Pediatric Obesity
Why do people focus only on calories?
Because they have multiple kids, jobs, and income
True or false: Small Changes can have a huge benefit.
True
What is a healthy diet?
A healthy diet includes fruits, vegetables, whole grains, low or non fat dairy, seafood, legumes, nuts, moderation in alcohol, lower consumption in red and processed meats, sugar sweetened drinks, and refined grains.
Ex- DASH, MyPlate, and Mediterranean Diet
What is the BMI Assessment in Children?
Underweight: <5th percentile for age
Normal: 5-84 percentile for age
Overweight: 85-94 percentile for age
Obese: >/=95th percentile for age
Morbidly obese: >/=99th percentile for age
What are benefits of exercising?
Better health through better body composition
Stress Reduction
Appetite Control
Increased Basal Metabolism
May change set-point
Total calories that are expended are considered to be important
Losing fat in particular parts of your body
What are vulnerable periods?
Intrauterine
-Maternal smoking during pregnancy
-Maternal diabetes and gestational diabetes which increases the risk of obesity
-Maternal obesity
Infancy if formula feed
Puberty among both men and women gain weight and growth spurt
Pregnancy could be associated with overweight before or/and gain too much
Stress which some people eat food while others don't
Aging which makes everything slows down
What rewards can you chose besides food?
Books, video games, and shirts
What is intuitive eating?
Intuitive eating is focusing on our own hunger and satiety cues while reducing calories and fats in foods.
What is the assessment of pediatric obesity?
Assessment:
1. Calculate, chart, and classify BMI for all children (2-19 yo) at least yearly
2. Assess dietary patterns
3. Assess activity/inactivity
4. Assess readiness for change
5. Assess obesity related co-morbidities
6. Assess ongoing progress
What are the different types of bariatric surgeries?
Restrictive:
limits how much food is eaten by decreasing the part of the stomach that holds food.
· Increased satiety with small amounts of food
Laparoscopic Adjustable Gastric Binding:
· Adjustable band around the top part of the stomach
· Band controls the rate food leaves the pouch: gradual wt. loss
· Less operative risk: follow-up for band adjustments
· Less wt. loss occurs with gastric bypass
Vertical Banded Gastroplasty:
Staples and non-adjustable pouch at the top of stomach
Delayed gastric emptying
Gastric Bypass:
· restricts amount of food eaten & amount of food that is absorbed
· 2/3 of excess wt. is lost within 2yrs
· Stomach capacity changes from ~4oz to 1-2oz
Malabsorptive: food travels through a short section of small intestine
· Limits amount of food absorbed
More food expelled as waste instead of storage for energy
How do you avoid obesity?
Promote breastfeeding
Diet and physical activity
-5+ servings of F/V daily
-2 or fewer hours of screen time per day and no television in child's bedroom
-1+ hours of physical activity each day
-No sugar sweetened beverages
Eat breakfast daily
Limit eating out
Encourage family meals
Limit portion sizes
Increase calcium and fiber
Diet should be balanced in macronutrients
Limit consumption of energy dense foods
Why do we not exercise?
1. Lack of time
2. Lack of energy
3. Don't enjoy it
4. Can't stick with it
5. Can't afford a membership
6. Not seeing changes in their body fast enough
7. Don't know how
8. Lack of motivation
9. It hurts
10. Lack of commitment to stick with it
What can you not eat in the paleo diet?
Dairy
Cereal grains and cereal grain like seeds (quinoa)
Legumes
Starchy vegetables
Salt containing foods
Fatty/cured meats
Soda and juice
Sweets
What are symptoms associated with obesity related health conditions?
Sleep apnea or snoring
Short sleep time or restlessness
Shortness of breath
Wheezing
Recurrent abdominal pain
Heartburn
Frequent headaches
Polyuria or polydipsia
Amenorrhea or oligomenorrhea
Hip or knee pain
Skin conditions
Depression
Problems w/social interactions
Anxiety, school avoidance, social isolation
Poor self-esteem
Body disatisfaction
History of ED
What is cognitive behavioral therapy?
focuses on triggers, cues, barriers, and goal-oriented behavior change
What are environmental factors?
Snacking
Beverages which juice has sugar
Increased portions-large
Fast food
Multiple caregivers
Consuming more food away from home as they get older
What are the five stages of trans-theoretical model (aka stages of change)?
Pre-contemplation: Not thinking about it
Contemplation: You are thinking about it which is an indicator that a person feels motivated to make improvements in diagnoses or overall health. In this stage, you can ask about their own concerns and talk about diagnoses.
Preparation: Making a plan can be going to support groups
Action: Actually making the changes to see improvements over time. Relapse happens within the 1st 3-6 months and it takes 2-8 months to form a habit
Maintenance: Continue working on it daily
What is a balanced hypocaloric diet?
500-1,000 calorie deficit sustainable, does not eliminate food groups. Example: Weight Watchers, Jenny Criag, Slim Fast
CONS: on and off the diet which makes weight gain come back, can feel discouraging
How many genes are related to obesity?
300+ different genes increases the risk of obesity but often has to do with environmental factors
What does metformin do?
inhibits hepatic glucose production; improves glucose; promotes weight loss
True or false: Children who have parents with college degrees have obesity.
False
Describe the post-bariatric surgery diet recommendations
Clear liquids (1-5 days post op)
30ml per hr as tolerated
H2O, broth, plain gelatin, pulp-free juices, ice pops, tea, etc. (anything not leaving undigested residue in stomach
Full liquids (2-5 days - 2wks)
5-6 small meals (2-3oz)
Includes all clear liquids but also foods that turn to liquid at room temp. Ice cream, pudding, cream soups, etc.
Pureed, low fat, no concentrated sweets (~2-4 wks)
Mechanical Soft, low fat, NCS (~4-8wks)
5 small meals (2oz)
Maintenance
3-5 meals (4-6oz)
What are the four phases of the Atkins diet?
1. Extreme restricted carb intake to 25 g or less each day
2. Add carbs in the form of nuts, seeds, some fruit, and cottage cheese. Start with 5 grams each day to reach to 25 g.
3. Fine tuning means continuing to add in more carbs while trying to maintain your own goal
4. Controlled weight maintenance and manage your own carb intake if tolerance changes or regain a couple of pounds
What are the four phases of obesity trajectory?
Phase 1-steady increase in childhood obesity
Phase 2-emergence of serious obesity related to co-morbidities
Phase 3-medical complications lead to life threatening disease to death in middle age
Phase 4-acceleration of obesity epidemic by transgenerational transmission
When should bariatric surgery be considered?
People have tried to lose weight by focusing on exercising, changing their diet, taking medications, etc and does not seem to work.