Childhood obesity in our country figures are worrisome.
17% Of the total number of children are overweight, and of them a 9% obese, is also known that 75% of these children have obese parents and that 40% does not do any kind of physical activity. (*)
Childhood obesity has several immediate and long-term physical and emotional consequences. Physics include: sleep apnea, hypertension, orthopedic abnormalities (wear and tear of the joints, flat feet, among others.) The relationship between obesity and non-communicable chronic diseases has been widely studied and shown firmly * while the affective include depression, anxiety, low self-esteem, difficulty in the relationship, among others.
Early intervention on the subject is more than justified
(*) Enso in children 2000. (Pisabarro, Irrazabal and cabbage)
WHEN A CHILD IS OBESE: DIAGNOSIS
Message to parents:
It is essential to leave a safe diagnostic and face treatment that contemplate the reality of each child.
The diagnosis is based on relating factors such as weight and height and compare them with the parameters expected for the sex and age are illustrated in anthropometric tables. In some cases it may be necessary to supplement the information with laboratory data, it is evaluated along with the pediatrician. Also, the clinical impression that perceived professional, joined the story of parents, which is fundamental to complete an overview of the child, their habits, tastes, activities and changes in weight, complete the diagnosis.
Tools for the professional
ASSESSMENT OF NUTRITIONAL STATUS: ANTHROPOMETRIC AREA
1. Indicators: weight, size, cranial, perimeter, circumference of the arm, folds
2. Indices: weight/age height/age weight/height, index of body mass, classification of Waterlow, and Gomez
3 Curves: they allow assessing the evolution over time
INDEX |
POINT of Court (always depends on the objective of the study)
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REVIEWS
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Point Z or Z-score
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+-2 standard deviations
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Percentiles
Probability of belonging or not to a population
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It depends on the indicator
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% of median
Weight of the pob. Observed / p of the medium x 100
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It depends on the indicator
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Inconsistent with point Z
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Weight / age
This index reflects the body mass in relation to the chronological age.
The modification for short-term weight-for-age, indicates the weight change
for the talla.6
It does not require the measurement of the size, this could be an advantage when there is
with elements to measure the height.
However, it cannot us distinguish between a malnourished child with size normal or high, and a child well nourished or obese but with stature.
36
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Normal: 10-90
Who proposed the term "low weight" to describe the weight for age,
While "underweight" is used to refer to the pathological process
underlying.
Similarly, proposes to refer with the term "high weight" to describe the weight
high for the age. (as few children have high weight for age as a result of )
his high stature, for all practical purposes the high weight for age reflects the weight
high for carving or overweight).6
Relationship weight / age has been the basis of numerous classifications of malnutrition,
especially of the Gómez classification.
Gomez was a Mexican pediatrician who in 1956 developed such classification as
criterion of risk of death of malnourished children.
It is based on linking observed a child with respect to weight weight centile
50 of a population for the same age and sex:
Observed weight
Weight that should have X 100 = % weight / age
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Classification of Gomez
CLASSIFICATION OF GOMEZ
CLASSIFICATION % WEIGHT / AGE
Grade I 90 - 76%
Grade II 75 - 60%
Grade II > 60%
This classification has some disadvantages, such as the need to know
exactly the age of the child, cannot us differentiate between an event acutely and one
chronic.
In addition, for processing was not taken into account the possibility of submitting
edema, by what can be interpreted wrongly.
There is no doubt, that if we have elements to assess the size, this classification
It should not be used by the limited information provided to us.
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Height-for-age
Reflects the linear growth reached and as previously said its shortcomings
they indicate us nutrition long-term or cumulative health deficiencies. 6
Not allows us to make diagnosis of malnutrition or obesity at the time of the
measurement, so recommend merges with index of weight for height
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Percentiles 3-97; + 2SD
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"Stature" is the definition that describes the low height for age . But not us
This indicating the reason that an individual is low and may reflect a process
pathological or normal variation.
"The growth arrest" describes that stature is pathological; you want to
say, it reflects a failure of the retrieved linear growth process. In areas with
little development, where we found a prevalence of low height-for-age, can be
assume that most of these children suffer from the growth arrest. Without
However, when the prevalence of low height is low, most of the children with carving
low for the age, they are genetically low.
According to data from the who global variation in prevalence of low height-for-age
It is from 5 to 65% in the countries few developed. (below - 2's of the)
NCHS/who reference population).
Often incorrectly used the term "chronic malnutrition" for
describe the low height for age , however not set difference between the
deficiency associated with an event of the past and the one associated with a
continuous long-term process. This is the reason why the who advises against the
use of both terms as synonyms.
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Weight for height
This index reflects the body weight with respect to the size, and has the advantage that no is
It requires knowing the age for employment.
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% of fitness: 90-110%; Percentiles 3-97; + 2SD
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According to the who, the appropriate description to describe the weight low for carving is
"thinness", a term that not necessarily implies us that the child runs a
pathologic process. On the other hand, if we talk about "wasting" we will be referring
a recent and serious process which has led to a significant loss of weight,
usually in response to acute hunger or disease
"Overweight" is the term of choice to describe the high weight for height. Without
However, even before the existence of a strong correlation between high weight for height and
Obesity as measured by adiposity, a greater amount of muscle mass,
It can contribute to high weight for height. So, according to the report presented
the term "obesity" should be used by the World Health Organization,
only in the context of measures of adiposity, as the thickness of the
skin folds, and not to describe the high weight for height.
This p/t ratio is not suitable for assessing children under 1 year, since
for each measure of body length children tend to be heavier
Children older; Some authors suggest use it after two years
of life, and instead recommended weight/age index.
It is suggested that the rate of p/t be calculated every child under 6 years of age,
BMI is determined to all child over 6 years in the paediatric control.
"Consensus on the diagnosis and treatment of Pediatric obesity":
Children under 6 years
% adequacy of p/t
Overweight: 110-120%
Mild obesity: 120-130%
Moderate obesity: 130-150%
Severe obesity: 150-170%
Morbid obesity: > 170%
6 Or older
Years IMC according to reference
The CDC international
Overweight > 85 percentile
Obesity > percentile 95
Source: adapted from Argentine archives of Pediatrics
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BMI weight / size x size
Unlike adults, for children it is necessary to relate the value of BMI with
the age and sex.
Because of these limitations, it is recommended the BMI-for-age
as a better indicator for use in children from the age of 6.
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It is necessary to clarify that, currently, suggested different terms for the
diagnosis of childhood obesity:
BMI > 85 percentile, it is suggested the term: "risk of overweight"
BMI > 95 percentile, it is suggested the term: "overweight"
For practical purposes they are similar or synonymous terms, however, they are better
accepted psychologically for the child and his family.
Then let's see the anthropometric classification of Waterlow modified, of the combination of torque weight size and height-for-age.
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4. SPEED OF GROWTH
For the calculation of the rate of growth, it is necessary to have two measurements of weight or height separated by an interval of time, according to the following formula:
V = e / t
Where:
V = Speed of growth, expressed in cm per year or gr per year
e = Difference in cm / Gr. between the heights or weights two measurements taken.
t = Interval of time in years between the two measurements (to be calculated in decimal age).
It is important to note, that for the calculation of the rate of growth is to take two samples of stature, separated by one interval of not less gives 3 months and ideally, close to a year. These intervals reduce the possibilities for error in the calculo.12
The NORMAL growth rate oscillates around the percentile speed curves 50 annual measurements.
Then, when we consider that the speed of growth is low?: when the speed of growth curve is below the percentile 3 standards, based on measurements taken according to the anthropometric techniques, at greater intervals of 4 to 6 months and preferably one year in children older than 2 years. or when the curve of growth rate stays below the percentile 10 for 2 years.
Conceptually, the stature achieved by a child at a certain age represents the resulting end of all growth, from its conception to the time of measurement; However the rate of growth is expression of growth during the period in which the mediciones.4 were taken
5. BIOCHEMICAL EVALUATION
Biochemical evaluation of nutritional status has more useful, when a decrease of reserves body of a nutrient is given either produce biochemical alterations and functional changes by arencia, not for overweight and obesity
6 DIAGNOSIS BY BODY COMPOSITION
ASSESSMENT of NUTRITIONAL status: ANAMNESIS (allows to investigate characteristics qualitative / quantitative feed)
Within the nutritional evaluation, we find one of the strengths of the graduates in nutrition. The food assessment enables us to obtain information, but focusing it from another point of view. We can investigate the type of food consumed by a person, or a population group, and thus know which are your tastes, habits, customs, food myths, rejections, frequency that consumed these foods, among others. When different food indicators are combined, we can get quantitative data, which, compared with the recommended, will discuss nutritional adequacy.
Options
1. Food history (in annex)
2. 24 Hours reminder (will check above all the ingested in the last 24 hours)
3. Frequency of consumption (provided a picture with all the food and is requested to check if they are consumed daily, weekly, or eventually)
4. Journal of food will be a model of registration which must be completed during the indicated period and deliver it at the next meeting. You must record all intakes that do, main meals, and between hours. It is very useful for following consultations and evaluation of results.
5. Combine them (tab with Anthropometry + anamnesis)
The analysis of the obtained data
Whatever the method used for the collection of food data, their results should then be compared with the recommendation for the interviewee child, in order to be able to make a value judgement and make a decision. This is used what we call the percentage of adequacy of intake for a certain
nutrient.
TREATMENT
Can a child "do diet"?
The best treatment of obesity is to prevent it when we see that the child has a mother and father obese or overweight, we detect "obesogenos" eating habits or a history of CNCD (enf. Non-communicable chronic)
When they just begin to eat we can recommend:
Respect the schedule of meals, to create a good habit in this respect Propose consistent portions to the age, single-platter with different foods Do not add sugar or honey to meals Avoid soft drinks and juice drinks
When are larger:
If you don't want a food we do not change what is on the other. We try to implement more exercise and less television. We propose a few treats and at specific times We do not relate the awards with desserts We do not change all the time the fruit gelato We have fruit in the House We put salad on the table We propose at least 3 snacks a week from home and negotiate the other twoAFTER A DIAGNOSIS OF OBESITY OR OVERWEIGHT
As obesity is the result of the interaction of genetic, environmental, nutritional, and emotional factors, it is advisable to seek professional help and point to all causes.
In general, we say that we can raise two types of nutritional strategies:
q Try that the child does not increase weight and to grow. It is expected that in 2 years resume growth with the necessary food and physical changes channel.
q If it is necessary to find a decrease in weight will arm, then a proposal reduced-calorie with respect to current intake. Looking at the contribution of proteins, vitamins and minerals, supported the motivation and nutrition education that allow the child and the family carry out successfully the plan.
Changes in general are running a:
q Modify the quality of the food for a lower energy input: milk whole nonfat, meats and cheeses with lean fat, sugar by natural sweeteners, pasta and biscuits stuffed by simple
q Control the size of the portions: gradually take the child to eat the amount of food you really need and no more
q Order meal times, avoiding snacks and main meals salteos
q Care for the form of preparation of food, for example to avoid fried foods
q Handle exceptions like birthdays, weekends and outputs.
q Incorporate and optimize the activity so that it is effective but enjoyable for the child
MESSAGE TO THE MOTHER / FATHER
If we notice that the child increases weight in striking form is important to stop this increase, if it already went weight is essential to correct it, always in consultation with the pediatrician
Compilation by Lic.Nut. Luciana Lasus hand
Nestle the Uruguay
Literature
* Nutrition and feeding of children in the first years of life. PALTEX. PAHO 1997
Manual for feeding in Uruguay 2005 healthy practices. MSP and others. (.PDF-file) and www.msp.gub
Dietary guidelines for children (Argentina) (.PDF file)
Children's anthropometric evaluation. University of the Republic. Faculty of medicine. ENYD. AEM
New tables who nutritional assessment: http://www.who.int/childgrowth/standards