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Management of Overweight
Children
By: Hazwani Md NoorSupervisor: Dr. dr. Aryono Hendarto
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Clinical Scenario 8-years-old, Female
Came to RSCM for Chemotherapy follow-up
Diagnosed with ALL since 2 months ago
High-dose dexamethasone therapy Increased appetite, Ate 5x/day meal, Sleep
Increased 10 kg BW
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Clinical Scenario Normal vital signs
Moon face
Central Obesity
Purple Striae
BMI 20.1 (89th %) = Overweight
Parents concerned about weight problems
How to manage?
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Overview Increasing rates of overweight & obesity in
Indonesia
Associated with higher social status
Increase cardiovascular risk factors,chronic diseases (e.g. T2DM, HT, stroke)
Current management: lifestyle,pharmacotherapy, surgical intervention
Effective management still uncertainUsfar A, Lebenthal E. Obesity as a poverty related emerging nutrition problems: the case of Indonesia. Obesity Reviews.2010;11(12):924-8.
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Clinical Question
Population : Overweight children
Intervention : Overweight management
Comparator : -
Outcome : Weight reduction
Question: What is the management ofoverweight problem in children?
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Methods
Literature search conducted using
Pubmed, EMBASE and National GuidelineClearinghouse on 19thSeptember 2011.
Articles obtained using children,overweight, management and theirsynonyms as the entry terms.
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MethodsEngine Search Terms Hits
PubMed ((children OR pediatric) AND overweight AND
management
2546
EMBASE (('child':ab,ti) OR ('pediatric':ab,ti)) ANDoverweight:ab,ti AND management:ab,ti
194
NationalGuideline
Clearinghouse(NGC)
(children OR pediatric) AND overweight ANDmanagement
1393
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Pediatric
OR
Children
Overweight ManagementA
N
D
A
N
D
2546
Screening title/abstract
83
Screening full-text and duplicates
Useful articles: 2
Exclusion criteria
-Diagnostic, Etiologic &
Prognostic Study
-Animal study
-Text not in English
-Publication before year 2000
Inclusion criteria
-Therapeutic study
-English language
-Full-text available
Pubmed EMBASE NGC
194 1393
252 428
Screening title/abstract
206 16 112
5
Selection criteria
-Overweight management in
children
Date of search: 19th September 2011
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Articles August GP, Caprio S, Fennoy I, Freemark M, Kaufman
FR, Lustig RH, et al. Prevention and treatment of
pediatric obesity: an endocrine society clinical practiceguideline based on expert opinion. Journal of ClinicalEndocrinology & Metabolism. 2008;93(12):4576. [TES]
Logue J, Thompson L, Romanes F, Wilson DC,Thompson J, Sattar N. Management of obesity:summary of Scottish Intercollegiate Guidelines Network(SIGN) guideline. Bmj. 2010;340. [SIGN]
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Critical Appraisal Appraisal of Guidelines for Research &
Evaluation II (AGREE II)Domains Score
SIGN Guideline TES Guideline
1.Scope & Purpose 66.7% 60%
2.Stakeholder & Involvement 66.7% 50%
3.Rigour of Development 47.5% 55%
4.Clarity of Presentation 66.7% 60%
5.Applicability 45% 37.5%
6.Editorial Independence 50% 50%
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Results Lifestyle Intervention
-most effective
-diet changes, increasing physical activity,decreasing sedentary behavior, behavioralinterventions, family involvement
Weight maintenance in overweightchildren
Logue J, Thompson L, Romanes F, Wilson DC, Thompson J, Sattar N. Management of obesity: summary of Scottish IntercollegiateGuidelines Network (SIGN) guideline. Bmj. 2010;340.
August GP, Caprio S, Fennoy I, Freemark M, Kaufman FR, Lustig RH, et al. Prevention and treatment of pediatric obesity: an endocrinesociety clinical practice guideline based on expert opinion. Journal of Clinical Endocrinology & Metabolism. 2008;93(12):4576.
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Results Pharmacological Treatment
-If intensive lifestyle modification fails andsevere comorbidity
-Only prescribed if doctor familiar with drugspotential side-effects
(E.g.: Orlistat gastrointestinal side effects)
Logue J, Thompson L, Romanes F, Wilson DC, Thompson J, Sattar N. Management of obesity: summary of Scottish IntercollegiateGuidelines Network (SIGN) guideline. Bmj. 2010;340.
August GP, Caprio S, Fennoy I, Freemark M, Kaufman FR, Lustig RH, et al. Prevention and treatment of pediatric obesity: an endocrinesociety clinical practice guideline based on expert opinion. Journal of Clinical Endocrinology & Metabolism. 2008;93(12):4576.
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Results Surgical Intervention (Bariatric Surgery)-Only in adolescents with extreme obesity
and severe comorbidities despite lifestyleintervention with or without pharmacologicalmanagement
-Discuss with parents and children(readiness for long-term follow-up andlifestyle intervention)
Logue J, Thompson L, Romanes F, Wilson DC, Thompson J, Sattar N. Management of obesity: summary of Scottish IntercollegiateGuidelines Network (SIGN) guideline. Bmj. 2010;340.
August GP, Caprio S, Fennoy I, Freemark M, Kaufman FR, Lustig RH, et al. Prevention and treatment of pediatric obesity: an endocrinesociety clinical practice guideline based on expert opinion. Journal of Clinical Endocrinology & Metabolism. 2008;93(12):4576.
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Discussion Weight maintenance-Decrease BMI as Increase height
Dr. should prescribe lifestyle intervention Problems with pharmacological
intervention
Lack of FDA approval Reduced efficacy over time
Limited studies on efficacy and safety
Risk of severe side-effects & long-termotential morbidit & mortalit
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Discussion Oct 2010, FDA voluntarily withdrawn
Sibutramine increase risk of heart
attack and stroke Surgical intervention not recommended in
young children
-long term side-effects and complicationsfor growing child still unknown.
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Conclusion &
Recommendations
Intensive lifestyle intervention most
effective, safe, cost-saving Patient should undergo lifestyle
intervention
Improve diet calorie, fat, fast food,fibers, fruits, veg
sugared beverages
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Prescribe at least 60 min of daily moderate
to vigorous physical activity Limit screen time (watch tv, play
videogames) 1 2 hr per day
Maintain weight