Obesity พญ. หทัยทิพย์ ต่างงาม โรงพยาบาลนครพิงค์
จำนวนผู้ป่วยเด็กโรคอ้วน 2 4 1 5 3 16 15 40 6 จำนวนผู้ป่วยเด็กโรคอ้วน รพ.นครพิงค์ ปี 60 (จังหวัดเชียงใหม่) Total = 114
ภาวะแทรกซ้อนของโรคอ้วน
Weight for height (W/H) = body weight (kg) x 100 Diagnosis Severity of obesity Overweight Obesity Morbid obesity W/H > 120-140 >140-200 >200 Weight for height (W/H) = body weight (kg) x 100 Ideal body weight (kg)
Growth curve Boys and Girls 2-19 yr
A 8 year-old girl >> Obesity Example Weight for height W/H = 45 x 100 28 = 160% 45 >> Obesity 28
A 11 year-old boy >> Obesity Example Weight for height W/H = 48 x 100 33 = 145% 47 >> Obesity 33
Etiology Exogenous obesity Endogenous obesity Nutrition Environment/ Lifestyle Endogenous obesity Endocrine obesity Syndromic obesity
Prader-Willi Syndrome
Exo- VS Endogenous Obesity Exogenous Family history uncommon Common Height Short stature Normal/Tall IQ Low IQ Normal IQ Bone age Retarded Normal Physical exam Abnormal
Principle of Management No complications control the weight or increase slowly Severe obesity or complications - Reduce wt urgently 5-10 % within 6 mo - Reduce 300-400 Kcal/day (not <1200 Kcal/day in 6-12 yrs.old) - Morbid obesity 800 Kcal/day in some institute
Management: Foods control < 2 years old: No need for weight reduction > 2 years old - Reduce high caloric foods (Ice-cream, chocolate, cake etc.) School- age: - No fasting - Do not skip meals esp. breakfast - Reduce high caloric foods - Increase vegetables, low caloric fruits
Management: Exercise - Physical activity : swimming, walking, riding bicycle : 30 minutes : at least 3 days./ wk. - Decrease physical inactivity
Management: Behavior modifications - Self monitoring: daily record of food intake, exercise, leisure time - Stimulus control : adjust environment - Reinforcement : rewards, admiration - Cognitive restructuring: positive thinking & internal self support - Buddy system/social support
Case Scenario
Weight Height