Dr Hisham Al Khatib

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• Dr Hisham Al Khatib

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Importance of Obesity

• Imbalance of diet.
• Increase mortality.
• Obesity and related diseases.
• Interest in childhood obesity has increased as a
  result of the increasing prevalence of childhood
  obesity and the recognition that obese children
  tend to become obese adult.
• WHO consider obesity to be one of the top ten
  causes of preventable death worldwide.

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Factors contributing to childhood obesity

• 1- Environmental factors that increase food
  intake and decrease energy expenditure
• 2-Family variables.
• Parental obesity.
• Family size.
• Parental age.
• Socioeconomic status.
• Mother education.
• TV/Computer viewing.

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Prevention(First line of treatment)

• Recognize children at risk of obesity.
• Encourage and support breast feeding.
• Promote healthy eating habits.
• Promote physical activity.
• Recommend limitation of TV viewing and computer
  timing.
• Programs to prevent obesity should be directed to
  the whole population.

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Treatment(Why difficult to treat obese children)

• First-
• Difficult to diagnose obesity in children than
  adult.
• Second-
• Treatment must be negotiable through other
  people.
• Third-
• To ensure that the growth and development of the
  child is not impaired.

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Treatment

• gt Weight maintenance recommended for children
  2-6 years with BMIgt95 and no weight related
  complications.
• gtWeight loss recommended for children 2-6 years
  with BMIgt95 and weight related complications.
• gtWeight loss for older children with BMIgt95
  whether or not they have weight related
  complications.

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Principles in the management of childhood obesity
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Motivation.

• Develop interest in personal appearance and
  fitness.
• Develop interest in doing things for others.
• Encourage hobbies.
• Avoidance-using food as a reward.

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Dietary Management

• Confine eating to meal times and establish
  recognized periods.
• Seek diet that are filling but not fattening.
• Avoid unnecessary high energy goods, fried foods,
  added fats and sugars sweets, chips, crisps,
  biscuits and sweet meal drinks.
• Use low energy substitutes for necessary foods
  semi-skimmed or skimmed milk, low energy
  spreads, low energy yoghurts, cottage cheese
  rather than cream cheese.
• Use whole meal cereals, fresh fruits and
  vegetables to increase bulk of meals.
• Avoid chewing gum (even sugar free) as gum
  discourage the child from getting accustomed to
  the mouth being empty.
• Modify school dinners

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Principle in Designing such Diets

• The diet must supply less energy than the
  patients maintenance requirements, otherwise
  there will be no weight loss.
• The diet must supply all nutrient requirements
  apart from energy and conform with good nutrient
  principles, otherwise it will eventually lead to
  malnutrition.
• The diet must be acceptable to the patient,
  otherwise the patient will not comply with
  dietary advice.

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Physical activity

• Good nutrition and lots of active play will
  cultivate a brilliant mind in your child and help
  him become healthy adult for years to come.
• Increased levels of physical activity (simple
  exercise can help to get the child started on the
  exercise program)
• Exercise levels should be increased slowly to
  avoid possible discouragement.

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Medications

• No magical pill for weight loss.
• To be used after unsuccessful effect of diet and
  physical activity.
• Limited to those individuals with serious
  comorbidities.
• Long term safety of this medication is still
  being evaluated.
• Safety and efficacy not yet established for
  patients lt 16 years of age.

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Orlistat (Xenical)

• Intestinal lipase inhibitor that inhibit the
  absorption of dietary fats.
• Improves weight management in obese adolescents.
• Side effects (flatulance, stool leakage).

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Sibutramine (Meridia)

• Appetite suppressant (works in the brain
  nervous system).
• Side effects (high blood pressure, insomnia,
  anxiety, headache, depression).

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Metformin (oral hypoglycemic agent)

• Improves insulin sensitivity.
• Promotes modest weight loss in adult.

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Herbal products

• Not recommended for children.
• May cause gtincrease heart rate.
• gtIncrease blood pressure.
• gtheadache.

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Calcium

• Children with low calcium intake are more likely
  to gain weight compared to children with a high
  calcium intake.

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Surgery (Last Option)

• Jejunoileal bypass.
• gtside effects (intractable diarrhea, nutrient
  deficiencies, kidney stones, and hepatic failure)
• Gastric by pass (reduce gastric capacity)
• gtmost common operation.
• gtexcellent weight loss .
• gtno significant
  malabsorption.
• gtsafety profile is better.

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Surgical option (cont)

• Gastric banding.
• gtless invasive operation.
• gtlower incidence of mortality.
• gtreversible.
• gtsignificant weight loss.
• (sometimes need to repeat the operation)

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Conclusion

• Childhood obesity is a complex problem and the
  physician must be able to recognize children at
  risk.
• Prevention should be the first management
  approach.
• Early intervention shows that many of the
  complications associated with obesity are
  minimized by weight reduction.
• Efforts should be integrated, that is with
  involvement of the community, parents, children's
  schools, health authorities, nutritionist and
  food companies to establish an effective,
  practical and logistic programs.

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Conclusion (cont)

• If children continue to gain weight at the
  current rates, obesity will soon become the
  leading cause of death.

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Finally

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• If Diet is Bad there is NO Benefits of
  Medications
• and If diet is Healthy there is NO Need for
  Medications

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