Overweight/Obese
NHMRC: Clinical practice guidelines on managing obesity (to read)
20% preschool
25% school-age
Adolescence don't "slim down" naturally
Hx
Duration
Previous attempts at weight loss
Pubertal history
Menstrual irregularity
Binge eating
Is food a friend or enemy
Do you ever want to get rid of what you just ate
Are their times when all you can think of if food
Do you ever feel like you cannot stop
Do you lose track of time when you eat
Do you turn to food for comfort
Risk factors:
Screen time >2h ?in the bedroom ?eat in front of TV
Inactivity - ?sports, ?transport to school ?free time
Energy dense food - Lunch bought or brought, soda/juice
Parental obesity - role model, controls food and activity
Causes:
Lifestyle (99%)
Genetic
Endocrine
Medications
Complications:
Social rejection: look different, not good at sport
Teasing
Low self esteem > depression
Difficulty buying clothes, discrimination
bulemia
CVS disease - HTN, LVH, CAD
Resp - Asthma, exercise intolerance, OSA (snoring, day time somnolence, witness apnoea, morning headache) PHTN
Liver - fatty liver, gallstones (2%)
Pancreas - insulin resistance
Ortho flat feet, joint, back pain, SCFE, tibia vara (Blounts Disease), ankle sprains, fractures
GIT - constipation, reflux, abdominal pain
GUT - day time wetting, nocturnal enuresis
G - menstrual irregularities PCOD
Neuro - BIH,
derm - chaffing, sweating/odour, pigmentation
dyslipidemia
GDM, Birth wt
Development
Feeding/diet
FHx
obesity
T2DM
GDM
ACS
CVA
Cholesterol
HTN
OSA
Fatty liver
PCOS
Eating disorders
Bariatric surgery
Ethnicity - all except caucasian high risk
Motivation to change (use there priorities not yours) SMART goals
Ex
Ht, Wt, Waist circumference
BP
Gait, mobility
Striae, intertrigo, Acanthosis nigricans, hirsutism, acne
Neck - tonsils, goitre, caries
Hepatomegaly
Tanner stage
Dysmorphism, delay, short stature (?genetic)
Ix
if obese, FHx, high risk ethnicity, co-morbidities, suggestion of genetic disorder
Fasting lipids (total, LDL,HDL,Trig) , BSL, insulin, LFTs, TFTs
Fe Studies (inflammation impairs Fe absorption)
Vitamin A, C, D, E, B12/Folate, Zinc
bHCG and testosterone if girl with hirsute/acne/irreg bleed
Rx:
<12yo focus on parents, >12yo focus on child
Treat depression (inc parental) THEN obesity
Treat family (role models)
ROCKET
Raise the issue - "Healthy weight", complications, allow face saving "harder these days, more risks"
Offer resources - "Blast off" pamphlet, happy to revisit at any time,
http://kidshealth.schn.health.nsw.gov.au/projects/childhood-obesity
http://www.healthykids.nsw.gov.au
http://www.health.gov.au/internet/main/publishing.nsf/Content/health-pubhlth-strateg-food-guide-index.htm
http://www.walk.com.au/pdfs/DOHA_205465_ParentsCarers.pdf
http://au.mendcentral.orghttp://www.healthyactive.gov.auhttp://www.healthyactive.gov.au
Calculate BMI
Keep focused - Hx/Ex
Explore risks
Treat
List of SMART goals
Persistence with "easier" choices not "will power"
Diet plan (no evidence of risk of eating disorder)
If they sleep in they get a protein drink
Exercise plan - aqua aerobics, ex. bike, walking, swimming to start, jogging cycling after. Avoid high impact on joints. (plus wet/hot weather plan)
Food diary
Exercise / screen diary (pedometer/pedometer app)
Cotton undershirt + bike shorts for chaff
Weekly review for wt loss (whole family weighed)
Monthly for weight maintenance
Daily shower, dry folds
Watch for thrush
Antiperspirant
Fibre and hydration for constipation
Group strategies - camp,
Minimise nagging in return to action
Praise the effort not the result
Avoid juice
Orlistat
Bariatric surgery
Very low energy diet - dietitian
Metformin if insulin resistant
Screen for caries
Environment
removing bad food house
Smaller plate size
Don't leave out snacks
no TV in bed room
TV in a cabinet
TV off during day to encourage outdoor activity
improve ergonomics of access to exercise
Refer to Dietitian
Refer to Psychologist for Positive Parenting, Binge eating
Refer to exercise physiologist for exercise program tailored to pathology
Refer to physio for injury treatment
Refer to: Healthy Lifestyle Service
aged 2-16 years
at or above the 85th centile on the BMI-for-age growth charts
Fax a referral letter including height, weight, pathology results, relevant family history and contact details: 02 8627 0141
Phone: 02 8627 0403
Belmore Early Childcare Health Centre
38 Redman Parade, Belmore
12:00-5:00pm, first Tuesday of the month
CPC RPA Clinic
John Hopkins Drive, Camperdown
12:00-5:00pm, third Monday of the month
Growing health kids (SWS)
[email protected]
Go 4 fun
Prognosis
- overwt < 3yo does predict adult unless parent obese
- overwt 6yo 50% will still be as adult
- overwt adolescent 75% will still be as adult
20% preschool
25% school-age
Adolescence don't "slim down" naturally
Hx
Duration
Previous attempts at weight loss
Pubertal history
Menstrual irregularity
Binge eating
Is food a friend or enemy
Do you ever want to get rid of what you just ate
Are their times when all you can think of if food
Do you ever feel like you cannot stop
Do you lose track of time when you eat
Do you turn to food for comfort
Risk factors:
Screen time >2h ?in the bedroom ?eat in front of TV
Inactivity - ?sports, ?transport to school ?free time
Energy dense food - Lunch bought or brought, soda/juice
Parental obesity - role model, controls food and activity
Causes:
Lifestyle (99%)
Genetic
- Congenital leptin deficiency
- leptin is released by adipocytes giving the brain a reading of total adipose store
- opposes ghrelin produced by the stomach when it is empty
- regulates appetite by down regulating neuropeptide Y, the most potent stimulator of appetite
Endocrine
- Hypothyroidism
- Growth hormone deficiency (short)
- Hypercortisolism (Cushings - volaceous striae)
- Hypothalamic lesion
Medications
- Antipsychotics: olanzipine, risperidone
- Antiepileptics: valproate
- Glucocorticoids
- Insulin
Complications:
Social rejection: look different, not good at sport
Teasing
Low self esteem > depression
Difficulty buying clothes, discrimination
bulemia
CVS disease - HTN, LVH, CAD
Resp - Asthma, exercise intolerance, OSA (snoring, day time somnolence, witness apnoea, morning headache) PHTN
Liver - fatty liver, gallstones (2%)
Pancreas - insulin resistance
Ortho flat feet, joint, back pain, SCFE, tibia vara (Blounts Disease), ankle sprains, fractures
GIT - constipation, reflux, abdominal pain
GUT - day time wetting, nocturnal enuresis
G - menstrual irregularities PCOD
Neuro - BIH,
derm - chaffing, sweating/odour, pigmentation
dyslipidemia
GDM, Birth wt
Development
Feeding/diet
FHx
obesity
T2DM
GDM
ACS
CVA
Cholesterol
HTN
OSA
Fatty liver
PCOS
Eating disorders
Bariatric surgery
Ethnicity - all except caucasian high risk
Motivation to change (use there priorities not yours) SMART goals
Ex
Ht, Wt, Waist circumference
BP
Gait, mobility
Striae, intertrigo, Acanthosis nigricans, hirsutism, acne
Neck - tonsils, goitre, caries
Hepatomegaly
Tanner stage
Dysmorphism, delay, short stature (?genetic)
Ix
if obese, FHx, high risk ethnicity, co-morbidities, suggestion of genetic disorder
Fasting lipids (total, LDL,HDL,Trig) , BSL, insulin, LFTs, TFTs
Fe Studies (inflammation impairs Fe absorption)
Vitamin A, C, D, E, B12/Folate, Zinc
bHCG and testosterone if girl with hirsute/acne/irreg bleed
Rx:
<12yo focus on parents, >12yo focus on child
Treat depression (inc parental) THEN obesity
Treat family (role models)
ROCKET
Raise the issue - "Healthy weight", complications, allow face saving "harder these days, more risks"
Offer resources - "Blast off" pamphlet, happy to revisit at any time,
http://kidshealth.schn.health.nsw.gov.au/projects/childhood-obesity
http://www.healthykids.nsw.gov.au
http://www.health.gov.au/internet/main/publishing.nsf/Content/health-pubhlth-strateg-food-guide-index.htm
http://www.walk.com.au/pdfs/DOHA_205465_ParentsCarers.pdf
http://au.mendcentral.orghttp://www.healthyactive.gov.auhttp://www.healthyactive.gov.au
Calculate BMI
Keep focused - Hx/Ex
Explore risks
Treat
List of SMART goals
Persistence with "easier" choices not "will power"
Diet plan (no evidence of risk of eating disorder)
If they sleep in they get a protein drink
Exercise plan - aqua aerobics, ex. bike, walking, swimming to start, jogging cycling after. Avoid high impact on joints. (plus wet/hot weather plan)
Food diary
Exercise / screen diary (pedometer/pedometer app)
Cotton undershirt + bike shorts for chaff
Weekly review for wt loss (whole family weighed)
Monthly for weight maintenance
Daily shower, dry folds
Watch for thrush
Antiperspirant
Fibre and hydration for constipation
Group strategies - camp,
Minimise nagging in return to action
Praise the effort not the result
Avoid juice
Orlistat
Bariatric surgery
Very low energy diet - dietitian
Metformin if insulin resistant
Screen for caries
Environment
removing bad food house
Smaller plate size
Don't leave out snacks
no TV in bed room
TV in a cabinet
TV off during day to encourage outdoor activity
improve ergonomics of access to exercise
Refer to Dietitian
Refer to Psychologist for Positive Parenting, Binge eating
Refer to exercise physiologist for exercise program tailored to pathology
Refer to physio for injury treatment
Refer to: Healthy Lifestyle Service
aged 2-16 years
at or above the 85th centile on the BMI-for-age growth charts
Fax a referral letter including height, weight, pathology results, relevant family history and contact details: 02 8627 0141
Phone: 02 8627 0403
Belmore Early Childcare Health Centre
38 Redman Parade, Belmore
12:00-5:00pm, first Tuesday of the month
CPC RPA Clinic
John Hopkins Drive, Camperdown
12:00-5:00pm, third Monday of the month
Growing health kids (SWS)
[email protected]
Go 4 fun
- no waitlist
- Face to face or Online
- Aboriginal face to face
- 1 afternoon for 10 weeks ie one term
- first review parent referral
- Repeat attendance only at clinician referral
- Go4fun will refer to GHK if eligible
- Refer to G4F if eligible
Prognosis
- overwt < 3yo does predict adult unless parent obese
- overwt 6yo 50% will still be as adult
- overwt adolescent 75% will still be as adult