Iran, 2007 • Meta-analysis](https://reader036.vdocuments.us/reader036/viewer/2022081616/6018ce563bd11276b01d18dd/html5/thumbnails/40.jpg)
Family History
� Focused family history• Obesity, type � diabetes, cardiovascular disease
(particularly hypertension), and early deaths from heart(particularly hypertension), and early deaths from heartdisease or stroke
� Family history may be the touch point foremphasizing family involvement.
![Page 41: Child obesity treatment - cgdrc.mui.ac.ir · Prevalence of BMI> 85th percentile in 6-year-old children at school entry (n=899,035) in Iran, 2007 • Meta-analysis](https://reader036.vdocuments.us/reader036/viewer/2022081616/6018ce563bd11276b01d18dd/html5/thumbnails/41.jpg)
Review of SystemsObesity Assessment: Findings on Review of Systems and Possible Etiologies
American Academy of Pediatrics. Pediatric Obesity Clinical Decision Support Chart. Elk Grove Village, IL: American Academy of Pediatrics; ����.
![Page 42: Child obesity treatment - cgdrc.mui.ac.ir · Prevalence of BMI> 85th percentile in 6-year-old children at school entry (n=899,035) in Iran, 2007 • Meta-analysis](https://reader036.vdocuments.us/reader036/viewer/2022081616/6018ce563bd11276b01d18dd/html5/thumbnails/42.jpg)
Severe Obesity Related Emergencies
� Hyperglycemichyperosmolar state
� DKA
� Pulmonary emboli
� Cardiomyopathy ofobesity
![Page 43: Child obesity treatment - cgdrc.mui.ac.ir · Prevalence of BMI> 85th percentile in 6-year-old children at school entry (n=899,035) in Iran, 2007 • Meta-analysis](https://reader036.vdocuments.us/reader036/viewer/2022081616/6018ce563bd11276b01d18dd/html5/thumbnails/43.jpg)
Comorbidities Requiring ImmediateAttention
� Pseudotumor cerebri
� Slipped capital femoralepiphysis
� Blount’s disease� Blount s disease
� Sleep apnea
� Asthma
� Nonalcoholichepatosteatosis
� Cholelithiasis
![Page 44: Child obesity treatment - cgdrc.mui.ac.ir · Prevalence of BMI> 85th percentile in 6-year-old children at school entry (n=899,035) in Iran, 2007 • Meta-analysis](https://reader036.vdocuments.us/reader036/viewer/2022081616/6018ce563bd11276b01d18dd/html5/thumbnails/44.jpg)
Chronic Obesity Related ComorbidConditions
� Insulin resistance(metabolic syndrome)
T II di b� Type II diabetes
� Polycystic ovary syndrome
� Hypertension
� Hyperlipidemia
� Psychological
![Page 45: Child obesity treatment - cgdrc.mui.ac.ir · Prevalence of BMI> 85th percentile in 6-year-old children at school entry (n=899,035) in Iran, 2007 • Meta-analysis](https://reader036.vdocuments.us/reader036/viewer/2022081616/6018ce563bd11276b01d18dd/html5/thumbnails/45.jpg)
Physical ExaminationObesity Assessment: Physical Examination Findings and Possible Etiologies
American Academy of Pediatrics. Pediatric Obesity Clinical Decision Support Chart. Elk Grove Village, IL: American Academy of Pediatrics; ����.
![Page 46: Child obesity treatment - cgdrc.mui.ac.ir · Prevalence of BMI> 85th percentile in 6-year-old children at school entry (n=899,035) in Iran, 2007 • Meta-analysis](https://reader036.vdocuments.us/reader036/viewer/2022081616/6018ce563bd11276b01d18dd/html5/thumbnails/46.jpg)
Laboratory Evaluation
� BMI >��% <��%• Fasting blood glucose, lipid profile,
• AST, ALT q � years
� BMI >��%� BMI >��%• Fasting blood glucose, lipid profile,
• AST, ALT q � years
• Laboratory evaluation as always depends on clinicalassessment.
![Page 47: Child obesity treatment - cgdrc.mui.ac.ir · Prevalence of BMI> 85th percentile in 6-year-old children at school entry (n=899,035) in Iran, 2007 • Meta-analysis](https://reader036.vdocuments.us/reader036/viewer/2022081616/6018ce563bd11276b01d18dd/html5/thumbnails/47.jpg)
Medical Screening by BMI Category
American Academy of Pediatrics. Pediatric Obesity Clinical Decision Support Chart. Elk Grove Village, IL: American Academy of Pediatrics; ����.
![Page 48: Child obesity treatment - cgdrc.mui.ac.ir · Prevalence of BMI> 85th percentile in 6-year-old children at school entry (n=899,035) in Iran, 2007 • Meta-analysis](https://reader036.vdocuments.us/reader036/viewer/2022081616/6018ce563bd11276b01d18dd/html5/thumbnails/48.jpg)
Comprehensive MultidisciplinaryProtocol
� Multidisciplinary obesity care team• Physician, nurse, dietician, exercise trainer, social worker,
psychologist
� Eating and activity goals are the same as in Stage �.
� Activities within this category should also include:• Structured behavioral modification program, including
food and activity monitoring and development of short-term diet and physical activity goals
![Page 49: Child obesity treatment - cgdrc.mui.ac.ir · Prevalence of BMI> 85th percentile in 6-year-old children at school entry (n=899,035) in Iran, 2007 • Meta-analysis](https://reader036.vdocuments.us/reader036/viewer/2022081616/6018ce563bd11276b01d18dd/html5/thumbnails/49.jpg)
Comprehensive MultidisciplinaryProtocol
� Behavior modification• Involvement of primary caregivers/families in children
under age �� years
• Training of primary caregivers/families for all childrenTraining of primary caregivers/families for all children
� Goal• Weight maintenance or gradual weight loss until BMI is
<��th percentile and should not exceed ���g/month inchildren aged �–� years, or � Kg/week in older obesechildren and adolescents
![Page 50: Child obesity treatment - cgdrc.mui.ac.ir · Prevalence of BMI> 85th percentile in 6-year-old children at school entry (n=899,035) in Iran, 2007 • Meta-analysis](https://reader036.vdocuments.us/reader036/viewer/2022081616/6018ce563bd11276b01d18dd/html5/thumbnails/50.jpg)
Tertiary Care Protocol
� Referral to pediatric tertiary weight managementcenter with access to a multidisciplinary teamwith expertise in childhood obesity and whichoperates under a designed protocolC i d di d i i li d h� Continued diet and activity counseling and theconsideration of such additions as mealreplacement, very-low-calorie diet, medication,and surgery
![Page 51: Child obesity treatment - cgdrc.mui.ac.ir · Prevalence of BMI> 85th percentile in 6-year-old children at school entry (n=899,035) in Iran, 2007 • Meta-analysis](https://reader036.vdocuments.us/reader036/viewer/2022081616/6018ce563bd11276b01d18dd/html5/thumbnails/51.jpg)
Partnership with Families
� Families have a critical role in influencing a child’shealth.
� Effective interaction with families is the cornerstone� Effective interaction with families is the cornerstoneof lifestyle change.
![Page 52: Child obesity treatment - cgdrc.mui.ac.ir · Prevalence of BMI> 85th percentile in 6-year-old children at school entry (n=899,035) in Iran, 2007 • Meta-analysis](https://reader036.vdocuments.us/reader036/viewer/2022081616/6018ce563bd11276b01d18dd/html5/thumbnails/52.jpg)
Communication� Positive discussion of what healthy lifestyle changes
families can make (evidence base)� Allow for personal family choices.� Have families set specific achievable goals and follow
up with these on revisits.up with these on revisits.� Be aware of cultural norms, significance of meals and
eating for family/community, beliefs about specialfoods, and feelings about body size.
� Motivational interviewing
![Page 53: Child obesity treatment - cgdrc.mui.ac.ir · Prevalence of BMI> 85th percentile in 6-year-old children at school entry (n=899,035) in Iran, 2007 • Meta-analysis](https://reader036.vdocuments.us/reader036/viewer/2022081616/6018ce563bd11276b01d18dd/html5/thumbnails/53.jpg)
Obesity treatment pyramid
![Page 54: Child obesity treatment - cgdrc.mui.ac.ir · Prevalence of BMI> 85th percentile in 6-year-old children at school entry (n=899,035) in Iran, 2007 • Meta-analysis](https://reader036.vdocuments.us/reader036/viewer/2022081616/6018ce563bd11276b01d18dd/html5/thumbnails/54.jpg)
![Page 55: Child obesity treatment - cgdrc.mui.ac.ir · Prevalence of BMI> 85th percentile in 6-year-old children at school entry (n=899,035) in Iran, 2007 • Meta-analysis](https://reader036.vdocuments.us/reader036/viewer/2022081616/6018ce563bd11276b01d18dd/html5/thumbnails/55.jpg)
- Appropriate weightgain in pregnancy
![Page 56: Child obesity treatment - cgdrc.mui.ac.ir · Prevalence of BMI> 85th percentile in 6-year-old children at school entry (n=899,035) in Iran, 2007 • Meta-analysis](https://reader036.vdocuments.us/reader036/viewer/2022081616/6018ce563bd11276b01d18dd/html5/thumbnails/56.jpg)
-Encouragingbreastfeedingbreastfeeding-Adequateduration ofbreastfeeding
![Page 57: Child obesity treatment - cgdrc.mui.ac.ir · Prevalence of BMI> 85th percentile in 6-year-old children at school entry (n=899,035) in Iran, 2007 • Meta-analysis](https://reader036.vdocuments.us/reader036/viewer/2022081616/6018ce563bd11276b01d18dd/html5/thumbnails/57.jpg)
-Avoiding food forcing
![Page 58: Child obesity treatment - cgdrc.mui.ac.ir · Prevalence of BMI> 85th percentile in 6-year-old children at school entry (n=899,035) in Iran, 2007 • Meta-analysis](https://reader036.vdocuments.us/reader036/viewer/2022081616/6018ce563bd11276b01d18dd/html5/thumbnails/58.jpg)
-Learning to havehealthy food choices
![Page 59: Child obesity treatment - cgdrc.mui.ac.ir · Prevalence of BMI> 85th percentile in 6-year-old children at school entry (n=899,035) in Iran, 2007 • Meta-analysis](https://reader036.vdocuments.us/reader036/viewer/2022081616/6018ce563bd11276b01d18dd/html5/thumbnails/59.jpg)
-Regular daily physical activity-Reducing the screen time
![Page 60: Child obesity treatment - cgdrc.mui.ac.ir · Prevalence of BMI> 85th percentile in 6-year-old children at school entry (n=899,035) in Iran, 2007 • Meta-analysis](https://reader036.vdocuments.us/reader036/viewer/2022081616/6018ce563bd11276b01d18dd/html5/thumbnails/60.jpg)
-Balance between energy intake andexpenditure
![Page 61: Child obesity treatment - cgdrc.mui.ac.ir · Prevalence of BMI> 85th percentile in 6-year-old children at school entry (n=899,035) in Iran, 2007 • Meta-analysis](https://reader036.vdocuments.us/reader036/viewer/2022081616/6018ce563bd11276b01d18dd/html5/thumbnails/61.jpg)
- Early sleeping- Enough sleep
![Page 62: Child obesity treatment - cgdrc.mui.ac.ir · Prevalence of BMI> 85th percentile in 6-year-old children at school entry (n=899,035) in Iran, 2007 • Meta-analysis](https://reader036.vdocuments.us/reader036/viewer/2022081616/6018ce563bd11276b01d18dd/html5/thumbnails/62.jpg)
-Coping with stress
![Page 63: Child obesity treatment - cgdrc.mui.ac.ir · Prevalence of BMI> 85th percentile in 6-year-old children at school entry (n=899,035) in Iran, 2007 • Meta-analysis](https://reader036.vdocuments.us/reader036/viewer/2022081616/6018ce563bd11276b01d18dd/html5/thumbnails/63.jpg)
-Slow eating
![Page 64: Child obesity treatment - cgdrc.mui.ac.ir · Prevalence of BMI> 85th percentile in 6-year-old children at school entry (n=899,035) in Iran, 2007 • Meta-analysis](https://reader036.vdocuments.us/reader036/viewer/2022081616/6018ce563bd11276b01d18dd/html5/thumbnails/64.jpg)
-Drinking enough water
![Page 65: Child obesity treatment - cgdrc.mui.ac.ir · Prevalence of BMI> 85th percentile in 6-year-old children at school entry (n=899,035) in Iran, 2007 • Meta-analysis](https://reader036.vdocuments.us/reader036/viewer/2022081616/6018ce563bd11276b01d18dd/html5/thumbnails/65.jpg)
etc…..
![Page 66: Child obesity treatment - cgdrc.mui.ac.ir · Prevalence of BMI> 85th percentile in 6-year-old children at school entry (n=899,035) in Iran, 2007 • Meta-analysis](https://reader036.vdocuments.us/reader036/viewer/2022081616/6018ce563bd11276b01d18dd/html5/thumbnails/66.jpg)
Medications• FDA weight loss drug withdrawals• Sibutramine (Meridia) a selective serotonin
norepinephrine reuptake inhibitor (SNRI)• Fenfluramine and dexfenfluramineFenfluramine and dexfenfluramine• Rimonabant (Acomplia)
![Page 67: Child obesity treatment - cgdrc.mui.ac.ir · Prevalence of BMI> 85th percentile in 6-year-old children at school entry (n=899,035) in Iran, 2007 • Meta-analysis](https://reader036.vdocuments.us/reader036/viewer/2022081616/6018ce563bd11276b01d18dd/html5/thumbnails/67.jpg)
• Anorexiants are administered to manage obesity inadults. Indications include weight loss and maintenanceof weight loss, in conjunction with a reduced calorie diet,specifically in patients who are obese with an initial bodymass index (BMI) of 30 or 27 mg/m2 and other riskfactors (eg, diabetes mellitus, dyslipidemia,hypertension).
• Orlistat (Alli, Xenical)Orlistat is a gastrointestinal lipase inhibitor that inducesweight loss by inhibiting nutrient absorption.
![Page 68: Child obesity treatment - cgdrc.mui.ac.ir · Prevalence of BMI> 85th percentile in 6-year-old children at school entry (n=899,035) in Iran, 2007 • Meta-analysis](https://reader036.vdocuments.us/reader036/viewer/2022081616/6018ce563bd11276b01d18dd/html5/thumbnails/68.jpg)
• Adrenergic Agonists• Adrenergic agonists are stimulants that release tissue
stores of epinephrine, causing subsequent alpha- and/orbeta-adrenergic stimulation. These drugs have providedbenefits to patients with obesity and are approved inadults for short-term use (8-12 wk).
• Caffeine• Phentermine is a sympathomimetic amine that increases
the release and reuptake of norepinephrine and dopamine.• Diethylpropion is a sympathomimetic amine that is
effective as an adjunct for anoretic therapy of exogenousobesity.
![Page 69: Child obesity treatment - cgdrc.mui.ac.ir · Prevalence of BMI> 85th percentile in 6-year-old children at school entry (n=899,035) in Iran, 2007 • Meta-analysis](https://reader036.vdocuments.us/reader036/viewer/2022081616/6018ce563bd11276b01d18dd/html5/thumbnails/69.jpg)
• Herbs/plants?• Green coffee
![Page 70: Child obesity treatment - cgdrc.mui.ac.ir · Prevalence of BMI> 85th percentile in 6-year-old children at school entry (n=899,035) in Iran, 2007 • Meta-analysis](https://reader036.vdocuments.us/reader036/viewer/2022081616/6018ce563bd11276b01d18dd/html5/thumbnails/70.jpg)
Green tea/white tea
![Page 71: Child obesity treatment - cgdrc.mui.ac.ir · Prevalence of BMI> 85th percentile in 6-year-old children at school entry (n=899,035) in Iran, 2007 • Meta-analysis](https://reader036.vdocuments.us/reader036/viewer/2022081616/6018ce563bd11276b01d18dd/html5/thumbnails/71.jpg)
- Citrus fruits/peels- Artichoke- …..
![Page 72: Child obesity treatment - cgdrc.mui.ac.ir · Prevalence of BMI> 85th percentile in 6-year-old children at school entry (n=899,035) in Iran, 2007 • Meta-analysis](https://reader036.vdocuments.us/reader036/viewer/2022081616/6018ce563bd11276b01d18dd/html5/thumbnails/72.jpg)
![Page 73: Child obesity treatment - cgdrc.mui.ac.ir · Prevalence of BMI> 85th percentile in 6-year-old children at school entry (n=899,035) in Iran, 2007 • Meta-analysis](https://reader036.vdocuments.us/reader036/viewer/2022081616/6018ce563bd11276b01d18dd/html5/thumbnails/73.jpg)
![Page 74: Child obesity treatment - cgdrc.mui.ac.ir · Prevalence of BMI> 85th percentile in 6-year-old children at school entry (n=899,035) in Iran, 2007 • Meta-analysis](https://reader036.vdocuments.us/reader036/viewer/2022081616/6018ce563bd11276b01d18dd/html5/thumbnails/74.jpg)
![Page 75: Child obesity treatment - cgdrc.mui.ac.ir · Prevalence of BMI> 85th percentile in 6-year-old children at school entry (n=899,035) in Iran, 2007 • Meta-analysis](https://reader036.vdocuments.us/reader036/viewer/2022081616/6018ce563bd11276b01d18dd/html5/thumbnails/75.jpg)
THANK YOU FOR YOUR ATTENTION