1. Childhood Obesity Pediatrics: October In-Service Employee Training Presentation by: Lillian Nelson

2. Childhood Obesity and Physical Therapy Number of pediatric PT patients with obesity has increased in recent years.  According to the CDC, the childhood obesity rate has tripled in the last 30 years.  In 2010, 17% of American children and adolescents 2-19 years of age were reported to be obese.(1) This is due to:  Shifting dietary patterns  Sedentary activities instead of active play.  Childhood orthopedic injuries due to excess weight.

3. Etiology  Obesity is the accumulation of excess body fat.  BMI greater than 30 kg/m^2  >25kg/m^2 is considered overweight  Positive energy balance is typically the cause.  More calories taken in than are expended (2)

4. Biological Factors A child’s genetics “load the gun” but their environment “pulls the trigger”. The patient’s past medical history should include these information points to help determine the cause of excessive weight gain:  “Obesogenic”  A new term for certain genetic traits that predispose someone to gain weight. (4)  Birth Weight  Infant Feeding:  Formula vs Breast Milk  Adiposity Rebound:  Lowest BMI should be at 5-6 years old before gaining body fat again into adulthood.  If the child did not have an adiposity rebound or it was not at age 5-6 this may point to other homeostatic imbalances.  Sexual Maturation:  Body fat total, distribution, and percentage are associated with maturation.  Heavier female children have earlier onset of menarche. (5)

5. Environmental Factors Environment is the more important, and easier to manipulate, factor when treating childhood obesity.  Intake:  Energy Density  Glycemic Index  Vegetables and Fruits  Soft Drinks  Serving Sizes  Meal Frequency, Snacking Habits  Physical Activity:  Average amount of time spent walking and bicycling in ages 5-15 dropped 40% from 1977-1995, mostly due to less children walking/biking to school.(3)  Sports  PE at School  Free Time:  Television Viewing and Computer Games  Parental Obesity and Family Environment:  Genetic and Shared Lifestyle  SES:  Urban poor at highest risk.  Self Esteem and Quality of Life

6. Weight Management in Children- Critical Measurements  BMI  Body Composition  Waist Circumference  Physiology:  ICF Model  Comorbidities  Physical Disabilities  Cognitive Disabilities  Psychology:  Depressed or Happy  Relationships (Children and Parents)

7. Treatment- What Determines Need for Intervention?  It is our job as PTs to recognize the need for weight loss and educate our patients of potential benefits of weight loss.  Increased Energy  Less Functional Limitations  Less Orthopedic Problems  Improved Self Esteem

8. Treatment Each patient’s treatment will be slightly different based off of:  BMI: Use Standard Growth Chart  95 th percentile OR 85 th percentile and presence of Co-morbidities.  Presence of co-morbidities:  Diabetes Mellitus  Dyslipidemia  Hypertension  High triglycerides  Asthma  Menstrual Problems  Sleep Apnea  Age: infancy, childhood, adolescence  Different energy needs depending on stage of life  Parent’s Weight and Lifestyle:  Parent’s play a large role in the success of the intervention (4)

9. Treatment (4)

10. Treatment  Exercise Prescription:  Based off initial evaluation  Results of submaximal exercise testing and strength testing  Goals should be to improve cardiovascular endurance and strength as appropriate.  Focus on fun activities  Weight maintenance in combination with growth in height will lead to decreased BMI over time. (2)  Maintain current weight and not gain  Supervised exercise first, then home exercise or maintenance program

11. Lifestyle Modifications  Teach positive lifestyle modifications that will last beyond the PT intervention!  Decrease severity of obesity related diseases, functional impairments, and limitations.  Increase self esteem and quality of life  60 Minutes of physical activity per day:  Outdoor play  Sports team  Referral to a dietician  Educate the parents:  Ways to change the family’s diet and activity level.  Limit “inactivity” such as TV watching and computer games.  Positive reinforcement and goal setting techniques appropriate for weight loss goals.  Example- As a reward for good grades, let the child have an hour at a batting cage or roller skating rink instead of candy or a new video game. (5)

12. Discussing the Topic of Weight  Use “people first” language  Stress that childhood obesity, if untreated, can lead to:  Life Long Obesity  Metabolic Syndrome  Cardiovascular Disease  Diabetes  Renal Failure

13. Family Education The family needs to be taught how to create positive changes for the child so their weight loss is maintained after they are discharged from PT.  Dietary:  Meal Planning  Availability of healthy snacks  Portions  Physical Activity:  Encourage active play  Limit sedentary activities  Behavioral:  Goal Setting  Self Monitoring  Positive Reinforcement Techniques

14. Works Cited 1.Han, Lawlor and Kimm. Childhood Obesity. The Lancet. May 2012. 375:9727, 15–21:1737– 1748. Accessed 13 October 2012. Available at 2.Racette, Susan. Obesity: Overview of Prevalence, Etiology and Treatment. Journal of The American Physical Therapy Association. March 2003. 83: 276-288. Accessed 14 October 2012. Available at: http://ptjournal.apta.org/content/83/3/276.full?sid=99f5772b-187e- 4e50-b086-c9cf4a1473e2http://ptjournal.apta.org/content/83/3/276.full?sid=99f5772b-187e- 4e50-b086-c9cf4a1473e2 3.Stewart, Laura. Childhood Obesity. Journal of Medicine. January 2011. 39:1:42-44. Available at: 4.Stanford, Breckon and Copeland. Treatment of Childhood Obesity: A Systematic Review. Journal of Child and Family Studies. 2012. 21:545–564. Accessed 13 October 2012. Available at: http://0-www.springerlink.com.ilsprod.lib.neu.edu/ content/ a045x772h054406r /fulltext.pdfhttp://0-www.springerlink.com.ilsprod.lib.neu.edu/ content/ a045x772h054406r /fulltext.pdf 5.Wang, Y. Child Obesity and Health. International Encyclopedia of Public Health. 2008. 590- 604. Accessed 14 October 2012. Available at http://0- www.sciencedirect.com.ilsprod.lib.neu.edu/science/article/pii/B9780123739605006286http://0- www.sciencedirect.com.ilsprod.lib.neu.edu/science/article/pii/B9780123739605006286