Guidelines for MBS
Class II obesity: BMI >120% of the 95th percentile or BMI ≥ 35 kg/m2 with a major co-morbidity
Class III obesity: BMI >140% of the 95th percentile or BMI ≥ 40 kg/m2
What % of children between 2-19 yo are affected by Obesity?
20%
Prevalence of Obesity based on Income Class?
Lowest in High Income
Highest Prevalence of Obesity based on Gender/Race?
Black Girls & Hispanic Boys
What Class of obesity is growing the fastest?
Class III (140% +)
What parenting style is most conducive to a healthy weight?
Authoritative (Responsive/Warm AND High Expectations)
Authoritarian is unresponsive with High Expectations.
Does High Or Low Birthweight contribute to increased risk of Childhood Obesity?
Both
Does smoking in utero increase or decrease risk of childhood obesity?
Increase (dose dependent)
How does untreated AHDH and Recurrent Abx use affect weight?
Increase risk of obesity.
ADHD via due to impulsivity and poor planning
Abx use due to altered Gut Biota
Angleman’s Syndrome
Spastic/jerky movements, early seizures, Small happy head, developmental delay with babbling
Maternal Imprinting - chromosome 15 called the ubiquitin protein ligase E3A (UBE3A)
Pediatric Underweight, Healthy, Overweight Obese, Severe Obese % and Classes?
Under: < 5 %
Healthy: 5 to < 85%
Overweight: 85 to < 95%
Obesity: 95 to < 99%
Severe: 99% and Above
Class I: 95 to < 120%
Class II: 120 to < 140%
Class III: 140 and beyond
Slipped capital femoral epiphysis (SCFE) and DDx (3 others)
New-onset unilateral limp and external rotation (resistance to internal rotation) of the hip. Results from the instability of the growth plate of the proximal femur (from fat or growth spurt)
Blount disease is the bowing of the tibia (varus) and can be seen in children with obesity.
Legg-Calve-Perthes disease is idiopathic avascular necrosis of the femoral head and can present similarly to SCFE, including impaired internal rotation; however, it usually affects younger patients (ages 5-6 years old). It may be painless and present only as a limp.
Osgood-Schlatter disease is seen in young, active patients and presents with a pronounced tibial tuberosity.
Lab Eval Recs for Obese Children?
Age 2-9 years old: May evaluate for dyslipidemia in those with obesity
Age ≥ 10 years old:
Obesity:
- Lipids, Glucose, LFT’s.
Overweight:
- Lipids.
- May do Glucose and LFT’s in the presence of risk factors for type II diabetes and metabolic dysfunction-associated steatotic liver disease (MASLD).
Describe Early Adiposity Rebound (EAR)
BMI typically increases in the first year of life, then decreases, reaching a nadir around 5–7 years of age.
A second rise in BMI, known as adiposity rebound, is normal.
However, when this rebound occurs BEFORE AGE 5, it is considered early adiposity rebound and increases the risk of overweight, obesity, and related health issues.
Early Adiposity Rebound, what kind of growth charts is it best seen on?
EAR is best seen on absolute BMI charts, not BMI percentile charts.
Metabolic Syndrome Criteria 12-19 yo?
3/5
- TG >/= 100
- HDL </= 10th % tile
- Fasting BG > 100
- WC >/= 90th % tile
- BP >/= 90th % tile
How does OSA management in Children differ from Adults?
Those that sill have adenoids and tonsils should be referred to an otolaryngologist to eval for adenoidectomy and tonsillectomy.
6 months of watchful waiting in those without severe OSA is appropriate.
Healthy Sleep Ranges By Age (5-9, 10 - 14)
5-9 years old: 11 to 14 hours
10-14 years old: 10 - 12
PEDIATRIC MBS INDICATIONS
Class II obesity: BMI >120% of the 95th percentile or BMI ≥ 35 kg/m2 with a major co-morbidity
Class III obesity: BMI >140% of the 95th percentile or BMI ≥ 40 kg/m2
Intensive health behavior and lifestyle treatment (IHBLT), amount of hours/months?
Longitudinal care providing ≥ 26 hours over a 3-12 month time period is the minimum
Interventions ≥ 52 hours provided the most significant reduction in BMI and improvements in cardiometabolic health.
Which Age Group Is Most Effected By Obesity with regards to Sleep Deprivation?
While sleep deprivation impacts individuals across all ages, the strongest predictive relationship between insufficient sleep and obesity occurs in school-aged children (particularly those aged 6–13 years) facing the highest relative risk.
In contrast, longer sleep durations offer protective benefits against obesity. Children aged 13 years and younger who slept 10 hours or less had a 76% increased risk of excess weight compared to those sleeping more than 12 hours per night. Additionally, each one-hour increase in daily sleep duration was associated with a 21% reduction in obesity risk. One study found that children aged 5–11 years experienced a BMI increase later in life (measured at age 32) of 0.93 for each hour of reduced sleep.
