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Dr Ritambhara Lohan
OBESITY IN CHILDREN!!! Nowadays this problem is prevailing like a disease in our society. On one hand we are dealing with malnutrition and on the other hand this era of obesity has emerged more especially in a high end society. Obesity is a nutritional disorder which leads to various other health problems. Timely prevention and treatment is utmost important especially when it comes to children who are nowadays more vulnerable age group hit by obesity. Obesity- it is excess deposition of body fat • Weight for age >120% • BMI >95th centile Data: • In aged 0 to 5 years increased from 32million globally in 1990 to 42 million in 2013 • Current trends will increase to 70 million globally by 2025 • Vast majority of overweight children live in developing countries • India have shown prevalence of overweight 10–14% and obesity in 3–6% of children Risk factors: • Prenatal Period IUGR Overweight mother • Early complementary feeds, formula feeds, less breast feeds • Parental weight, low parental education • Medications- antipyschotics etc • Dietary- more junk food, sweetened beverages, less nutritive diet • Life style- more screen time, less physical activity Types: • Primary obesity- more common >95% • Secondary obesity- 1. Genetic syndromes- Prader willi, Down’s etc 2. Hypothalamic- infectious, radiation, surgery etc 3. Endocrine- hypothyroidism, cushing syndrome 4. Drugs- antiepileptics, steroids 5. Psychological factors- depression, attention seeking, bulimia Obesity causes multi organ problems like : • Hypertension • Type 2 Diabetes • Dyslipidemia • Sleep abnormalities • Asthma • Osteopenia • GERD • Cholelithiasis • Early puberty • PCOS • Depression • Low self esteem • Anxiety • Poor school performance • Acanthosis nigricans, intertrigo Investigations: • Lipid profile • GTT • Thyroid function • Serum LH, FSH, testosterone • Bone age assessment • Growth hormone • Serum Vitamin D • Serum insulin, HbA1C Management: Multidisciplinary approach • Dietary- Carbohydrates 40–45% Proteins 10–20% Fat 30–40% • Weight monitoring • Physical activity • Medication 1. Look for anti obesity drugs (for >16 years of age)- Orlistat 2. Surgical- BMI >50kg/m2 without comorbidities and >40 kg/m2 with comorbidities- Laparoscopic adjustable gastric banding, sleeve gastrectomy etc. Prevention: • Diet 1. Exclusive breast feeding 2. Timely complementary feeding 3. Health feeding practices 4. More fibre diet 5. Proper age related diet 6. Avoid junk food • Life style changes and physical activity • Behaviour- in the form of parental motivation, positive reinforcement, timely monitoring ECHO (Ending Childhood Obesity) WHO: • Provide policy recommendations to governments to prevent infants, children and adolescent from developing obesity and to identify and treat pre existing obesity • To reduce the risk of morbidity and mortality due to non-communicable diseases, lessen the negative psychosocial effects of obesity both in childhood and adulthood. Obesity only harms your body and mind. Do not wear it, shave it off.

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