obesity

1. OBESITY
EPIDEMIOLOGY
Data indicate that approximately 17% of children in the United States
ages 2 to 20 are obese(bodymass index of ≥95th percentile) and more
than 30% of U.S. adults are obese. Many obesechildren becomeobese
adults, and the risk of remaining obese increases with age and degree of
obesity. Obesity runs in families and is rarely related to genetic
influences. The largest increases in the prevalence of obesity are seen in
the most severely overweight classifications and in certain ethnic groups,
such as African-American and Mexican-American children.
There is associations between obesity and
1. television watching
2. excessive dietary intake
3. urban versus rural areas
4. Obesity during pregnancy. Obese mothers are three to five times
more likely to be obesein childhood
5. Also, some small for gestational age (SGA) newborns have higher
risks for abnormal postnatal weight gain and diabetes.
Mini PBL1
Childhood Obesity
Sara is a 7 years old pretty girl. Her parents got worried as her weight is
progressively increasing. Parents said that Sara likes chocolates and
biscuits as all other children.
Sara spent most of her day playing video-games. In schoolshe has some
problems with some students as they make fun of her body shape.

2. Her grandmother keeps saying to Sara that fatty girls look more beautiful
than thin ones and gives her whatever sweets she likes.
The schoolnurse advised her regarding healthy nutrition and physical
activities. Unfortunately Sara was not able to follow the advices.
The family physician told the parents that obesity in children is a national
problem in UAE as obesity in children is 2 -3 times of the international
standards.
The doctorrepeated the nurse's advices and warned against the long term
effects. The doctoralso recommends doing some genetic testing for
excluding some related syndromes.
Objectives:
To understand that the causes of obesity are complex and that in all
probability they result from a combination of genetic, environmental and
sociocultural influences.
Therefore, students must be able to:
1- State the genetic causes of child obesity and their long term effects.
2- Discuss the acquired reasons that may have resulted in Sara’s weight
gain and
3- The psychological impact that they may have on her, pointing out the
remedy to her situation.
4- Describe the role of society in fighting against child obesity.
Questions:
1. What are the most common genetic syndromes associatedwith
Sara's condition?
Answer:
A. Prader Willi Syndrome; Neonatal hypotonia, normal growth
immediately after birth, small hands and feet, mental retardation,
hypogonadism; somehavepartial deletion of chromosome15
B. Bardet–Biedl Syndrome; Retinaldegeneration, syndactyly,
hypogonadism, mentalretardation; autosomalrecessive
C. Cushing syndrome ; Adrenal hyperplasia or pituitary tumor
D. Carpenter
syndrome;
Polydactyly, syndactyly, cranialsynostosis,
mental retardation
C. MOMO syndrome ; Macrosomia (excessivebirth weight), Obesity,
Macrocephaly (excessivehead size) and Ocular abnormalities

3. D. Leptin / receptormutations; The leptin hormoneregulates adipose-
tissuemass through hypothalamus effects on hunger and energy use. It
acts through the leptin receptor (LEP-R),
E. Irregular levels of grehlin hormone released by the stomach. is a
peptide hormoneproduced by ghrelinergic cells in the gastrointestinal
trac
2. Basedonher age, does she pose as a candidate whose weightgain
may have resulted from a genetic condition?
Answer:
No, because genetic abnormalities associated with morbid obesity are
usually expressed in the early infancy stage.
3. What are the long term effects of child obesity?
•Heart disease
• Type 2 diabetes, stroke
• Cancer
Osteoarthritis
Sleep apnea (breathing problems)
4. What are other acquired reasons that may have resulted in Sara’s
weight gain?
Answer:
‐ Diathesis (biological or genetic traits) -stress model – genes render
people to becomemore susceptible to environmental pressures and hence
to the development of problematic eating attitudes and behaviors.

4. ‐ Depression– a disruption in the serotonergic system results in
dysregulation in the appetite and feeding behaviors.
‐ Negative emotionality – feeling bad about one’s self results in them
becoming very self-critical, whereby focusing on their limitations and
short comings while magnifying their flaws‫العيوب‬ and defects.
‐ Negative body image – bodydissatisfaction leads to attempted weight
loss, however upon failure excess weight it racked on due to binge eating.
‐ Childhood sexualabuse- has been shown to predict the later onset of
binge eating.
‐ Perfectionism(conforming to the thin ideal due to social pressure) – in
an attempt to perfect the image of one’s body, upon failure, excess weight
is racked on due to binge eating.
‐ Obsessive-compulsive personalitydisorders - have a higher risk of
suffering from eating disorders.
‐ Family dysfunction and behaviors - such as marital discord, rigidity,
parental overprotectiveness, excessive control and making disparaging
comments about the woman’s appearance, whereby focusing on her need
to diet are all factors that may contribute to the development of eating
disorders.
‐ ‘Sociallycontagious’ – if someone close to us (spouse‫الزوج‬ , sibling or
friend) or even the culture that we are surrounded by encourages
consumption while discouraging exercise, such increases our own
chances for obesity.
5. Describe the possible psychologicalconsequence ofobesityon
children.
Answer:
Obesity is not considered to be an eating disorder or a psychiatric
condition in the DSM (is the standard classification of mental disorders);
however, its prevalence is rising at an alarming rate and is accounting for
more morbidity and mortality than all other eating disorders combined.
Obesity may lead to the following eating disorders:
‐ Anorexia nervosa; the restricting / purging type
‐ Bulimia Nervosa;bouts of extreme overeating are followed by fasting
or self-induced vomiting or purging
‐ Eating DisorderNot Otherwise Specified(EDNOS)
1. Meet all criteria for anorexia nervosa except their weight falls
within the normal range
2. Meet all criteria for bulimia nervosa except they engage in binge
eating or purging behaviors less than twice per week or for fewer
than three months

5. 3. Purge after eating small amounts of food while retaining a normal
bodyweight
4. Repeatedly chew and spit out large amounts of food without
swallowing
5. Meet criteria for binge eating disorder
‐ Binge-eating disorder (BED)
1. Eating much more rapidly than normal.
2. Eating until feeling uncomfortably full.
3. Eating large amounts of food when not feeling physically hungry.
4. Eating alone becauseof feeling embarrassed by how much one is
eating.
5. Feeling disgusted ‫اشمئزاز‬ with oneself, depressed, orvery guilty
afterward
All of the above may consequently lead to suicidal attempts as a
result of the onset of depression, in addition to death due to the
long-term effects of child obesity mentioned below.
6. What is the remedy to Sara’s condition?
Answer:
• Psychological
o Cognitive behavioral therapy (CBT) that involves changing the
behavior and maladaptive styles of thinking. Additionally, self selected
reading materials into sucha therapeutic program always helps.
• Nutritional
Follow healthy eating habits and increasing physical activity
฀ Five a day rule (the consumption of at least five portions of fruitand
vegetables each day),
฀ Avoid high fat diets
฀ Limit sweets
o Avoid crash dieting as a growing child needs a wide range of foods for
healthy development.
o Be patient and expect changes on long term rather than dramatic
changes.
o Avoid the appetite suppressants as they are not safe for growing
children.
o Sleep more – babies who sleep fewer than 12 hours a day are more
likely to be overweight at the age of 3 and adults who only sleep 5-6
hours a night gain more weight over time than those who sleep 7-8 hours
a night.

6. 7. What is the role of community to help solving the problem of child
obesity?
Answer:
• Stakeholder groups should be involved in facilitating and promoting
cross-cutting programs
• Private and public health educationprograms for high risk groups
such as children of obeseparents, children in low-income households
• Communities should improve the street, sidewalk, and street-crossing
safety of routes to school. Communities can improve healthy food
availability by offering grants, loans, and tax benefits to vegetables/fruits
providers, cafeteria, restaurants or groceries offering healthy foods
• Schools should develop programs to encourage walking and biking to
school.