Diagnosis Severity of obesity Overweight Obesity Morbid obesity

Diagnosis Severity of obesity Overweight Obesity Morbid obesity W/H > 120 -140 >140 -200 >200 Weight for height (W/H) = body weight (kg) x 100 Ideal body weight (kg)

Growth curve Boys and Girls 2 -19 yr

Example A 8 year-old girl Weight for height W/H = 45 x 100 28 = 160% 45 28 >> Obesity

Example A 11 year-old boy Weight for height W/H = 48 x 100 33 = 145% 47 33 >> Obesity

Etiology �Exogenous obesity � Nutrition � Environment/ �Endogenous � Endocrine Lifestyle obesity � Syndromic obesity

Prader-Willi Syndrome

Exo- VS Endogenous Obesity Family history Height IQ Bone age Physical exam Endogenous uncommon Short stature Low IQ Retarded Abnormal Exogenous Common Normal/Tall Normal IQ Normal

Principle of Management �No complications control the weight or increase slowly �Severe obesity or complications - Reduce wt urgently 5 -10 % within 6 mo - Reduce 300 -400 Kcal/day (not <1200 Kcal/day in 6 -12 yrs. old) - Morbid obesity 800 Kcal/day in some institute

Management: Foods control < 2 years old: No need for weight reduction > 2 years old - Reduce high caloric foods (Ice- cream, chocolate, cake etc. ) School- age: - No fasting - Do not skip meals esp. breakfast - Reduce high caloric foods - Increase vegetables, low caloric fruits

Management: Exercise - Physical activity : swimming, walking, riding bicycle : 30 minutes : at least 3 days. / wk. - Decrease physical inactivity

Management: Behavior modifications - Self monitoring: daily record of food intake, exercise, leisure time - Stimulus control : adjust environment - Reinforcement : rewards, admiration - Cognitive restructuring: positive thinking & internal self support - Buddy system/social support