Childhood Obesity and the Metabolic Syndrome
Cynthia G. Feliciano,MD
Pediatric Endocrinologist
(Summarized by Laura Aguinado,MD)
CME ON NUTRITION ……..July 15,2010
Our guest lecturer talked about the relationship of obesity in relation to the
development of the metabolic syndrome in our CME held at the Paragon building in
Alabang last July 15. It was emphasized that childhood obesity is a condition which can lead
to the development of insulin resistance syndrome and should be accurately recognized
and promptly addressed since it can lead to the development of serious health problems
later in life. These problems are multisystemic and include cardiac problems i.e.
development of hypertension, atherosclerosis; pulmonary problems , V/Q mismatch,
asthma, obstructive sleep apnea ; gastrointestinal problems related to the development of
liver disease such as non-alcoholic steatohepatitis; renal alterations, neurologic
derangements predisposing to stroke, they can be predisposed to the development of type
2 DM and even orthopedic problems to name some.
Aside from these medical conditions, children can also be plagued by psychosocial
problems, feelings of inferiority and peer discrimination because of their weight and
appearance.
Dr. Feliciano tackled the need to address issues of obesity in our pediatric patients.
To know if a patient is at risk, the BMI should be computed using the formula :
BMI = weight in kg
Height in m2
In adults and adolescents, a BMI equal to 25 corresponds to obesity. In children, the
height and weight should be plotted on the appropriate growth charts, for this purpose, the
CDC growth charts are the ones routinely used though it was mentioned that the WHO
growth charts are likewise appropriate however the population used was less
heterogenous. If the child falls within the 85th-95th percentile then the child is overweight,
but values above the 95th percentile means that the child is obese. In classifying pediatric
patients the speaker cautioned the group about the negative connotation of the terms and
advised that it would be better to label them as “at risk for overweight” and “overweight”,
respectively.
The body fat distribution is also correlated with the development of the metabolic
syndrome with the android body type (apple shaped) or those whose fat is concentrated
around the belly area being more predisposed than the bottom-heavy gynecoid body type
(pear shaped).
Once recognized, the parents should be advised on a treatment regimen under the
supervision of a subspecialist especially if there are risk factors present or there is a
positive family history . The treatment involves a step-wise approach starting with
lifestyle based treatments which includes food management, exercise and behavior
modification before going to the more intensive modalities such as administering weight
loss medications and surgical procedures.
Obesity is best prevented before associated disease conditions develop. Even though
the problems which were discussed commonly manifests itself around the 4th decade of
life, compelling evidence shows that the initiating events take root during childhood and
may even start as early as the prenatal period hence good nutrition of the mothers was also
emphasized.
The success in the treatment and management of obesity, involves a concerted
effort of the primary specialist, the pediatric endocrinologist , nutritionist and the childs
parents or other primary caregiver to ensure that the goals of a healthier and more active
lifestyle can be achieved.
(This CME on Nutrition was PPS-STC’s 1st scientific meeting broadcasted live through
USTREAM’s videostreaming)