Name : Aliza Sameer Shaikh

Class: FY-BBA
Roll No: 59
Topic: A study obesity and its
health effect during childhood.

Business Demography
INTRODUCTION
 Defination : The word OBESITY refers to the deposition of excessive fat in the body .
Different methods can directly measure body fat The word obesity infers the deposition of
excessive fat in the body. Different methods can directly measure body fat like skinfold
thickness, hydro densitometry, bioelectrical impedance, and air displacement
plethysmography. These methods are not readily available in the clinical setting and are
expensive. Body mass index (BMI) provides an economical method to assess body fat
indirectly. BMI is measured using a formula [BMI = weight (kg)/ height (m)^2]. As growth in
children varies with age and sex, so do the norms for BMI. The following definitions are
used to classify weight status based on BMI for children from 2 to 20 years of age.
 Overweight – 85th to less than the 95th percentile.
 Obese (class 1) – 95th percentile or greater
 Severe (class II) obesity – ≥ 120% of 95th percentile (99th percentile) or ≥ 35 kg/m^2
(whichever is lower)
 Class III obesity is a subcategory of severe obesity and is defined as BMI ≥140 % of
95th percentile or ≥ 40 kg/m^2.
 The World Health Organization (WHO) recommends using BMI Z-score cut-offs of
>1, > 2, and > 3 to define at risk of overweight, overweight, and obesity,
respectively. Z-score is measured in terms of standard deviations from the mean.
Continuing
Education Activity

 Obesity in childhood is the

most challenging public
health issue in the twenty- OBJECTIVE
first century. Childhood
obesity is associated with
increased morbidity and Outline the definition of childhood obesity.
premature death.
Prevention of obesity in
Describe the etiology and pathophysiology of childhood
children is a high priority
obesity.
in the current situation.
This activity reviews the
etiology, pathophysiology, Summarize the consequences of childhood obesity.
and consequence of
childhood obesity and also
highlights the role of the Explain how interprofessional teamwork can improve
interprofessional team in effective management interventions for childhood obesity
the prevention and
management of childhood
obesity.
Issues of Concern

 Etiology and Pathophysiology  Biological Factors

 The complex interaction of individual and  There is a complex interaction between the

environmental factors plays a crucial role neural, hormonal, and gut-brain axis
in developing obesity. The most important affecting hunger and satiety. Hypothalamus
factors contributing to childhood obesity regulates appetite and is influenced by key
are summarized below. hormones, ghrelin, and leptin. Ghrelin is
released from the stomach and stimulates
 Environmental Factors
hunger (orexigenic), whereas leptin is mainly
 Changes in the environment in the past secreted from adipose tissue and suppresses
few decades in terms of easy access/ appetite (anorexigenic). Several other
affordability of high-calorie fast food, hormones like neuropeptide Y and agouti-
increased portion size, increased intake of related peptide stimulate hunger, while pro-
sugary beverages, and sedentary lifestyles melanocortin and α-melanocyte-
are associated with increased incidence of stimulating hormone suppress
hunger. These hormones control energy
obesity. Increasing use of electronic
balance by stimulating the hunger and
devices [television, tablets, smartphone,
satiety centers in the arcuate nucleus of the
videogames] by children has led to limited
hypothalamus through various signaling
physical activity, disruption of the sleep-
pathways. Stress-related psychiatric
wake cycle, depression of metabolic rate, disorders with associated abnormal sleep-
and poor eating patterns. wake cycles can also lead to increased ghrelin
levels and, in turn, increase appetite.
 FACTORS RESPONCIBLE:
GENETIC FACTORS ENDOCRINE FACTORS
 Endocrine Factors
 Genetic syndromes causing severe obesity include
 Endocrine causes constitute less than 1% of cases of obesity
 Prader Willi syndrome: Early growth faltering in children.[18] It is usually associated with mild to moderate
followed by hyperphagia and increased weight obesity, short stature, or hypogonadism. These include
gain by 2 to 3 years. The mild or moderate cortisol excess [steroid medications or Cushing syndrome],
hypothyroidism, growth hormone deficiency, and
cognitive deficit, microcephaly, short stature, pseudohypoparathyroidism.
hypotonia, almond-shaped eyes, high-arched  Medications
palate, narrow hands/feet, delayed puberty are  Numerous medications can cause weight gain. These include
common features. antiepileptics, antidepressants, antipsychotics, diabetes
 Alstrom syndrome: Blindness, deafness, medications [insulin, sulfonylureas, thiazolidinediones],
glucocorticoids, progestins, antihistamines [cyproheptadine],
acanthosis nigricans, chronic nephropathy, type 2 alpha-blockers [terazosin], and beta-blockers [propranolol].
diabetes, cirrhosis, primary hypogonadism in Close monitoring for excessive weight gain should be done
males, and normal cognition are common when any of these medications are used in children.
features in Alstrom syndrome.  Toxins
 Bardet Biedl syndrome: Intellectual disability,  Endocrine-disrupting chemicals, such as bisphenol A and
dichlorodiphenyltrichloroethane, have been hypothesized to
hypotonia, retinitis pigmentosa, polydactyly, predispose to obesity by modulating estrogen receptors and
hypogonadism, glucose intolerance, deafness, and possibly metabolic programming.[19]
renal disease are the features in Bardet Biedl  Viruses
syndrome.  Few studies in animal models have proven that obesity can be
 Other syndromes include Beckwith- triggered by infection with adenovirus. However, human
studies have found conflicting results.
Weideman syndrome and Cohen syndrome.
CLINICAL SIGNIFICANCE
 Childhood obesity significantly impacts both physical and psychological
health. Obesity can lead to severe health conditions, including non-
insulin-dependent diabetes, cardiovascular problems, bronchial asthma,
obstructive sleep apnea (OSA), hypertension, hepatic steatosis,
gastroesophageal reflux (GER), and psychosocial issues. The preventive
and therapeutic interventions in childhood obesity are crucial in
decreasing the burden of comorbid health conditions.
 Problems Caused Are : Metabolic Syndrome, Dyslipidemia,
Glucose Intolerance, Hypertension, Hypertension,
Hypertension, Asthma, Asthma, Sleep Apnea, Orthopedic
Complications, Polycystic Ovary Disease , Persistence of
obesity into adulthood, Psychosocial impact, Eating Disorders,
Academic Performance .
DIAGRAMS SHOWING OBESITY
Enhancing Healthcare Team Outcomes

 Prevention is the best intervention to decrease the prevalence of obesity. The pediatrician should explore
the risk of obesity and overweight during every clinical visit for all children.
 Both bottle-fed and breastfed infants are at risk of overfeeding. However, overfeeding is more prevalent
among bottle-fed infants. Exclusive breastfeeding and delayed initiation of solid foods may reduce the
future risk of overweight.
 Skim milk is a safe replacement for whole milk after two years of age. Parents or caretakers should never
use food like sweets for a reward. The entire family should have a balanced diet that comprises less than
30 percent of calories from fat. AAP recommends consuming a variety of vegetables and fruits, whole
grains, proteins, low-fat dairies and decreasing the intake of sodium, saturated fats, and refined sugars
beginning at the age of two years.
 An essential step in preventing obesity is reducing sedentary time. Limit the screen time, including
television, video games, or mobile, not more than 2 hours per day for more than six-year-old children and
not more than 1 hour per day for 2-6 years of age group. AAP strongly recommends not allowing kids less
than two years to have screen time.
 Encourage physical activity for children. Children aged 3 to 5 years should be active throughout the day.
Children and adolescents ages 6 to 17 years should be physically active for at least 60 minutes every day.
 As per CDC, 60% of middle school kids and 70% of high school kids do not meet the standard sleep
recommendations. AAP recommends that children aged 1 to 2 years sleep 11 to 14 hours per day, children 3
to 5 years sleep 10 to 13 hours, children 6 to 12 years sleep 9 to 12 hours, and adolescents aged 13 to 18 years
should regularly sleep 8 to 10 hours. Avoiding heavy meals close to bedtime, being physically active
throughout the day, and removing electronic devices in the bedroom will help to get better sleep.
The pediatrician should explore for associated morbidity in all obese children. The detailed assessment in obese
children should include assessing cardiac comorbidities, orthopedic complications, and psycho-social
complications.
Reasonable weight-loss goals should be initially 5 to 10 pounds (2 kg to 4.5 kg) or a rate of 1 to 4 pounds (0.5 to 2 kg)
per month
 The pediatrician should explore for associated morbidity in all obese children. The detailed assessment in obese children
should include assessing cardiac comorbidities, orthopedic complications, and psycho-social complications.
 Reasonable weight-loss goals should be initially 5 to 10 pounds (2 kg to 4.5 kg) or a rate of 1 to 4 pounds (0.5 to 2 kg) per
month.
 Dietary management: Dieticians provide dietary prescriptions mentioning the total calories per day and recommended
percentage of calories from carbohydrates, protein, and fat. The Traffic Light Plan is one method of providing dietary
management. The Traffic Light Plan classifies foods as green (low energy density), yellow (moderate energy density), and red
(high energy density). These categories help children in adopting healthier eating patterns.[41] The dietician plays a
significant role in guiding the diet plan for the patients.
 Physical activity: As per the fitness level, begin the physical activity with the goal of 30 minutes/day in addition to any school
activity. Treatment should target gradually increasing the activity to 60 minutes per day. An exercise physiologist, along with
the physician, can help the patients to achieve their target physical activity.
 Behavior modification: Primary care-based behavioral interventions such as self-monitoring, nutritional education,
improvement of eating habits, increasing physical activity, attitude change, and rewards help manage childhood obesity.
 Family involvement: Review overall family activity and television viewing patterns and always involve parents in nutrition
counseling. Family-based behavioral treatment is the most robust intervention for childhood obesity.
 Psychotherapy: Behavioral therapy and Cognitive therapy are commonly used by the psychologist in the management of
obesity. Behavioral therapy trains patients to act differently around food, and cognitive therapy trains patients how to change
their thoughts and emotions related to food.
 None of the anorexiant medications are FDA approved for use in childhood obesity. Orlistat is the only FDA-approved
medication for use in adolescents.
 Surgical procedures like gastric bypass have not been studied sufficiently in children to advise their use.
 An interprofessional team that provides a holistic and integrated approach can help achieve the best possible outcomes.
Collaboration, shared decision making, and communication are key elements for a good outcome. Multidisciplinary teams
include a primary physician, a dietician, a nurse or nurse practitioner, a clinical exercise physiologist, and a psychologist. The
interprofessional team can provide a comprehensive weight loss program that benefits the patients.
CONCLUSION
THANK YOU…….