Obesity Case Notes

Obesity Case Discussion

Case Presentation

• A father brings his 12-year-old daughter, a known asthma case under control with specialist follow-ups, due to concerns about her weight gain.
• The exam includes plotting and explaining findings on a growth chart and outlining a management plan.
• Recent exam formats may omit history taking, emphasizing growth chart interpretation and explanation.

Growth Chart Interpretation

• Definitions:
  • Overweight: BMI between 85th and 95th percentile.
  • Obese: BMI above the 95th percentile.
• Growth Charts: Red (pink) for girls, blue for boys, with charts available for different age groups.
• Plotting Example (Weight chart):
  • At 4 years: 13 kg (between 10th and 25th percentile).
  • At 8 years: 31 kg (90th percentile).
  • At 12 years: 99 kg (above 97th percentile).
• Plotting Example (BMI chart):
  • At 4 years: BMI 15 (between 25th and 50th percentile).
  • At 8 years: BMI 18 (between 75th and 85th percentile).
  • At 12 years: BMI above 97th percentile.
• Explanation to the Father: Explain that her BMI is being compared to other children of the same age and sex, and that being above the 97th percentile means her weight or BMI is higher than 97% of children in that group.
• Categorization: Emphasize that a BMI above the 95th percentile is categorized as obesity.
  • We are comparing your daughter's weight and body mass index to children in the same group in the same age group.
  • Her BMI is above the ninety seventh percentile. That means her weight or her body mass index is more than 97% of children in the same age group. Same sex, same age group.

History Taking (if required)

• Focus: Identifying risk factors (diet, exercise) and complications of obesity.
• Complications to Consider: Type 2 diabetes, menstrual problems, sleep apnea, worsening asthma, mental health issues (bullying, home situation, depression), GI problems (reflux, constipation), and joint problems (especially hip issues like slipped capital femoral epiphysis).
• Questions to ask:
  • Start with an open-ended question to address the father's concerns about weight gain.
  • How much weight gain? Over what period of time?
  • Rule out organic causes like thyroid issues (weather preference, cold intolerance, constipation) and diabetes (increased thirst/urination).
  • Diet: What does she eat? (junk food intake).
  • Exercise: How active is she? (addressing concerns about asthma-related limitations).
  • Medications: Steroid use.
  • Joint Pain: Specifically hip pain.
  • Mood: How has her mood been?
  • Sleep: Sleeping well? Snoring?
  • Home and School: Assess the home situation and bullying at school.
  • Asthma Control: Night symptoms, exercise limitations, Ventolin usage (daytime symptoms and Ventolin usage of less than two times per week).
  • Briefly cover birth history and immunization status (well baby questions).

Positive Findings Example

• She has an unhealthy diet, loves chips and coke, doesn't eat vegetables.
• She doesn't exercise due to the father's concern that it will worsen her asthma.
• She spends a lot of time watching TV.

Management Plan

• Diet: Discuss a healthy diet, reduce junk food, increase vegetables and fruits, and refer to a dietitian for a tailored plan.
• Exercise: Recommend regular exercise (150 minutes per week) and address concerns about asthma; inform them that well-controlled asthma should not limit exercise.
  • Good controlled asthma, so a well controlled or good controlled asthma, will not cause limitation on exercise.
  • If still concerned, one or two puffs of Ventolin can be taken before exercise based on asthma guidelines for exercise-related symptoms.
• Weight Management Clinic: Refer to a pediatric weight management clinic for dietitians for diet plans and exercise physiologists for exercise plans.
• Investigations: Conduct thyroid function tests, fasting blood sugar levels, and lipid profiles to check for underlying causes or complications.
• Complications Discussion: Explain the risks associated with obesity, such as cardiovascular disease, increased risk of diabetes, joint problems, and psychological issues like depression.

Key Management Points

• Address diet and exercise.
• Conduct investigations and provide appropriate referrals (weight management clinic, dietitian, exercise physiologist)
• Discuss potential complications of obesity.