Obesity

Published on 06/06/2015 by admin

Filed under Pediatrics

Last modified 06/06/2015

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15 Obesity

Amanda Jones, Beth Rezet

Obesity is currently one of the most significant health problems in the United States, and the prevalence of this disease is increasing worldwide. A combination of metabolic, genetic, environmental, behavioral, and social factors affects a person’s risk for developing obesity. As the epidemic of obesity increases, there is a concomitant increase in the comorbid diseases associated with obesity, such as diabetes, hypertension, dyslipidemia, nonalcoholic fatty liver disease, sleep apnea, and orthopedic problems.

It is estimated that approximately 15% of children in the United States meet the criteria for being obese. The prevalence of obesity is greatest in children of African-American, Native American, and Mexican American descent. Preventing and treating obesity involve balancing caloric intake with energy expenditure. This basic concept is increasingly difficult in our society given the availability of inexpensive, high-calorie foods and the relatively sedentary lifestyle of most children.

Etiology and Pathogenesis

The causes of obesity are multifactorial, with both genetic and environmental influences playing roles in the balance between caloric intake and energy expenditure. Patients with at least one obese biologic parent have a threefold increased risk of developing obesity in their lifetime; having two obese biologic parents is associated with a 10-fold increased risk for developing obesity. Rarely, a genetic syndrome or endocrine disease contributes to the cause of a patient’s obesity. Examples of these disorders include Prader-Willi syndrome, Cushing’s disease, and hypothyroidism. Evaluation for these causes should be based on physical examination findings and history.

Clinical Presentation

The standardized measurement of weight appropriateness is the body mass index (BMI), which is validated in children older than 2 years of age. Before age 2 years, it is often useful to rely on a patient’s weight-to-height measurement. In adults (age 18 years and older), the term overweight corresponds to a BMI of 25 to 30, and a BMI of 30 or greater correlates with obesity. Throughout childhood, there is both an increase in weight and height, and it is therefore necessary to refer to BMI percentiles, which are adjusted for age and gender:

• Healthy weight: 5% to 85% BMI for age and gender

• Overweight: 85% to 95% BMI for age and gender

• Obesity: >95% BMI for age and gender

BMI is calculated using a formula (weight (kg) ÷ [height (m)]²⁾ or by using a BMI calculator, such as that provided by the Centers for Disease Control and Prevention (http://www.cdc.gov/healthyweight/assessing/bmi/index.html.) BMI should be calculated and plotted on the appropriate standardized graph to ascertain the BMI percentile at every well-child visit.

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