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Childhood obesity
1. SUPERVISOR
Dr. Nisha Kumari Ojha
M.D. (Ay.) Ph.D(Ay.),PDCR, BSc.
HOD & Associate Professor
SCHOLAR
Dr. M.N.Sampath Marasingha
M.D. (Ay.)SCHOLAR
National Institute of Ayurveda ,Jaipur
India.
Clinical Understanding of Sthaulya w.s.r to
Childhood Obesity
2. Sthaulya Paribhasha
A person, having heaviness and bulkiness of the body due to
excessive collection of fat is called obese (Sthula) and the condition
is called obesity (Sthaulya).
3. Acharya Charaka mentioned that a person in whom there is excessive
accumulation of Meda (fat/adipose tissue) and Mamsa (flesh/muscle
tissue) leading to flabbiness of buttocks, abdomen and breast,
disproportionate increase of body parts & lack of enthusiasm has been
categorized as Atisthula.
(Ch. Su. 21/8-9)
Definition of Sthaulya:
4. CONT.
• Vagbhatta has mentioned three types of sthaulya while
describing the efficacy of langhana therapy are described as:
(A. H. Su. 14/12-14).
• a) Hina sthaulya: mild degree of overweight
• b) Madhyama sthaulya: moderate degree of overweight
• c) Ati sthaulya: excessive state of overweight
6. Aharatmaka Nidana
Atisampuram
Guru ahara sevana
Madhura ahara sevana
Sheeta ahara sevana
Snigdha ahara sevana
Role of aharatmaka nidana
Ahara plays a major role for increasing medo dhatu in sthoulya. Acharya Susrutha
mentioned sthoulya and karshya depend upon the quality and quantity of ahara
Su.S.Su15/32
On the basis of samanya vishesha siddhanta the excessive food consumption of similar
substance lead to the over production of dhatu.
7. Viharaja Nidana
Avyayama
Atinidra
Diva swapna
Role of Viharatmaka Nidana
All the viharatmaka Nidana indicates decreased physical activity, which
aggravates kapha and leads to meda deposition .
Divaswapna having abhishyandhi property leads to blockage of the micro
channels of the body specifically in medovaha srotas.
8. Manasika Nidana
Harshanityatvat
Achinthanat
Role of Manasika Nidana
Harshanitya and achintana are two psychological factors mentioned by
Acharya Charaka, these factors are kapha aggravating and hence lead to
meda sanchaya.
9. Beeja dosha Nidana
In concept of genetic predisposition classics states that a defects in Beeja
and Beejabhaga can make the fetus prone to certain genetic disorders
including Sthaulya.
Acharya Charaka has mentioned that Beeja Dosha plays a major role for
Medovriddhi.
10. Purvarupa of Sthaulya (Prodromal Symptoms)
The symptoms of medovaha srotodushti are described as purvarupa of prameha which
can be considered as purvarupa of sthaulya.
Some of the purvarupas are
Pipasa (feeling of thirst),
Alasya (laziness),
Mukha talu kantha shosh (excessive thirst),
Vishtram sharirgandham (bad odour of body),
Nidra (sleep), tandra (drowsiness),
Malam kaye (sweating),
Madhurasyata (sweatness of mouth),
Angashaithilya (lethargies) etc
11. RUPA OF STHAULYA (SIGN & SYMPTOMS)
Pendulous buttocks, abdomen and breast (chala sphika udara stana)
Enlargement of abdomen (udara parshva vriddhi ),
Fatigue (shrama ), excessive sleep (nidradhikya ),
Dyspnoea (kshudra swasa ),
Snoring (krathana ),
laziness (alasya ),
Low vitality ( alpavega ),
unable to bear the any physical exercise (sarvakriyasu asamrthata ),
lack of physical strength (alpabala ) and low vitality power (alpa prana ).
12. PHYSIOLOGY OF MEDA DHATU (FAT TISSUE):
Medo Dhatu is the 4th dhatu in the sequence of the 7 tissues explained in
Ayurveda.
Medo dhatu produced from the mamsa dhatu.
There is clear description in Ayurveda regarding medo dhatu which can be
compared with depot fat tissue (adipose tissue) and rasa-rakta gata sneha (fat
present in blood) to the cholesterol, triglyecerides, HDL, LDL, VLDL.
13. Medadhatu Poshaka
Poshya Poshya
(Mobile in nature) (Immobile in
nature)
Which is circulated in whole body
(Along with gatiyukta Rasa-rakta
dhatu For nourishing the poshya meda
dhatu)
Which is stored in the body.
(Udara,Sphik and Stana )
According to modern science, it
can be Correlated with
Cholesterol and Lipids Which
are present in circulating blood
According to modern science, it
can be correlated with Adipose
tissues/fat
14. Samprapti Ghataka
Dosha: Kapha kledaka
Vata samana vyana
pitta pachaka
Dusya: Meda , later other dhathus also
Agni : Jatharagni sandhukshana medo dhatvagni mandya.
Srotas: Medovaha. Mansavaha,Swedavaha Srotasa
Srotodushti: Sanga.
Udbhava sthana: Amashaya.
Vyakta sthana: Sarvanga, specially in sphik, udara, stana.
Roga marga: Bahya
Swabhava: Chirakari.
16. Sthoulya lakshanas (C.S.21/4,S.S.15/32)
According to Charaka chala sphika, chala udara, chala stana, atimeda mamsa vriddhi
are lakshanas of sthaulya (Ca Su 21/8)
Beside these symptoms ashta dosha of sthaulya viz. Ayushohrasa (deficient in
longevity)
Javoparodha (slow in movement)
Krichvyavayata (Difficult to indulge in sexual intercourse)
Daurbalya (weak)
Daurgandhya (emits bad smell from the body)
Swedabadha (perspiration)
Kshudhatimatra (excessive appetite)
Pipasatiyoga (excessive thirst)
are the most prominent clinical features of sthaulya as narrated by Charaka .
17. SADHYA – ASADHYATA
Regarding sthaulya, most of the acharyas have described
bad prognosis and sahaja sthaulya is considered incurable.
Charaka also emphasized the fact that the treatment of
sthaulya is more difficult than karshya.
18. Management of Obesity
Charaka has said that it is very difficult to treat atisthoola people
because, if Karshana therapy is applied then it leads to further
aggrivation of already aggrevated Jathragni and vayu.
If Brimhana therapy is applied it further increase the meda.
19.
20. AYURVEDIC MANAGEMENT
• PRINCIPLE
• “GURU CHAAPTARPANAM CHESTAM STHULANAM KARSHANAM PRATI”
• Atarpan (depleting therapy) includes specific regimen in food , activities
(ahara–vihara) and medicines(ausadhi) that could control dosas like vata &
kapha, thereby check the aetiopathogenesis of the disease.
23. Management of Obesity other than oral
administration (ch.su. 21/21)
Diets and drinks that alleviate vata and kapha and which can reduce fat.
Enema with drugs that are sharp, unctuous and hot.
Intake of guduci (Tinospora Cordifolia), murta (cyperus rotundus), haritaki
(Terminalia chebula), bibhitaka (Terminalia blerica) and amalaka (Emblica
officinalia)
Administration of takrarista.
Administration of honey
24. Ruksha udvartana is the bahi parimarjana chikitsa indicated for the
management of sthoulya A.S.Su 24/33-3-
Acharya charaka has also mentioned Ruksha udvartana for sthoulya. Ch.S.Su 21/21
Vaghbhata has mentioned the benefits of Ruksha udvartana in general as kapha
hara, medasa pravilayana, etc (A.H.Su 2/15)
Ruksha Udvartana
25. BASTHI
• Ruksha , ushna and tikshana basthi are suggested by acharya charaka for sthoulya
chikithsa
• eg.kshara basthi
• lekhana basthi
• sharangdhara has given a clear description regarding the properties of lekhana
dravya and characteristics of lekhana basthi (sha.s.pu 4/10)
26. Lekhana Basti
The reference of lekhana basti was taken from Su.Ch.38/82 The ingredients are
follows.
Triphala kwatha(Amlaki, harithaki, vibhitaki)
Gomutra
Madhu
Yavakshara
Ushakadi gana dravya contains ushaka, saindhava ,shilajatu, kasisa, hingu & tutha.
27. Acharya Susrutha has recommended the use of
triphaladi Taila nasya in the patient of medovridhi
Su .s.chi.37/33-35
28. Raktamokshana
Acharya charaka has also mentioned
Raktamoksha for treatment
of Santarpana janya vyadhi
including Atistoulya
Cha.s.su23/6-9
29. YOGA
• Yoga has considered all aspects of Obesity (physical, emotional and
mental)
• Regular practice of Yoga and controlled life style reduces obesity
(weight is reduced).
• Yoga is suitable for people in any age group.
• Yoga helps achieve control over mind and behavior (one can easily
control food habits and change life style to reduce the obesity.)
• Yoga has different effect on obesity, which is permanent in nature
than other techniques for obesity reduction. Weight loss is permanent
but one needs to practice few important techniques regularly.
37. Management protocols ( Dr.Dinesh k.s. –Clinical paediatrics in Ayurveda )
Kaşāyas
• Varādi kasāya- if the child is more pitta dominant
• Varaņādi kaşāya- if the child is not pitta dominant.
• Asanādi gaņa kaşāya- especially if the child has skin lesions like acanthosis, or
issues of hypersensitivity.
Ariştas
Lodhrāsava – broad spectrum.
Ayaskrti- broad spectrum. takra]
cūrņa
Guggulu pañcapala cūrņa- especially this curna is to be prescribed if the child is suffering from recurrent
boils and abscess along with obesity.
Vidangādi cūrna- broad spectrum.
Triphala cũrņa- 'Therapeutic beauty of triphala is that it is apatarpaņa, still does not cause dhātu depletion.
Also, it is a powerful rasāyana.
38. Trikațu cūrņa-This is best if the child doesn't have much agni in kostha. In hypothyroidism,
type 1 diabetes and in prader willi syndrome trikațu cūrņa is found highly effective
shilajatu
Gudika
Kāñcanāra guggulu.
Vilvādi gudika
Śiva gudika
Candraprabhā vați
Navak guggulu
Triphala guggulu
Medhahara vati
Guggulu tablet
Kaiśora guggulu-
( we make triphalāmrtādi kasāya by using the same ingredients of kaiśora guggulu to treat
obesity.)
40. Procedure based therapies
Udvartana - follow this at least 7 days in a month with yava kola kulattha curņa.
Snehapāna, svedana, vamana, virecana, vasti and nasya-
Svedana-So best sveda procedure is cũrņa pinda sveda and āragvadhādi kasāya
parişeka sveda.
All these
procedures can be
done in children
who can tolerate
these procedures.
Svedana is to be done with special
precautions as it is contra- indicated
in obesity. There are chances of
pittakopa and may produce recurrent
boils
44. .
Obesity is not recognized as a disease, which decreases
longevity, not just a cosmetic problem. Apart from
impaired mobility and interference with daily living
activities,
it also has several health consequences -
hyperinsulinemia, hypertension, diabetes, polycystic
ovarian syndrome (PCOS), dyslipidaemia, infections,
sleep apnoea with all its consequences, hyperuricemia,
psychosocial problems and eating disorders
Obesity in children is different from obesity in adults -
all children and adolescents need to grow; for example
during puberty, a child's weight will double and their
height increase by 20%
45. Definition of overweight and obesity
• Obesity is defined as abnormal or excessive fat accumulation that
may impair health .Obesity is a state of excess adipose tissue mass.
In children of 5-19 years overweight and obesity is assessed
according to the WHO "Body mass index-for –age.“
• Body mass index (BMI) is the most appropriate measure of
excessive weight in children. BMI is calculated by dividing the
weight (kg) by the height squared (m2).
• BMI greater than the 85th percentile suggests overweight,
• while BMI greater than the 95th percentile suggests obesity
It is caused by imbalance between calorie intake and calories utilized
46. BODY MASS INDEX
• Rapid changes in BMI occur in normal growth, and BMI varies with age and sex.
It rises in the first year of life, then falls during preschool years, before rising
again into adolescence.
• The point at which BMI starts to rise again (usually around 4–6 years of age) is
termed “adiposity rebound”. Thus, calculated BMI values need to be compared
with age and sex reference standards.
47. Classification of overweight and obesity BMI chart
• According to W.H.O definition B.M.I greater then or equal to 25 is over
weight; B.M.I greater than or equal to 30 is obesity.
• Obesity is a major risk factor for non communicable diseases i.e cardio
vascular diseases ; diabetes; musculoskeletal disorders etc.
obesity BMI (Kg/m2)
Underweight < 18.5
Normal 18.5 – 24.9
Overweight 25.0 – 29.9
obesity 30.0 – 39.9
35.0 – 39.9
Extreme obesity > 40.0
48. BMI more than 85th percentile for age are considered overweight
BMI more than 95th percentile for age are considered obesity
BMI greater than 99th percentile for age are considered severe obesity
49. Obesity is becoming an increasing problem in children and adolescents, with an
estimated 30% or more overweight in the urban and semi-urban India too, .
Prevalence is 31% in age group of 2-6yrs,
16% in ages 6-19yrs.
obesity in childhood is increasing rapidly. and recently the prevalence of obesity
crossed the prevalence of malnutrition
The prevalence of overweight and/or obesity in Indian children is around 20%
posing significant risk of lifestyle diseases in future.
PREVALENCE
Almost half of overweight children are overweight adolescents,
and almost 80% overweight adolescents are obese adults
50. ETIOLOGY
Excess fat accumulates because there is imbalance between energy
intake and expenditure. Whenever the energy intake is more than the
energy expenditure, the excess calories of energy is stored in adipose
tissues.
This can arise in different ways, and obesity is clinical sign with
several possible causes.
There is no satisfactory etiological classification for obesity, but
number of factors are known to be associated with its development.
51. Age :
Obesity is most prevalent in middle age, but can occur at any stage of
life. Obesity in childhood and adolescence is likely to be followed by
obesity in adult life.
Socio-economic Status :
In some developed countries, poorer children or those who live in rural
settings are more at risk of obesity, where as in countries undergoing
economic transition childhood obesity is associated with a more affluent
lifestyle and with living in urban regions.
Environmental factors :
Increased consumption of high carbohydrate beverages, fast food,
increased snacking between meals, decline in levels of physical activity,
increase in sedentary activities,
52. Endocrine Factors :
• Growth failure, developmental delay and dysmorphism in an
obese child denote an endocrine etiology
• An endocrine influence on body fat is seen both in normal
physiological situations and in pathological states.
physiological situations
• Obesity in woman commonly began at puberty, during pregnancy
or at menopause,
53. Cushing syndrome central obesity, hypertension, and striae with retarded skeletal
maturation
Hypothyroidism extremely rare cause of isolated obesity and other features such as
developmental delay and coarse skin are always present
GH deficiency and short stature slow linear growth
pseudohypoparathyroidism, short metacarpals ,subcutaneous calcifications dysmorphic facies ,
Short stature,hypocalcemia hyperphosphatemia
Hyperinsulinism ( nesidioblastosis ,pancreatic adenoma ,Mauriac syndrome)
Pathological states
55. However, majority of obese patients show no clinical evidence of an endocrine
disorder.
The plasma concentration of insulin and cortisol is commonly raised and that of
growth hormone reduced
56. Genetic syndromes:
Several genetic syndromes have obesity as their major clinical
feature. Many of these syndromes are associated with hypogonadism
or hypotonia (Prader-Willi, Carpenter and Laurence-Moon- Bardet-
Biedl syndromes).
Disorder Features
Prader-Willi syndrome Infantile hypotonia, hyperphagla,
almond-shaped eyes, acromicria,
hypogonadism and behavioral
abnormalities
Laurence-Moon-Bardet- Biedl syndrome Hypogonadism, retinitis pigmen- tosa,
polydactyly, renal abnor- malities and
intellectual disability
Beckwith-Wiedemann syndrome birth, organo- Macrosomia megaly, ear
lobe creases, macro- glossia, abdominal
wall defects and hemihypertrophy
57. Hypothalamic obesity:
CNS insults due to surgery, radiation, tumors and trauma result in
rapid onset obesity.
These disorders are associated with excessive appetite, signs and
symptoms of CNS involvement and other hypothalamic-pituitary
defects.
Monogenic obesity:
Monogenic obesity represents a very small proportion of children with obesity.
They are more likely when the obesity is morbid, has an early onset of obesity and
strong family history.
Leptin deficiency was the first monogenic cause of obesity identified. Inefficient
leptin action (deficiency or resistance) results in uncontrolled appetite and obesity.
Abnormalities in mineralocorticoid receptor and proconvertase are associated with
obesity. Melanocortin-4 receptor (MC4 K) defects are the commonest monogenic
form of obesity and are associated with growth acceleration .
58. OTHER RISK FACTORS FOR OBESITY IN
CHILDHOOD AND ADOLESCENCE
Early infant feeding:
Breastfeeding is possibly protective for the development of obesity.
Parental obesity, eating patterns, and attitudes:
Parental obesity more than doubles the risk of adult obesity among both
obese and non-obese children.
Dietary disinhibition in the mothers of preschoolers is associated with
subsequent excess weight gain in their daughters, and a 6-year outcome
study of children showed that parental dietary disinhibition is associated
with greater increases in body fatness.
59. Early adiposity rebound:
Earlier adiposity rebound is associated with increased body fatness in
adolescence.
Underlying medical disorders:
Secondary obesity may occur with medical conditions, including
hypothyroidism, hypercortisolism, growth hormone deficiency and
hypothalamic damage.
Prescription drugs:
Some drugs may contribute to obesity. These include glucocorticoids,
antipsychotic drugs (eg, risperidone) and some antiepileptic medications
60. EVALUATION OF OBESE CHILDREN
• Only a small percentage of childhood obesity is associated with a
hormonal or genetic defect, with the remainder being idiopathic in
nature.
• An endogenous cause for obesity can be either suspected or
eliminated from the differential diagnosis in virtually all children
based on a careful history and physical examination.
• In most cases, this should negate the need for expensive and
unnecessary laboratory evaluations.
• Growth failure characterizes endogenous obesity.
62. The hormone leptin is associated with obesity.
It has several functions, one of which is control of appetite.
After eating, this hormone is released by adipose tissue and acts on the
hypothalamus resulting in a feeling of
satiety, or fullness, which suppresses the appetite.
In obesity, there are usually high blood levels of leptin and the negative
feedback system, which usually suppresses the appetite, no longer operates
normally.
The leptin hormone
63. Types of obesity and differential diagnosis
On the basis of aetiology
Endogenous: Due to impaired endocrine gland
secretion.
Exogenous: Due to sedentary lifestyle and over
nutrition
Idiopathic or essential obesity: When all possible
causes of weight gain have ruled out.
Physiological - Occurs after puberty,
pregnancy and lactation
Pathological
64. S.no. Types Description
1. Central It involves only the trunk and neck regions, generally
called android/apple shaped obesity. Such type of obesity is
principally associated with increased risk of metabolic
complications like congestive heart diseases, hypertension,
diabetes mellitus, dyslipidaemia and different types of
cancers.
2. Generalise
d
This obesity is mainly pear shaped and also known as
gynoid obesityand fat distribution is mainly on the hips
and buttocks, called gluteal femoral fat. Persons afflicted
with gynoid type of obesity are moreprone to development
of mechanical disorders such as varicoseveins, joint
disorders etc.
On the basis of distribution of fat
65. 3. Superior It involves the face, neck, arms and upper
part of the trunk. It is alsoknown as buffalo
type.
4. Inferior Involving the lower part of the trunk and legs.
5 Lipomatous Multiple lipomatosis with the localised
deposits of fat over the body.
6 Girdle Involving hips, buttocks, abdomen and with a
fatty apron.
On the basis of distribution of fat
66. Hyperplastic obesity Hypertrophic obesity
The total number of fat cells is increased
in hyperplastic obesity.
Involves enlargement or increase size of
fat cells.
On the basis of histopathology
67. S.no. Types Description
1. Developmental This is also associated with emotional problems but begins in
childhood and has more ominous psychological impact. These
youngsters generally have a family setting where one or both
parents use them as an object to fulfil the needs of parents and to
compensate for failures and frustration in parent's own life.
2. Constitutional It is presumably due to genetic and physiological causes and
isusually associated with normal personality development.
3. Reactive This type results in anxious parents who under the effect of
tension or emotional disturbances over eat with drastic reduction
of physical activity.
Psychological classification
68. On the basis of severity
On the basis of waist to hip ratio
Android obesity Gynoid Obesity
The adiposity is pronounced on the
upper half of the body, secondarily on
the abdomen, epiploon and the
mesentery (Apple shaped).
Collection of fat occurs on the hips
and buttocks below the waist or
gluteofemoral region, i.e. pear-
shaped bodies.
Mild Moderate Severe
69. On the basis of onset
S.
No.
Classification BMI Risk of co-
morbidities
1. Underweight <18.50 Lower
2. Normal weight 18.5-24.99 Average
3. Overweight ≥25.00
4. Pre-obese 25.00-29.99 Increased
5. Obese class I 30.00-34.99 Moderate
6. Obese class II 35.00-39.99 Severe
7. Obese class III ≥40.00 Very severe
On the basis of BMI
Gradual onset Insidious onset Rapid onset
70. Differentiating features of constitutional and pathological obesity
Feature Constitutional Pathological
Pattern Generalized Central
Growth rate Accelerated Retarded
Skeletal maturation Advanced Retarded
Dysmorphic features Absent May be present
Endocrine features Absent May be present
71. Features of common causes of obesity
Disorder Features
Prader-Willi syndrome Infantile hypotonia, hyperphagla, almond-
shaped eyes, acromicria, hypogonadism and
behavioral abnormalities
Laurence-Moon-Bardet- Biedl syndrome Hypogonadism, retinitis pigmen- tosa,
polydactyly, renal abnor- malities and
intellectual disability
Beckwith-Wiedemann syndrome birth, organo- Macrosomia megaly, ear lobe
creases, macro- glossia, abdominal wall
defects and hemihypertrophy
Cushing syndrome Hirsutism, central obesity, growth retardation,
striae, buffalo hump, hypertension and
myopathy
Hypothyroidism Growth retardation, coarse facies,
developmental delay
Pseudohypoparathyroidism Tetany, round facies, short fourth metacarpal,
cutaneous calcifications
76. Criteria of diagnosis of obesity
1) Body mass index
Body mass index (BMI) is the most widely used parameter to define obesity
BMI =Weight (Kg) / Height (m2)
2) Weight for height
Weight for height more than 120% is diagnosed as obesity
3) Skinfold thickness
Skinfold thickness measured over subscapular, triceps or biceps regions is an indicator for subcutaneous
fat. Age specific percentile cut-offs should be used with values more than 85th percentile being abnormal.
4) Waist circumference and waist hip ratio:
Waist circumference is measured at the minimum circumference between the iliac crest and the rib cage. Hip
circumference is measured at the maximum protuberance of the buttocks, and the waist hip ratio (WHR) may
be calculated from these values
5) Bioelectrical impedance analyses,
6) Dual energy X-ray Absorptionmetry Analysis (DEXA)
for actual fat %.Of the above none are standardized yet in children for routine clinical practice.
77. Skinfold thickness Waist circumference and waist hip ratio:
Weight
height
Dual energy X-ray
Absorptionmetry Analysis
78.
79. Manifestation
Signs :
1.Weight – 20% increased above desired weight.
2.B.M.I. – above 30 in males and above 28.6 in females are called obese.
3.Skin fold thickness – Obesity is indicated by a reading above 20 mm in a
man, and above 28 mm in a woman.
4.Waist hip ratio – When W.H.R. is above 0.9 in males and above 0.8 in females,
80. Diagnosis
In most cases the diagnosis will be apparent from the patients look but the
degree of obesity should also be assessed usually measurement of height and
weight table.
In addition the skin fold thickness over the triceps muscle can be measured
using special spring loaded calipers. Obesity is indicated by the reading above 20
mm in man and above 28 mm in woman.
81. .
Differential Diagnosis
Obesity must be distinguished from gain in weight due to
fluid retention associated with cardiac, renal or hepatic
disease, bearing in mind fact that, edema does not become
manifest clinically until the extra-cellular fluid has increased
by about 15%.
86. Conventional management of childhood obesity
Dietary change
• Avoid severe food restriction
Gradual approach to cut down calories
• Reduce portion size
• Select foods with lower fat content and low glycaemic index
• Meals should be based on vegetable and fruit ,whole grains ,lean
meat, fish and poultry.
• Reduce high-sugar foods and drinks
• Use water as the main beverage
87.
88. TRAFFIC LIGHT DIET PLAN
Groups foods into those which can be consumed
without any limitation (Green)
In moderation (Yellow)
Infrequent treats (Red)
Can be adapted to any ethnic group /regional cuisine
89. FEATURE GREEN LIGHT
FOOD
YELLOW LIGHT
FOOD
RED LIGHT FOOD
Quality Low calorie ,high
fiber, low fat,
nutrient dense
nutrient dense ,
but higher in
calories and fat
higher in calories
,sugar and fat
Type of food Fruits , vegetables Lean meats , dairy ,
starches , grains
Fatty meats , sugar
, fried foods
Quantity Unlimited limited Infrequent or
avoided
TRAFFIC LIGHT DIET PLAN
90. Increased physical activity
• Incidental activity
• Lifestyle activity
• Exercise programs
• Active transport (walking, cycling )
91. Decreased sedentary behaviour
• Reduce time spent watching television, playing
computer games, using other electronic media
• Encourage alternatives to motorised transport
92. Behaviour modification
• Build confidence
• Assess readiness for change
• Change habits associated with eating and physical
activity
• Set realistic goals for lifestyle change
93. Family Involvement
It is important to involve the entire family when treating obesity in
children. Many studies have demonstrated a familial aggregation of risk
factors for obesity, and the family provides the child's major social learning
environment. It has been demonstrated that the long-term (10-year)
effectiveness of a weight control program is significantly improved when
the intervention is directed at the parents as well as the child, rather than
aimed at the child alone.
94. Drug therapy
Metformin is indicated in children with insulin resistance , type 2 DM ,
Non alcoholic fatty liver disease and PCOD
Statin are the drug choice for children with persistent dyslipidemia
Non alcoholic fatty liver – metformin + vit. E +pioglitazone
PCOD - metformin + oral contraceptive + antiandrogen
Sibutramine, Orlistat
95. Bariatric surgery
• For adolescents with a BMI>/= 40,
• after attaining complete skeletal maturity,
• suffering from medical problems associated with obesity,
• after they have failed 6 months of multidisciplinary weight
management program
1. Vertical banded gastroplasty—
to reduce the volume of stomach
2. Gastric bypass
96. Preventing Obesity: Tips for Parents
• Respect your child's appetite: children do not need to finish every bottle or meal.
• Avoid pre-prepared and sugared foods when possible.
• Limit the amount of high-calorie foods kept in the home.
• Provide a healthy diet, with 30 percent or fewer calories derived from fat.
• Provide ample fiber in the child's diet.
• Skim milk may safely replace whole milk at 2 years of age.
• Do not provide food for comfort or as a reward.
• Do not offer sweets in exchange for a finished meal.
• Limit amount of television viewing.
• Encourage active play.
• Establish regular family activities such as walks, ball games and other outdoor activities.
97. Assessment of complication
The high incidence of complications in obese children calls for regular
follow up screening
Oral glucose tolerance test
Lipid profile
Liver function test
