Friday, February 22, 2008

C H I L D H O O D --O B E S I T Y .

Introduction:4- 5 decades backPediatricians were more conserned,with malnutrition(Kwashiorkor,Marasmus) management.Thoough it was essentially disorder of poverty, ignorance & illiteracy also played their parts..Now doctors very often see during examination of school children about 10% sufferining frim Obesity,&another 10% with overweight. This shows that there is no poverty now&litracy has done no contribution to stop Obesity in children. Ignorance level continues to be same.There seems to be little awareness about child's obesity & its attendant complications. For all disease &disorders prevention is the best. If diagnosed earlier,it is easily controllable &manageable.

Is your child chubby or obese?
1)what is obesity?Is it same like overweight?
Over weight means more weight for a perticular height.Obesity meansbeing more fatty +over weight,&is calculated as per Body Mass Index.
BMI=WEIGHT IN KG/HEIGHT IN SQUARE METERS.
2) WHAT ARE THE COMPLICATIONS OF OBESITY?
a)difficulty in breathing while walking ,or at rest.
b)difficulty in walking.
c)short life expectancy
d)diabetes mellitus-type II
e) heart disease.
f)cancer
g)depression
h)stress urinary incontinence
i)lower quality of life.
j)high blood pressure
k)high blood cholesterol
l)sleep apnoea(cessation of breathingwhile sleeping)
J)G E R D
K)osteo arthritis.
l)joint pain.
m)female reproductive health disorder.
3)How does BMI helps?.
Yes it does in many ways.There is a graph available(similar to road to health chart)with which a person's bmi CAN BE ASSESSED READILYby plotting height & weight to find out if a given person,belongs to following catagory for clinical assessment/treatment.
BMI-less than 17.5=malnutrition(anorexia nervosa)
BMI18.5--25 =optimal(normal)
BMIless than 18.5 =under weight.
BMI more than 25 =over weight
BMI more than 30 =obesity.
(All the above are applicable to children only)
4)Is it connected to endocrine problems?
Yes. The following endocrine disorders could be the cause for obesity.
a)Thyroid(blood test for T3 ,T4,TSH.)
b)PITUITARY.(BLOOD HORMONE ASSAY)
c)LIPID DISORDER.(BLOOD LIPID PROFILE--CHOLESTROL ANALYSIS)
d)CUSHING'S SYNDROME.(ADRENAL GLAND-HYPER FUNCTION)-HORMONE ASSAY
5)When do we suspect endocrine problem when a child is obese?

If a child at any age upto 12 has any or many of thefollowing clinical problems it is a fitting case to be reffered to a pediatric endocrinologist:
a)polycystic overy.(scan -abdomen)
b)high cholestrol blood(blood lipid profile)
c)high blood pressure.
d)BP+abnormal potassium(serum electrolytes)
e)unusual stretch marks anywhere in the skin.
f)weight gain centered around abdomen+thin extrimities.
g)weight gain with aesy bruising.
h)weight gain without adequate food
i)irregular menses+ or _ abnormal hair growthj
j)if left untreated may have pregnancy related complications in adult life.

6)what is the treatment?
Find out &treat the cause.Every text book says diet +exercise.Any experienced physician over 40 yrs of service will agree upon only one treatment:50-70% weight lossoccurs only on BARIATRIC SURGERY.Diet &excercise are useless in todays concept,if obesity is labelled.
7)Is it preventable? When does it become identifiable?
To a great extant it is preventable if the root cause is diagnosed early.Like ,vaccine preventable diseases parents must take suitable steps to identify early&prevent obesity by appropriate means.
Few recommended steps:
a)well baby?well child health check ups--yearly once.
b)systamatic plotting of road to health chart,upto 12 years.
c)Alteration in eating habits must be watched(whether over eating too much NV items)
Auther's true relevent story.:
10 yr old female child weighing 80 kgs.On questioning about diet history, she said she will go to her fathers restaurent daily after school hours &eat fried chicken legs-6 pieces .Now the readers can tell the treatment.
d)once obesity is confirmed--surgery is the answer.

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