Diagnosis Of Childhood Obesity Research Articles

Performance of triponderal mass index, body mass index z scores, and body mass index performance in the diagnosis of obesity in children and adolescents

ObjectivesChildhood obesity is a global health problem that affects millions of children and causes obesity-related adverse health outcomes in both childhood and adulthood. Although body mass index (BMI) z scores and percentiles are used in the diagnosis of obesity in children, it has been emphasized in recent years that the triponderal mass index (TMI) may be more accurate for this purpose. We aimed to compare TMI with BMI in the diagnosis of obesity in Turkish children and adolescents. MethodsThe records of 3540 children who applied to Gülhane Training and Research Hospital were retrospectively scanned and the data of 1161 children were included in the study. The body fat percentage (BF%) was calculated by a formula, and children with body fat in the ≥95th percentile were classified as obese. Receiver study characteristics analysis was performed to compare the effectiveness of TMI and BMI in the diagnosis of obesity. ResultsTMI correlated more with BF% (r = 0.863) than fat mass (r = 0.664); BMI correlated more with fat mass (r = 0.957) than BF% (r = 0.714) (P < 0.001). TMI had the highest area under the curve (AUC) in boys at diagnosis of obesity (6–11 y = 0.981; 12–15 y = 0.994). Girls ages 6 to 11 y had the same AUC for all 3 indexes (AUC = 0.977), whereas girls ages 12 to 15 y had the highest AUC for TMI (AUC = 0.967). However, the AUC values between all indices were very close. ConclusionsTMI can be used to diagnose obesity in Turkish children and adolescents in both boys and girls similarly and with good performance. The correlation with BF% and stability of TMI makes this index more advantageous. However, it should be noted that the performance of each of the 3 indices is very close to that of the others, and adjustments should be made according to age and sex.

A Systematic Review Looking at the Current Best Practices as well as Primary Care Practitioner's Views on the Diagnosis and Treatment of Childhood Obesity.

Childhood obesity is a significant and growing issue, with the WHO recognising worldwide childhood obesity rates as an epidemic. Primary care is often the first point for monitoring a child's development over time, hence could play an integral part in recognising and addressing childhood obesity. As a result, our systematic review has twoobjectives. The primary objective isto review the current evidence on best practices in diagnosing and treating childhood obesity. The secondary objective is to review recent qualitative studies looking into the view of primary care practitioners on the treatment and diagnosis of childhood obesity. The rationale for this is to help determine what opportunities there are in primary care in the NHS to tackle childhood obesity. Using searchesin MEDLINE, EMBASE, PSYCHINFO, HMIC and NHS evidence overa five-year period from March 2014 to March 2019, a total of 37 studies were eligible for inclusion in the review. Out of these, 25 studies identified exploring the diagnosis and treatment of childhood obesity. A few key themes in these studies were identified, including motivational interviewing, m-health, tools and resources used in consultations, the use of dieticians in the primary care team and factors concerned with the identification of obesity in children. The rest of the 12 qualitative studies involved eliciting the views of direct stakeholders about the diagnosis and treatment of obesity in children. Eight of the studies investigated providers' views towards the role of primary care practitioners in treating childhood obesity, two investigated the parents of obese children's perspectives and the other two investigated general practitioners' (GPs) views towards specific tools and resources. Regarding our primary objective, our findings showed many studies looking at interventions to reduce the BMI in obese children fail to do so in a statistically significant way. However, a few interventions have been more consistent in reducing BMI and obesogenic behaviours. Those interventions include ones utilising the motivational interviewing technique and those targeting families, rather than children. Another key finding was that tools and resources available to primary care providers can significantly impact their ability to diagnose and treat obesity, particularly when looking at the detection. Finally, evidence regarding the clinical effectiveness of e-health is limited, with views on their use also mixed. Regarding our secondary objective, the qualitative research identified demonstrated many common views from GPs across different countries. It showed healthcare providers (HCPs) perceiving the parents as lacking in motivation to address the issue, HCPs not wanting to damage the relationship with their patients due to it being a sensitive topic to bring up, and a lack of time, training and confidence. However, some of these views may not be generalisable to the UK due to cultural and system differences.

Not ‘putting a name to it’: Managing uncertainty in the diagnosis of childhood obesity

Childhood obesity is a challenging diagnosis. Children's body mass index (BMI) is an imprecise diagnostic of health, leading clinicians' interactions with patients and families to focus on the potential of future harm rather than the presence of infirmity or disease. This is complicated by emphasis on certainty in medical care; clinical diagnoses like childhood obesity are intended to help delineate good and bad health among patients. However, healthiness and wellbeing take on many meanings among individual children and families, especially in relation to weight. To better understand different forms of uncertainty and challenges in providing care, this study draws on 28 semi-structured interviews with U.S. health practitioners working with pediatric patients to examine strategies for communicating risk and defining success in the diagnosis and treatment of childhood obesity. Rather than focusing on patients' current BMIs or making the explicit diagnosis of obesity, clinicians turn to more optimistic prognoses emphasizing the gradual development of beliefs and behaviors that promote long-term physical, mental, and social health. This prognostic framework privileges the doctor-patient relationship over medical guidelines and protocols dictated by diagnoses, encouraging greater consideration of non-clinical factors shaping patients' health and weight. Clinicians expand their diagnostic framework and criteria to include information on the totality of patients' present and future lives, allowing for cognitively, emotionally, and socially attuned understanding of health and weight that is not focused on BMI. Critically, clinicians' awareness of the social etiology childhood obesity heightens their sense of futility about addressing it through clinical interventions, demonstrating the need for a diagnostic and treatment model that empowers doctors to look beyond the more proximate, biophysiological determinants of health.

ADIPOKINES AND HORMONES IN CHILDREN OF PRIMARY SCHOOL AGE WITH NORMAL AND EXCESS BODY WEIGHT

Prevention and early diagnosis of obesity in children is an urgent task. For this, biologically active peptides and hormones regulating the metabolism of adipose tissue can be used. The authors evaluated the nutritional status of 652 children aged 7-10 years living in Moscow and attending general education schools. Among these children, the case-control method was used to select 40 patients with overweight / obesity and 38 schoolchildren with normal weight and height (comparison group). Blood was taken from all children to quantify hormones and adipokines. Serum concentrations of hormones (ghrelin, insulin, glucose-dependent insulinotropic polypeptide, glucagon-like peptide 1 and glucagon), C-peptide and adipokines (adiponectin, adipsin, leptin, tissue plasminogen-activator inhibitor-1, resin, visfatin) in the blood sample were evaluated with the use of method of flow cytometry. There was found a significant increase in adipokine and hormone blood concentrations, depending on the degree of the disorder of the nutritional status of children. In makes them to consider as early biomarkers of obesity with diagnostic and prognostic significance.

Foundational knowledge regarding childhood obesity: a cross-sectional study of medical students

BackgroundDocumentation and diagnosis of childhood obesity in primary care is poor and providers are often unfamiliar with guidelines. This lack of knowledge may be attributed to insufficient training in medical school and residency; however, no studies have evaluated medical students’ knowledge of recommendations.MethodsWe distributed a modified version of the Physician Survey of Practice on Diet, Physical Activity, and Weight Control to medical students at a single university. Descriptive analyses assessed knowledge and attitudes of childhood obesity and diabetes.ResultsOf the 213 participating students, 74% indicated being unfamiliar with obesity screening recommendations. Few correctly identified BMI percentile cut-points for child overweight (21.2%), obesity (23.7%), and normal weight (29.4%). They reported screening glucose 4.5 years earlier in patients with risk factors compared to those without (p < 0.001).ConclusionsAlthough students recognized the need for earlier diabetes screening in children with risk factors, we determined that overall, student knowledge of obesity-related preventative care was inadequate.

Obesity in children and adolescents: diagnosis criteria

Currently in the world the main diagnostic parameter for assessing obesity is the magnitude of body mass index. In children, taking into account the growth and body weight indicators that dynamically change as the child grows up, it is common to use not absolute, but relative values of body mass index percentiles or standard deviations. The lecture examined various systems and methods for assessing the physical development of children in the world and in Russia domestic ones, R.N. Dorokhova and I.I. Bakhraha, World Health Organization (WHO), International Group for the Study of Obesity. A comparative analysis of the existing systems and the validity of the currently adopted Federal recommendations on the diagnosis of obesity in children based on the recommendations of WHO has been carried out.

Antibiotic and acid-suppression medications during early childhood are associated with obesity

ObjectiveGut microbiota alterations are associated with obesity. Early exposure to medications, including acid suppressants and antibiotics, can alter gut biota and may increase the likelihood of developing obesity. We investigated...

Estudio de la obesidad en una población infantil rural y su relación con variables antropométricas

GoalsTo know the prevalence of obesity in primary and secondary school students, and to evaluate the diagnostic accuracy of anthropometric variables for its detection. DesignCross-sectional study. LocationRural area of Córdoba. In the year 2014. ParticipantsStudent population. A stratified sampling was performed according to age, gender and educational centers. A total of 323 students from 6 to 16 years were included in the study, all parents had signed informed consent. Main measurementsThe prevalence of obesity was determined and sociodemographic, anthropometric, physical condition and dietary predictor variables were collected. A binary logistic regression was performed determining crude and adjusted Odds Ratio (OR) values, ROC curves were obtained and cut-off values were determined, calculating the sensitivity, specificity and Youden index. ResultsThe prevalence of overweight and obesity was 26.2% and 22.3%, respectively. Only 15.2% of school children had an optimal Mediterranean diet. The waist-height ratio (WtHR) was the predictive variable with the highest adjusted OR 7.1 (4.3-11.6) and the largest area under the curve 0.954 (0.928-0.979), from a global cut-off value to discriminate obesity of 0.507. This gave a sensitivity of 90% and specificity of 87.2%. ConclusionsThe high prevalence of obesity, the low-medium adherence to the Mediterranean diet and the low physical fitness make this population a priority target for the prevention of future cardiovascular events. The WtHR has been the best anthropometric predictor of obesity, recommending its use for the diagnosis of obesity in children at the expense of body mass index.

Identification and Management of Obese Patients in a Pediatric Orthopaedic Clinic.

Childhood obesity is a complex healthcare problem that affects all aspects of a child's health. The American Academy of Pediatrics and the Expert Committee recommends that all children be evaluated for current medical conditions including the risk for obesity by identifying elevated body mass index (BMI), physical activity habits, and diet. Childhood obesity is defined as a BMI of 95th percentile or greater on standardized age-based growth charts. Abdominal and visceral fat mass has a negative effect on bone formation during childhood and adolescence. Effective interventions are aimed at prevention and treatment and include collection and assessment of obesity, eating habits, physical activity, and family history. At a local outpatient pediatric orthopaedic practice, few patients had a diagnosis of childhood obesity and weight management varied by providers. The purpose of this quality improvement project was to improve identification of obese children and increase referrals to a weight management program. Setting: A hospital-affiliated pediatric orthopaedic clinic staffed with 3 orthopaedic surgeons and 2 nurse practitioners. 6- to 18-year-olds with a BMI of greater than 95th percentile (N = 239). Electronic medical record chart review for documented obesity and referral to weight management program: Intervention: Provider educational in-service reviewing management guidelines and referral process. Average percentages of documented obesity diagnosis increased from 11% to 53%. The number of referrals to Heart Healthy weight management program increased by 400%. An educational-based intervention in a pediatric orthopaedic clinic was effective in increasing the number of patients with a diagnosis of obesity and referred to a weight management program.

Оценка биоэлектрической активности головного мозга в комплексной диагностике ожирения у детей и подростков

Оценка биоэлектрической активности головного мозга в комплексной диагностике ожирения у детей и подростков

The reliability of body mass index in the diagnosis of obesity and metabolic risk in children.

Body mass index (BMI) is the most widespread and the simplest method for the evaluation of body mass; it is often used as a sole technique in the diagnosis of obesity in children. The objective of the study was to evaluate the relationship between anthropometric and biochemical parameters and the incidence of the metabolic syndrome in obese children. A total of 110 children, aged 2-17 years, participated in the study. No overweight children (BMI 85-95 percentiles) were included. BMI was interpreted using the 2000 Centers for Disease Control and Prevention Growth Charts. The skinfold measurements were performed using an John Bull British Indicators Ltd. calipers, and interpreted using an the reference table values. In addition to lower sensitivity (mentioned in several earlier studies), BMI also shows a lower specificity in the diagnosis of obesity in children: BMI showed at least 10% of non-concomitance with skinfold thickness and waist circumferences and 8% with waist-to-height ratio. In addition, subscapular skinfold thickness, waist circumference, and waist/height ratio showed stronger correlations with serum insulin levels, low-density lipoprotein cholesterol, and family history than BMI itself. The unreliability of BMI as the sole parameter for diagnosing obesity in children was found in our study. Even when overweight children were excluded from the study, the lack of specificity of BMI was demonstrated. We propose utilization of waist circumference and waist/height ratio along with the BMI for definitive diagnosis instead of relying on BMI only. In addition, waist circumference and subscapular fold thickness may be even better in estimation of metabolic risk than BMI.

A General Review of Childhood Obesity

The obesity observed between the ages of five-seventeen is defined as childhood obesity (CHO). The prevalence of CHO is increasing parellel to increasing obesity prevalence in developed and developing countries. CHO as an important predictor of adult obesity, independently raises the premature morbidity and mortality due to chronic diseases. It is ascertained that 40% of adults who are currently obese, were also obese during their childhood. CHO has particularly increased since the year of 2001. In developed countries it is observed in low and middle-income families whereas in developing countries it is seen in high-income families. Obesity is influenced by genetical, developmental and environmental factors. In last 30 years the prevalance of CHO is increasing although the prevalence changes between countries, it is about 30%. In the development of CHO, genetical factors, pregnancy, intrauterine environment, and breast-feeding, age, gender, nutritional habits within in the family, puberty, physical activity, some of the drugs, and psychological factors play a role. In the diagnosis of CHO, BMI-Z scores deveoped by the World Health Organization, the International Task Force of Obesity, and the US National Center for Health Statistics are used. But as the sociocultural and economical characteristics of each country, the national body mass index values are usually prefered. For the protection from CHO, prevention is the easiest and most effective approach. Therefore, beginning from the primordial prevention, before and during pregnancy, healthy nutritional behaviours should be developed within the families, and this life-style should be enhanced in individual, institutional, and national levels within the colloboration of related sectors.

Childhood obesity: Can electronic medical records customized with clinical practice guidelines improve screening and diagnosis?

The purpose of this project was to determine if customization of the electronic medical record (EMR) using evidence-based practice guidelines developed by the National Association of Pediatric Nurse Practitioners and the Expert Panel recommendations for the prevention, screening, and treatment of childhood and adolescent overweight and obesity would improve the rate of screening and diagnosis of obesity in children, 7 to 18 years of age. A retrospective review of encounters before and after implementation of customized EMR was conducted in a community health center. Data collected were compared for documentation of body mass index (BMI), completion of growth charts, scoring of risk questionnaire, and diagnosis of overweight or obesity. There was a clear increase in the frequency of recording BMI, completing BMI growth charts, and scoring questionnaires between written and electronic medical records. The number of children diagnosed with overweight or obesity increased with customized EMR but still remains well below the rates of obesity for this community. Customizing EMR with clinical practice guidelines improved adherence to recommendations for screening and identification of childhood overweight and obesity. Increased recognition and diagnosis will lead to improved interventions and improve outcomes for childhood obesity.

Obesity in Childhood and Adolescence: a review in the interface between adipocyte physiology and clinical challenges

Body weight is regulated by a feedback loop in which peripheral signals report nutritional information to an integratory center in the brain. The cloning of the ob gene is consistent with this concept and suggests that body fat content in adult rodents is regulated by a negative feedback loop centered in the hypothalamus. In recent years a number of additional signaling molecules secreted by adipose tissue have been discovered. These hormones, named adipocytokines, include resistin, adiponectin, and visfatin. Among the adipocytokines, adiponectin is perhaps the most interesting compound for the clinician since low adiponectin serum levels have been found in obese subjects and in particular in insulin resistant subjects. The definition and diagnosis of obesity in children and adolescents are surprisingly difficult. The level of fatness at which morbidity increases is determined on an acturial basis. In children and adolescents the degree of body fat mass depends upon ethnic background , gender, developmental stage, and age. Treatment and prevention of obesity in childhood and adolescence are major challenges for today's health care providers and societies.

Variation in Establishing a Diagnosis of Obesity in Children

Consensus guidelines provide recommendations for the diagnosis and management of obesity. We conducted a medical record review of children initially diagnosed with obesity at a general pediatrics visit. The diagnosis was made most often at health maintenance visits (46%). Body mass index was documented in 5% of initial visits; 74% had documentation of obesity-related history; 64% had documentation of counseling. In multivariate analysis, male patients were more likely to have diet history documentation; female patients were more likely to have weight loss program referrals. Future research should assess pediatricians' perceptions about obesity to better understand clinical practice patterns.

Criteria for medical intervention in obese children: a new definition of 'obesity disease' in Japanese children.

The Committee of the Japan Society for the Study of Obesity reported the new criteria for 'obesity disease' for Japanese adults in 2000. We defined the criteria for the diagnosis of obesity in children with medical problems, corresponding to the 'obesity disease' criteria in adults. Obesity in childhood was defined as follows: percentage of overweight (POW) and body fat exceeded the criteria. 'Obesity disease in childhood' was defined as obesity associated with health or medical problems, and with indications for medical intervention. Medical problems with indications for immediate intervention were grouped as A problems, which consisted of (i). hypertension; (ii). sleep apnea or hypoventilation; (iii). Type 2 diabetes mellitus or impaired glucose tolerance; and (iv). increased waist circumference or accumulation of visceral adipose tissue. Metabolic derangements or equivalent associated with obesity were grouped as B problems: (i). liver dysfunction; (ii). hyperinsulinemia; (iii). hypercholesterolemia; (iv). hypertriglyceridemia; (v). low serum high-density lipoprotein cholesterol; (vi). acanthosis nigricans, and (vii). hyperuricemia. Obese children over 5 years of age with following conditions were diagnosed as 'obesity disease in childhood': (i). any 'A problem', (ii) POW >or= 50% and any 'B problem', or (3) POW < 50% and more than one 'B problem' or equivalent. We decided to take physicosocial problems related to obesity into consideration as the criteria. The resultant criteria are proposed by the Committee for Research of Appropriate Body Build in Children*.