Childhood Bariatics (W8P1)

 (Continued Virtual Healthy School)

Grades Kindergarten-2

Reward Box 

• Reward boxes that are not food and/or candy or things that can undermine healthy eating or reinforce unhealthy habits
• Instead well-behaving students get to pick the activity for afternoon physical activity break or receive extra playtime

-Reward healthy habits

-Make a reward box and ask parents to donate non-food rewards and school supplies 

Cubby Area

• Collaborate with parents to supply healthy snack sin the classroom
• School wellness committee-parents learn about healthy options 
• Promote after-school snack program

-If children go home feeling hungry, they have decreased focus (to do school work) and are more likely to grab for "junk" food (high calories, little nutritional value)

-Veggies with catchy titles and visually appealing presentations

Centers for Disease Control and Prevention. "Virtual Healthy School". https://www.cdc.gov/healthyschools/vhs/index.html.  Last Accessed 2 April 2021. 

What steps should parents take to reduce their risk of chronic illness? Step kids/teens can take? Schools?

13.9% obesity (age 2-5)-"epidemic within an epidemic"

Children/Adolescent Bariatric Surgeries/Guidelines:

• AMOS-adolescent morbid obesity surgery 
• ASMBS-american society of metabolic/bariatric surgery
• FABS-5+-Follow-up of adolescent bariatric surgery at 5+ years
• LAGB: laproscopic adjustable gastriband 
• RYGB-Roux-en-Y gastric bypass
• Teen-LABS-Teen longitudinal assessment of bariatric surgery 
• VSG- vertical sleeve gastrectomy

*Do we have more research on surgeries to aide in obesity (temporarily) than prevention programs/insurance? For kids?

Adolescent= 13-18 years 

Obese- +95% BMI for age and sex/ BMI >35 or 

Adults-obestiy=35+BMI

1.5-2% higher in African American patients/most present in girls

2014-10% adolescents obese

1999-1.3% obese

• high probability of obesity into adulthood/anticipated cumulative impact of comorbid diseases

Treatment Crisis: "Although behavioral and lifestyle interventions will be successful for certain individuals, the overall outcomes of behavioral and lifestyle interventions are discouraging when viewed as a solution for a larger number of patients with severe obesity. Youth with severe obesity require effective intervention to prevent a lifetime of illness and poor quality of life".

Direct Correlation: preoperative BMI and higher probability of presenting with multiple comorbid conditions and/or associated cardiovascular risk factors

Those with the highest BMI at time of surgical intervention are less likely to achieve a nonobesity state

Success rate of behavioral intervention low but some respond

Must identify local or regional tertiary facility that is equipped to provide ongoing bariatric surgical care to the child. Must continue with cooperative team. 

Risks:

-Higher risk for pregnancy (must see family planner)

-Anemia 

-Bone mineral density loss

-Micronutrient deficiencies

Approved by insurance for less than 1/2 of adolescent patients

In contrast, 80-85% adults approved

Bolling, Christopher F., et al. “Metabolic and Bariatric Surgery for Pediatric Patients With Severe Obesity.” American Academy of Pediatrics, American Academy of Pediatrics, 1 Dec. 2019, pediatrics.aappublications.org/content/144/6/e20193224. 

Adolescent Mortality

• Individuals with childhood obesity 3x higher risk of mortality in adulthood
• Risk of death due to disease and risk of death due to suicide were higher

Conclusion: "Childhood/adolescent obesity is a highly prevalent and severe condition with increased risks of associated morbidity and premature mortality".

Lindberg, Louise, et al. “Association of Childhood Obesity with Risk of Early All-Cause and Cause-Specific Mortality: A Swedish Prospective Cohort Study.” PLOS Medicine, Public Library of Science, journals.plos.org/plosmedicine/article?id=10.1371%2Fjournal.pmed.1003078#:~:text=In%20the%20childhood%20obesity%20cohort,or%20contributing%20cause%20of%20death. 

18.4% obese (age 6-11)

20.5% obese (age 12-19)

1/4 students have chronic health conditions (asthma, diabetes, etc.)