Medical and nutritional literature

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Introduction

Obesity is a very complex fact. It has a diversity of reasons and results, and therefore, it is understandable enough too. In the wide medical and nutritional literature, is usually the treatment of obesity as a problem of clinical resident in physical make-up and the pattern of individual behaviour, and it was only recently that social causations and their effects, and up to the stigmatization is received more attention. However, obesity is negligible than ever before in the writings of sociologists and not at all in the literature on social deviance. Obviously, overweight is detrimental to health, a blot on the appearance, and social stigma. It is possible to think of overweight and obesity is a minimum of obesity and excess weight limit, respectively. (Cahnman 1968)

Firstly, I will repot a case study , and outline the child's condition . moreover, I will carry out a leterature search to identify any relevant studies to explore this condition by ilustrate the causes , the impact of the condition on the child and family and how to mange this condition. At the end I will provide my critique opinion in the conculsion.

International epidemic of childhood obesity

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In many countries studies have shown increases in the prevalence of overweight among children and give more concern about their health and well-being. Definitions of overweight and obesity in children differ between epidemiological studies, which makes comparisons between the spread of cross- sectional data is difficult. However, several studies have examined the change spread within populations over time, and the results were surprise. There was an increased rates of 2.3 to 3.3 times as much for nearly 25 years in United States, 2.0 times and 2.8 times over 10 years in England, and 3.9-fold over the past 18 years in Egypt (Figure 1) . Ebbeling, Pawlak and Ludwig 2002

Case Study

D.B., a white child male, was a breech delivery born in a full term, with 2.4 kg weight. He had a poor gaining weight and had been sucked reflex poorly. He had not sat independently until his first year of age. Moreover he had walked at 3 years. At 2years and half of age, he had a very high temperature of 42.2°C were associated with diarrhoea and vomiting.

The high temperature lasted for 4 hours and ensued shaking. He was 8.2 kg weight at this time. When his recovery from his illness, his appetite became insatiable and he put on 5.45 kg throughout the time of the next 6 months. At 4 years old he had 22.7 kg of weight and was readmitted. On his physical examination, there was no abnormalities were noted except for marked obesity and apparently tiny genitalia. The roentgenograms of the skull were within natural limits in the laboratory studies. As stated by standard reference tables, his bone age was 21 months. At 6 years of age, he proceeded to gain weight, reaching 42.3 kg. At 6 years and half of age, he was in hospital for the third and final time due to intermittent cyanosis, somnolence, shortness of breath and orthopnea.

Physical Findings

Obviously the child was obese; his height was 104 cm in addition to weight 53.4 kg with normal temperature and pulse. Furthermore, his blood pressure was 135/90 mm Hg. The breathing rate varies from 34-56/mm. He occurred florid, cyanotic, boring and passive. Occasionally and frequently incompatibly he would giggle. His ability to speak was very weak, only a few words, and would pointing at items to make his wishes. When he plays, he is trying to scare the people around him by creating noise. He was at around 18 month's level of mental development also he needed diapers. His ability to walk is poor and sometimes sleeps while he was sitting in a chair. Intermittently, if he is not attentive, he dozed. There was recognized interchanging convergent strabismus; nature fundi ,and an explicit lungs. There was a poor ventilatory exchange distinguished by shallow respirations. There were unclear heart tones. Second sound in respiratory area was not hardened although split document was clear. Apparently there were no murmurs. It was obvious that there were no abdominal organs. Genital seem small compared to body size but not unusual for age. Moderate and legs was appear . there was a moderate legs pitting edema. There was no clubbing of the digits. Moderately severe intertrigo, involving the skin of the groins, axillae and under the chin (Acute, with moderation intertriginous areas involving the axillae and groins and skin under the Chin),it was appear with secondary infection .

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Throughout the last period of hospitalization the patient's diet 1,300 calories was provide, low in both fat and salt. After a week the diet was reduced to 1,000 calories; moreover it was minimised to 800 calories was carried out 3 weeks after declaration, after that the calories was reduced to 600. Consequently, after eighth day of hospitalization, there was a significant decrease in the weight to 48.7 kg, and then to 46.4 kg on the sixteenth hospital day. During his course, he was receiving digitoxin every day. Ammonium chloride diuretics urine mercury was run on aid colon .(** this sentence is paraphrasing to the next sentence).Mercurial diuretics and ammonium chloride were administered to aid dieresis. Also he was provided daily by 15 mg of thyroid, in an effort to develop the metabolic rate and increase the reduction in weight. Occasionally, there was instability of rising temperature between 38.9 and 39.4°C without apparent reason. Infections treated topically.

The child was moved to the Children's Convalescent Centre after 66 days of hospitalization. His weight was steady because there was no further reduction in his weight. Furthermore, and there was a lack of progresses in the cardiopulmonary status. In the next ten days, in the summer he suddenly got a fever of 39.4°C, apnoeic, deeply cyanotic and died.

Causes of childhood obesity

There are many factors that cause obesity and raises in the consumption of energy or decrease energy expenditure by even a small amount in the long-term. Genetic factors can have a significant impact on the individual inclination, but the high prevalence rates among the population of genetically stable, indicating that the environment, and possibly perinatal must be the underlying factors behind the obesity epidemic in childhood.

The external causes of obesity are rare. For instance, genetic syndromes like Bardet- Biedl and Cohen usually appear with dysmorphic characteristics, growth delay, occasionally changes in retinas and deafness, along with obesity. And clinical genetics can assess children who suffer from any of these additional test results. Endocrine causes of weight gain and include thyroid malfunction and Cushing's disease. Both conditions conducive to the linear growth, poor and a history of normal linear growth make these unlikely circumstances. (Barlow and Dietz 1998 )

In 1997, it was found on two of the children who suffer from obesity heavily Pakistani of relative parents to have a mutation in the gene encoding for leptin, a hormone normally produced by adipocytes and secreted in the body, relative to fat mass. Since then, five genetic mutations have been distinguished that cause human obesity, each presentation in childhood. In addition, the candidate many alleles, such as those in the variable nucleotide region along the gene repeat of insulin, it was discovered that seems to affect the risk of obesity, an early start.

It seems that the tendency of obesity is caused by a complex interplay between at least 250 obesity involved genes and possibly perinatal factors.

Whitaker and Dietz advanced the thought- provoking hypothesis that "prenatal overnutrition might affect lifelong risk of obesity". In accordance with this hypothesis, maternal obesity increase food through the placenta, and permanent changes in appetite, performance endocrinologist, or energy metabolism. Observational studies results show a direct relationship maternal obesity, birth weight and obesity later in life, but the relative contributions of joint mother genes for factors and difficult to differentiate.

Children who have been fed bottle seem to be more at risk in later childhood obesity than of breast feeding one. Moreover, many studies have shown that there is a relationship between the later obesity in life and the children who suffer from obesity in there early life.

A lifestyle might cause obesity in children because it represented by lack of physical activity and immoderate inactivity (particularly television viewing). While watching television children seem to consume enormous amount of energy condensed foods.

Diet

Fat is the most energy-intensive large nutrients, overconsumption and often thought that the reason for the increase in weight. However, the relationship between fat food and obesity has become questionable. The results of epidemiological studies do not appear in the continued existence of a link between dietary fat and obesity among children and teens. Furthermore, the prevalence of obesity has greatly increased, despite the apparent decline in the proportion of total calorie and fat in the diet of children United States. Thus, the potential impact of other food factors on body demands careful commands.

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Carbohydrates and low in fats observed population level increase has been accompanied by a compensatory carbohydrate consumption, particularly in the form of refined foods such as starchy foods like breads, ready cereals and soft drinks, sweets, biscuits. High glycemic index foods plays very important role in regulation of appetite because it increases in blood glucose concentrations after eating. Consumption of meals are often food and high glycemic index promote hormonal sequence of events that trigger on hunger and why excessive adolescents. High glycemic index diet and obesity risk name linked Central, cardiovascular disease and type 2 diabetes in adults. However, the importance of glycemic index in the issue of obesity and related maladies failed to demonstrate long-term health in clinical trials.

Sugary soft drinks were the subject of many studies, partly because of the hasty boost in the rate of consumption by children. Results of the study under review showed that total energy consumption by about 10% higher among children of school age who drink fuzzy drinks than those who did not do so. Additionally, potential monitoring study results to a 60% increased risk of obesity in middle school children in each additional day service, and then the potential effects of factors confusion. Sugary soft drinks may encourage the consumption of energy and weight due to high glycemic index or compensation for calories consumed in liquid form less complete for calories consumed in solid form. In contrast, milk, low glycemic index drink, and it seems that overweight protect young people from infection obesity.

Snacks and fast food consumption increase, in developed and developing countries, may be of particular importance to the childhood obesity epidemic. Fast and usually include all possible negative factors mentioned above food, including saturated and unsaturated fats, high glycemic index, high energy density, increasingly, large part. In addition, these foods often low in fibre, micronutrients, and antioxidants; food components affecting the risk of heart disease and diabetes. The result of several studies indicates a correlation between fast food consumption and total energy consumption or body shape in young adults and matures.

Personal reflection

Family factors

Family interactions and the home environment could have a great impact on the risk of obesity. Over the last two decades family lifestyle has dramatically changed, with tends towards eating out and greater access to media than before. Apparently, children consume more in restaurants than at home, perhaps, because restaurants tend to provide larger quantity of substantial foods. Apparently, the existence of television in the bedroom is encouraged increasing the amount of viewing time by 38 minute per day. In contrast, there is a positive reflection of eating family dinner by decrease watching TV and improve the quality of diet. Furthermore, social support especially from parents and other associated strongly with participation in physical activity. In light of these findings on psychosocial factors on food and physical activity behaviour affecting energy balance is not surprising with these children who suffer from social problems such as neglect, or depression.

Self - esteem

Different studies have indicated clearly that early age children are vulnerable to obesity and have begun to integrate cultural preferences for thinness. Moreover, tests have shown that the priority 10-to 11-yearold boys and girls prefer as friends other children with a wide range of handicaps to children who are overweight. Furthermore, children aged between 6-10 years obesity already participant with a variety of negative characteristics such as laziness and confusion. One of the possible consequences of such differentiation is that children with excess weight may choose friends and other children who are of age and who may be less inclined to discrimination, less criticism about older child in weight, or more interested to play with children who are overweight because they are old. (Dietz 1998)

In spite of the negative association of obesity, obese young children have a positive self-image and self-confidence. Nevertheless, overweight adolescents improve a negative self-image that appears to continue into adulthood. One explanation of this apparent contradiction between children and young adult that self-image is receive from parental messages in childhood and progressively from the culture as children become teenagers. (Dietz 1998)

Psychosocial factors impact within the family about obesity assets and their implications for psychosocial has gotten limited recognition in the United States. Several Swedish studies have shown a connection of parental disregard and obesity. Moreover, there is an increased in the prevalence among children who are gaining weight quickly of their behavioural and learning difficulties which have been observed. Psychological difficulties which exist in overweight children may reflect maternal psychiatric illnesses or socioeconomic status (SES) rather than problems that result from the obese child. (Dietz 1998)

Depression

There is a considerable amount of work which focused on depression as a result of possible obesity and weight, but evidence indicates that the relationship between obesity and depression is modest at best, and perhaps even be small. This is the result of the review written by Friedman and Brownell, even though from their premise that the failure of most research possible moderation to study changeable, gender and socio-economic status (SIS) or ethnicity. It may be fractionally obscuring the real Association. It is clear from recent studies review those 10 years of research that did not fully described the feature of the relationship between obesity and depression in children and young adults. (Wardle and Cooke 2005)

The management of obesity

The ability of readiness to make the changes

Weight management program is crucial for both parent and their children because if they are not ready to change, it might be not only useless, but also dangerous to failed program. Moreover, it could reflect on the child in the negative way by reducing the child self-esteem and weaken future efforts to improve weight. Family could help the child situation if they are ready and can modify successfully activity. However, it might appear the opposite if the families are not ready to change. Physicians may find useful questions about ready patient. Relying on the severity of obesity, and families who are not ready to change might benefit from advice to improve motivation or delay to treatment until readiness. Motivational interviewing, an approach used with adults to prepare them to change behaviour addictive substances, may have applications in treatment. There is an appropriate way to address preparedness is to ask all representative of the family how anxious are about patient's weight, whether they think weight loss is achievable, and what methods need to alter. Parents with eating disorder may face difficulty in the changes in the family diet and activity. Physician with experience in eating disorders and parental and family should be assessed before starting weight control program to assess the need to provide individual or family treatment advice. (Barlow and Dietz 1998)

There was a great loose of weight for both children and parents for treating childhood obesity by using parents as the solitary agent of change. Furthermore, there was a significant improvement in the cardiovascular risk factor to children comparing with the intervention which children were the main factors to change. (Weizman and Fainaru 1999)

Diet History

There are no studies aimed at evaluating the most appropriate food intake for children. The Committee recommended a comprehensive assessment of each child eating habits to determine all foods and eating patterns that may lead to excessive calories. Families that can illustrate the daily or weekly calorie consumption and fat-rich foods, such as chips, cakes and desserts, and high-calorie fluids, such as soda, juice, full fat milk. Eating outside the home may be important cause of high-calorie consumption, for instance, restaurants, at school or with relatives, and they could not control the food options. For younger children, may the extended family or other caregivers of parents are responsible for overseeing some meals or snacks and which should be identified and involved in the transaction. For adolescents, social activities revolve around meals and snacks consumed outside the home. Clinical Nutrition Specialist should have access to the date when the lack of primary health care with time or has limited food assessment skills.

Physical activity history

There are accurate date of exercise will reveal the opportunities to increase energy expenditure. This assessment should not only quantitative active, such as sports-school physical education, but also in daily life activities, such as walking to school or to work, regulated playing outdoors. Time spent in passive activities, such as watching TV, should also be calculated. Doctors should acknowledge deterring activity, including rehabilitation and lack of supervision of adults after school. Learn about other caregivers from parents who may be responsible for overseeing the activity of the child will be allowed to develop alliances with them. Such alliances may enhance recommendations for successful treatment.

Goals of therapy

Behaviour Goals

Strongly Committee considered that the primary objective of the programme for the management of obesity uncomplicated healthy diet and make exercises, and not fulfil the perfect body weight. To this end, the programme should draw attention to the skills required to change performance and preserve those changes. Skills that families must learn: 1. current awareness of eating habits and activity, behaviour parenting; 2. Select the problem behaviours; specialists can help to recognize high-calorie foods; 3. Adjustment the current behaviour; and 4. Awareness and recognition of the behaviour of the problems arising from children and become more independent, and family change schedules, or other changes also take place that will change the treatment plan.

Medical Goals

The improvement of the complication is an important objective for children who suffer from secondary complications of obesity. This improvement is the new profit concrete behaviour that could enhance the psychological changes made in patient. During the programme of body control weight, it would appear some changes of abnormal the blood pressure or lipid profile because it may improve with weight control. These changes will remind the families that it leads to overall well-being.

Weight Goals

Strongly felt Millennium that the first step in weight control for all children with weight in excess of = 2 years of age is to maintain the primary weight. And expertise of the members of the Committee indicates that the child can reach this goal by making small changes in diet and activity. Initial positive result can be the basis for change in the future.