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Mentors: Marcina Cooper, M.D. Rahman Uddin, M.D. Veronica Zavala, P.A.

Alysha Bhanji How is a child’s development and growth affected by obesity? Dr. Cooper and Dr. Uddin Pediatric Clinic of La porte Mrs. Holk Some of the research comes from outside sources. Mentors: Marcina Cooper, M.D. Rahman Uddin, M.D. Veronica Zavala, P.A.

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Mentors: Marcina Cooper, M.D. Rahman Uddin, M.D. Veronica Zavala, P.A.

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  1. AlyshaBhanjiHow is a child’s development and growth affected by obesity?Dr. Cooper and Dr. UddinPediatric Clinic of La porteMrs. HolkSome of the research comes from outside sources.

  2. Mentors: Marcina Cooper, M.D.Rahman Uddin, M.D.Veronica Zavala, P.A. • Went to Stony Brook University in New York for undergrad and medical school. • In college she was on the Deans List and Graduated Magna Cum Laude.

  3. Mentorship

  4. Pediatric Obesity • Pediatric Obesity has been viewed as a growing epidemic of the past few decades. • 34% of Americans are affected. • Approximately 17%of children and adolescents are obese. • It can be viewed as the top public health threat. • Pediatric Obesity affects all organ systems. • Schneider, Marcie B., MD, and Susan R. Brill, MD. "Obesity in Children and Adolescents- Growth and Development." Pediatrics in Review. N.p., May 2006. Web. 24 Sept. 2012. <http://pedsinreview.aappublications.org/content/26/5/155>.

  5. Causes of obesity • Many factors, including genetics, environment, metabolism, lifestyle, and eating habits, are believed to play a role in the development of obesity. • More than 90% of cases are idiopathic or unknown but less than 10% are associated with hormonal or genetic causes. •  Obesity occurs when energy intake exceeds energy expenditure.

  6. Why is prevention of obesity important? • Its extremely wide ranged in all age groups, sexes, ethnic, and racial groups. • They are more likely to have risk factors for cardiovascular disease, type 2 diabetes, joint problems, etc.. • One study showed that children who became obese as early as age 2 were more likely to be obese as adults.

  7. The Pediatricians Role • The first step is during well care visits beginning with an assessment and calculation of body mass index (BMI). • Basic well care visits should be followed by treatment and prevention visits. • Going beyond the practice is important for prevention and treatment. Physicians and health professionals can play a key role in advocating for policy and built environmental changes.

  8. Diagnosis BMI is Body Mass Index. It is most commonly used by pediatricians to look at how an individuals height, weight, and age compare. Height and weight should be calculated accurately measured because it is sensitive to measurement errors. Hypertension can be diagnosed by using an NHLBI table (blood pressure table). How to calculate BMI: Weight in Pound Height in Inches Height in Inches x 703

  9. Food Pyramids Choose MyPlate, “10 Tips to a Great Plate”. http://www.choosemyplate.gov/downlaods/TenTips/DGTipsheet1ChooseMyPlate.pdf

  10. Obesity video http://www.youtube.com/watch?v=6wSIvplOStA

  11. Respiratory: Asthma • Children with higher levels of body fat and lower levels of physical activity had greater amounts of airway narrowing after exercise. • In obese people, lungs are under expanded and the size of breaths are smaller. • Systemic inflammation can also appear to originate in fat tissue which can affect the smooth muscle in the airways causing is to narrow excessively/ respiratory tract. • Myron, Kevin. "Is Obesity a Risk Factor for Asthma?" “Medical News Today”. MediLexicon International, 05 May 2005. Web. 13 Oct 2012. <http://www.medicalnewstoday.com/releases/24118.php>.

  12. Obstructive sleep apnea syndrome (OSAS) OSAS is recurrent episodes of partial or complete obstruction of the upper airway during sleep, which disrupt the normal ventilation and sleep patterns. Obese children are more apt to have persistent OSA after tonsillectomy and adenoidectomy than are nonobese children. It is not clear whether the mechanism of OSA is related to increased visceral fat having an effect on decreasing airway tone and predisposing the airways to collapse, or whether increased fat in the neck decreases the caliber of the airway.

  13. Obstructive sleep apnea syndrome (OSAS) 13-year-old girl referred for evaluation of sleep apnea and airway obstruction. Lateral scout image from CT shows narrowing of nasopharynx and excessive soft tissue. Strife, Janett L. American Journal of Roetgenology. American Roentgen Ray Society, 6 Dec. 2006. Web. 18 Nov. 2012. <http://www.ajronline.org/content/188/4/1118.full>.

  14. Musculoskeletal Disorders- Slipped Capital Femoral Epiphysis (SCFE) • SCFE is a hip disorder in adolescents that causes symptoms of hip or knee pain. It occurs when the femoral head slips off the femoral neck along a weakened growth plate. • The possibility exists that SCFE occurs in younger children in the presence of obesity, and that early age of onset and obesity increase the risk for bilateral disease Strife, Janett L. American Journal of Roetgenology. American Roentgen Ray Society, 6 Dec. 2006. Web. 18 Nov. 2012. <http://www.ajronline.org/content/188/4/1118.full>.

  15. Musculoskeletal Disorders- Adolescent Tibia Vara (Blount disease) • Blount Disease is due to the effects of weight on the growth plate. • The inner part of the shin bone, just below the knee, fails to develop normally. • This leads to decreased growth and a varus deformity. Early degenerative arthritis of the knee may result. Strife, Janett L. American Journal of Roetgenology. American Roentgen Ray Society, 6 Dec. 2006. Web. 18 Nov. 2012. <http://www.ajronline.org/content/188/4/1118.full>.

  16. Musculoskeletal Disorders- Osteoarthritis • Form of arthritis that features the breakdown and eventual loss of the cartilage of one or more joints. • Osteoarthritis commonly affects the hands, feet, spine, and large weight-bearing joints, such as the hips and knees. • Weight loss reduces physical pressure on all weight-bearing joints and bones. Marc C., M.D. "Osteoarthritis (Degenerative Arthritis) Causes."WebMD. WebMD, 15 Oct. 2011. Web. 01 Dec. 2012. <http://www.webmd.com/osteoarthritis/guide/osteoarthritis-causes>.

  17. Osteoarthritis of knee joint in 16-year-old girl with chronic knee pain. Anteroposterior radiograph of knee joint shows obesity, loss of height of medial component, and small osteophyte (arrow) Blount disease (tibia vara) in a girl. In 4-year-old obese girl, coronal T1-weighted MR image shows irregular, widening depression of medial growth plate; unossified medial epiphysis (arrow); and hypertrophy of medial meniscus. Strife, Janett L. American Journal of Roetgenology. American Roentgen Ray Society, 6 Dec. 2006. Web. 18 Nov. 2012. <http://www.ajronline.org/content/188/4/1118.full>.

  18. Gout • Gout is a condition in which the joints become painful, red and inflamed. • Gout is caused when the urate crystals accumulate in the joints, due to the high amount of uric acid in the blood.  • People with higher BMI have increased uric acid levels, which increases the risk of gout. • Being overweight and eating foods such as red meat and sea food, greatly increases the risk of gout.  "Obesity: A Major Risk for Gout."Obesity Site Wide Activity RSS. YGOY Health Care Community, 15 June 2010. Web. 01 Dec. 2012. <http://obesity.ygoy.com/2009/03/16/obesity-a-major-risk-factor-for-gout/>.

  19. Gastrointestinal: Gallbladder/Gallstones • People that are obese have more cholesterol in their bile • Gall stones are basically deposits of cholesterol. • People with excess fat around their stomach (abdominal obesity) may have a higher risk of developing gall stones. • Rapid weight loss or cycling further increases cholesterol production in the liver, which results in supersaturation and an increased risk for gallstones. • Scott, Jennifer A., MD. "Gallstones." ‘EverydayHealth.com’. Everyday Health Media, LLC, 25 Jan. 2010. Web. 13 Oct. 2012. <http://www.everydayhealth.com/gallbladder/gallstones-the-obesity connection.aspx>.

  20. Cardiovascular: Hypertension • Hypertension, also referred to as high blood pressure, is a condition in which the arteries have persistently elevated blood pressure. • High blood pressure is one of the most common complications of obesity. • Normal blood pressure is less than 120/80 but being obese can cause your blood pressure to raise to 140/90 because overweight individuals may have a higher blood volume and an increased production of insulin. • Blood pressure is also increased by raised sodium levels and thickening of the arteries. • Schneider, Marcie B., MD, and Susan R. Brill, MD. "Obesity in Children and Adolescents- Growth and Development." Pediatrics in Review. N.p., May 2006. Web. 24 Sept. 2012. <http://pedsinreview.aappublications.org/content/26/5/155>.

  21. Heart Disease • Overweight and obese people have an increased incidence of heart disease, and fall victim to heart attack, heart failure, sudden cardiac death, and abnormal heart rhythm more often than those that maintain a healthy BMI. • Obesity often increases the risk of heart disease because of its negative effect on blood lipid levels, which increase in obese patients and then, in turn, increase triglyceride levels and decrease high-density lipoprotein (good cholesterol)

  22. Endocrinologic: Type Two Diabetes • Type 2 diabetes is associated with insulin resistance. Insulin is an important hormone that delivers glucose (sugar) to our cells. • When a person is overweight, the cells in the body become less sensitive to the insulin that is released from the pancreas. • There is some evidence that fat cells are more resistant to insulin than muscle cells. If a person has more fat cells than muscle cells, then the insulin becomes less effective. Rose, Ellen S., MD. "Nutrition." Obesity Prevention and Treatment 32.9 (2011): 363- 73. Rpt. in Pediatrics in Review. 2011 ed. Vol. 32. Illinois: American Academy of Pediatrics, 2011. 363-73. Peds in Review. Web. 25 Sept 2012. <http://pedsinreview.aappublications.org>.

  23. Psychological • Poor self image and social isolation are the root of many other psychological problems especially in severely overweight people. • In younger children it may isolate them from opportunities to participate in sports and other physical activities which causes inactivity and over eating. • Low self esteem may cause depression, eating disorders, and low performance in school/ work. • Schneider, Marcie B., MD, and Susan R. Brill, MD. "Obesity in Children and Adolescents- Growth and Development." Pediatrics in Review. N.p., May 2006. Web. 24 Sept. 2012. <http://pedsinreview.aappublications.org/content/26/5/155>.

  24. Conclusion There are many conditions obesity can cause which will affect the growth and development of a child, but if not prevented at an early age, these conditions can develop into adulthood. If diagnosed at an early age, a Pediatrician can help guide and prevent obesity in children.

  25. Works Cited • Choose MyPlate, “10 Tips to a Great Plate.<http://www.choosemyplate.gov/downlaods/TenT ips/DGTipsheet1ChooseMyPlate.pdf> • Marc C., M.D. "Osteoarthritis (Degenerative Arthritis) Causes."WebMD. WebMD, 15 Oct, 2011. Web. 01 Dec. 2012. <http://www.webmd.com/osteoarthritis/guide/ osteoarthritis-causes>. • Myron, Kevin. "Is Obesity a Risk Factor for Asthma?" “Medical News Today”. MediLexicon International, 05 May 2005. Web. 13 Oct 2012. <http://www.medicalnewstoday.com/releases/24118.php>. • "Obesity: A Major Risk for Gout."Obesity Site Wide Activity RSS. YGOY Health Care Community, 15 June • 2010. Web. 01 Dec. 2012. <http://obesity.ygoy.com/2009/03/16/obesity-a-major-risk-factor-for-gout/>. • Rose, Ellen S., MD. "Nutrition." Obesity Prevention and Treatment 32.9 (2011): 363- 73. Rpt. in Pediatrics in Review. 2011 ed. Vol. 32. Illinois: American Academy of Pediatrics, 2011. 363-73. Peds in Review. Web. 25 Sept 2012. <http://pedsinreview.aappublications.org>. • Schneider, Marcie B., MD, and Susan R. Brill, MD. "Obesity in Children and Adolescents- Growth and Development." Pediatrics in Review. N.p., May 2006. Web. 24 Sept. 2012. <http://pedsinreview.aappublications.org/content/26/5/155>. • Scott, Jennifer A., MD. "Gallstones." ‘EverydayHealth.com’. Everyday Health Media, LLC, 25 Jan. 2010. Web. 13 Oct. 2012. <http://www.everydayhealth.com/gallbladder/gallstones-the-obesity- connection.aspx>. • Strife, Janett L. American Journal of Roetgenology. American Roentgen Ray Society, 6 Dec. 2006. • Web. 18 Nov. 2012. <http://www.ajronline.org/content/188/4/1118.full>.

  26. Thank You! • I would like to thank my mentors Dr. Cooper and Dr. Uddin along with the rest of the staff. You have given me such a great opportunity and an idea about my future. I would also like to thank my teacher, Mrs. Holk, for guiding me through this class and my parents for driving me everywhere and supporting me. I really enjoyed this mentorship and know everything I have learned will benefit me in college and my career.

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