PEDIATRIC OBESITY

Maria Angela
Andi Syurma Sari
Stase RS Pelamonia
PPDS Gizi Klinis FK-UNHAS
2016
Assessment
• In pediatric practice, every child should be assessed at least
annually for excess adiposity.
• Several expert recommended Body mass index (BMI) as the
preferred measure for evaluating obesity among children and
adolescents 2-19 years of age.
• BMI ≥95th percentile for age and gender should be
categorized as obese and those with BMI between 85th and
95th percentiles be categorized as overweight.
• BMI ≥99th percentile has been proposed as a classification of
severe obesity.
Nutrition Assessment
• Assessment tools for evaluation eating behaviour or physical
activity :
– WAVE (Weight, Activity, Variety, Excess)
– REAP (Rapid Eating and Activity Assessment for Patients)
Current recommendations include obtaining a qualitative
assessment of the patient’s diet with a particular focus on dietary
patterns that are thought to be linked to excess energy intake and
adiposity.
Nutrition Assessment
• Common nutrition diagnoses related to excess weight and obesity
are
(1) sugary beverage consumption,
(2) low intake of fruits and vegetables,
(3) excessive intake of high calories,
(4) high-fat and high-sugar foods related to fastfood intake, and
(5) eating away from home
Interventions
Behavioral
Self monitoring,
Behavioral
Parental Family-Centered Modification:
Stimulus control,
Treatment of
involvement Communication Tailored
Goal setting
Obesity (SMART)
Interventions

Initiation based
Recommendations Components of a
Specific Dietary on age, BMI
for Treatment: Multidisciplinary
Interventions percentile, history
Staged Approach
of success Team
Interventions
• Nutrition and feeding practices for pediatric patients are
dependent on parental or home caregiver engagement and
support.
• Common recommendations supported by the literature :
1. Meals and snacks are eaten at a table or in a designated eating space.
2. Avoid screens during mealtime (television, cellphone, iPad, video games,
etc).
3. Mealtime should be pleasant but not playtime (no toys at the table).
4. Avoid using the “clean plate rule.”
5. Eat meals as a family as much as possible.
6. Keep fresh fruits and vegetables in plain sight.
7. Use nonfood rewards.
8. Provide choices of healthy items
Interventions
Interventions
Interventions
• Weight loss goals vary with the age of the patient and the stage of
treatment.
• The goals for STAGES 1 AND 2 of treatment are typically for maintenance
of weight with increasing growth.
• From 2 to 18 years of age, maintenance of weight velocity or absolute
weight maintenance may be an appropriate goal at the initial levels of
intervention.
• For children 2-5 years of age, weight loss up to 1 lb (0.5 kg) per month
may be acceptable if BMI is >21-22 kg/m2.
• For those 6 years of age or greater, weight loss of up to 2 lb (1 kg) per
week may be acceptable.
2010. Nutrition in Clinical Practice . Multidisciplinary Treatment of Pediatric Obesity: Nutrition Evaluation and Management
2014. Nutrition in Clinical Practice . Challenges and Successes of a Multidisciplinary Pediatric Obesity Treatment Program