Obesity: Questions and Cases

Childhood Obesity

Learning objectives:

1. To recognize the importance of childhood overweight/obesity as a critical child health issue, understand causes, and identify risk factors
2. To understand what BMI is and how it is used
3. To understand issues of screening and management
4. To develop an appropriate healthy lifestyles promotion intervention for your practice

GR, a 3 year, 2 month old boy, is your first patient of the morning.  He is here for his annual physical.  You note that the medical assistant has checked his height and weight; he weighs 20 kg (44.4 lbs) and is 104 cm (40.9 inches) tall.

1.  What is GR’s BMI?  What is his weight status?

GR’s mother is appalled to hear you call her robust child “obese.” She believes he is healthy and looks like all his friends.

2.  What is the prevalence of childhood obesity? What is the etiology? Risk factors?

3.  What are the health sequelae?

GR’s mother is worried now.  She thought he was healthy, but now you are telling her all these things he might have.  She wants him tested for “everything.” 

4.  What is a reasonable approach to managing children who are overweight or obese for other medical issues? How do you assess GR?

GR’s mother wants to know what she should do right away for GR.  He also has two older siblings at home, who are normal weight.

5. What advice can you give about healthy lifestyles promotion?

GR’s mother has one last question.  She is worried that if GR is obese, does he have fat in his blood?  Do his siblings? She has heard that fat in the blood can cause heart attacks.

6. What do you tell her about cholesterol screening?

Feb 08/pah

Primary Reference

Barlow SE, Expert Committee. Expert committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: summary report. Pediatrics Dec 2007; 120 (supplement 4): S164-92.

For Further information:

Dietz WH, Robinson TN. Overweight children and adolescents. New Eng J Med May 19, 2005; 352: 2100-9.

My Food Pyramid; available at www.mypyramid.gov/

American Heart Association. Dietary recommendations for children and adolescents: a guide for practitioners. Pediatrics Feb 2006; 117 (2): 544-59.

Connor SM. Food-related advertising on preschool television: building brand recognition in young viewers. Pediatrics Oct 2006; 118 (4): 1478-85.

US Preventive Services Task Force. Screening and interventions for overweight in children and adolescents: recommendation statement. Pediatrics July 2005; 116 (1); 205-9.

US Preventive Services Task Force. Screening for lipid disorders in children: US Preventive Services Task Force recommendation statement. Pediatrics Feb 2008; 120 (1): e215-9.

For those with particular interest (and some spare time):

Assessment of child and adolescent overweight and obesity. Supplement to Pediatrics Dec 2007; 120 Supplement 4.

Drewnowski A, Specter SE. Poverty and obesity: the role of energy density and energy costs. Am J Clin Nutr 2004; 79: 6-16.

The Future of Children. Childhood Obesity. The Future of Children Spring 2006; 16(1); available at  http://www.futureofchildren.org/pubs-info2825/pubs-info_show.htm?doc_id=349724.