Monday, July 30, 2012 – Noon
Dr. Naim Alkhouri and Dr. Gordon Blackburn from the Pediatric Preventive Cardiology and Metabolic Clinic discuss childhood obesity and metabolic disorders.
ClevClinicHeart: Dr. Alkhouri - why is this (topic) an important for you?
Dr. Alkhouri: We are facing an epidemic of childhood obesity in the US. It is estimated 17% of children and adolescents are obese.
Childhood obesity is associated with multiple co-morbidities including Type 2 diabetes, increased cardiovascular risk, obstructive sleep apnea, fatty liver disease.
Dr. Blackburn: not only is there a problem in the US, but this is a worldwide trend effecting children's health.
ClevClinicHeart: You are addressing #childhood #obesity in your #ClevelandClinic Pediatric Metabolic Clinic. What type of patients are you seeing?
Dr. Alkhouri: We are seeing in the #ClevelandClinic Pediatric Metabolic Clinic patients who are overweight (BMI > 85th percentile).
These patients also have obesity related complications such as dyslipidemia, fatty liver, pre-diabetes/diabetes, sleep apnea & Familial hyperlipidemia (FH) and family history of cardiac disease.
ClevClinicHeart: How old are your patients?
Dr. Alkhouri: We see patients as young as 4 years old in our Clinic.
@lyfsgr8: We are active, but I could see how my 5-year-old could become obese quickly if I don't take the right steps. #important
Dr. Blackburn: Prevention is as important as treating. Activity is important; dietary & lifestyle issues should be addressed.
We view exercise not just as the patient's issue but a family issue. Set up programs that are fun & effective for whole family.
ClevClinicHeart: Dr. Alkhouri, What is fatty liver disease?
Dr. Alkhouri: Fatty liver is a complication of obesity & metabolic syndrome, which can cause fatty infiltration of liver.
Fatty liver can lead to inflammation & scarring of the liver which can lead to cirrhosis eventually. Early diagnosis is important.
Medical therapy for fatty liver includes: weight loss, exercise, vitamin E, metformin.
@lyfsgr8: What type of diet do you use to treat a 4-year-old patient?
Dr. Blackburn: Key strategies:
- limit calorie dense snacks;
- limit high-sugar drinks;
- and portion control.
It is not a specific diet. We evaluate the family's diet and then develop strategies to optimize caloric intake.
ClevClinicHeart: How do you treat dyslipidemia in children?
Dr. Alkhouri: weight loss and exercise is first step. Then, statins and omega 3 fatty acids are used.
ClevClinicHeart: Dr. Alkhouri, What is the long term impact of children being on statins long term?
Dr. Alkhouri: The American Academy of Pediatrics states use of statins when indicated is safe as early as 8 years of age.
[Editors note: The AAP does state that in children with FH, lipids should be checked at 8 years old: http://1.usa.gov/Mkd4XL. If elevated, as in adults, start with lifestyle changes and then when necessary, medical management should be initiated. This topic can be controversial. Guidelines are meant to guide the physician and family in treatment. It is always a personal decision between the patient, parents, and physician as to the treatment plan.]
@lyfsgr8: Are there any theories on what is causing obesity in infants?
Dr. Alkhouri: The primary focus is that it is an issue of increased caloric intake with a declining calorie expenditure. This is a family issue.
Infants who are large for gestational age and small for gestational age are at risk for becoming obese later in life. This can be related to metabolic programming during pregnancy and developmental years.
@lyfsgr8: Really interesting! Thank you.
ClevClinicHeart: When should a parent consider seeing a metabolic clinic for their child?
Dr. Alkhouri: Pediatricians should screen all children for overweight, obesity at each clinic visit. BMI is the most common screening tool.
Overweight is defined as BMI > or = to 85th %tile. Obesity is BMI > or = 95th %tile.
It is recommended to get a screening lipid panel at the age of 11 years for all children regardless of family history.
ClevClinicHeart: What is the 5 to go program for kids?
- 5 a day fruits and veggies- for a healthy body, healthy life!
- 4 dairy or calcium servings a day- for strong bones!
- Give and get 3 compliments a day- to build self esteem!
We remember to criticize, but we need to remember to praise.
- 2 hours or less of tv/media/computer/screen time a day, not counting homework- for a healthy brain!
- 1 hour or more of exercise a day- for a healthy body!
- and last: 0 fluids containing calories except for low fat milk!
ClevClinicHeart: Dr Blackburn, How do you motivate kids to exercise?
Dr. Blackburn: The key is finding activities the kids like to do. It does not have to be formal exercise, but active play.
The average N. American child has 7.5 hours sedentary exposure to media daily. This is outside of schoolwork! As the 5-4-3-2-1-0 suggests, 1 hour of active play daily & less than 2 hours TV or media exposure non-school related is the goal.
@lyfsgr8: I love your 5 to go program. #greatstuff
ClevClinicHeart: To end our chat, what message would you like to leave with?
Dr. Alkhouri: Although childhood obesity is associated with many complications, all of them are completely reversible with lifestyle modifications
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