Primary Care Approach to Multidisciplinary Management of Pediatric Obesity

.: PREFACE
ÖN SÖZ
PREFACE
Doç. Dr. Meltem EROLa, Doç. Dr. Didem KAFADARb
aSağlık Bilimleri Üniversitesi Bağcılar Eğitim ve Araştırma Hastanesi, Çocuk Sağlığı ve Hastalıkları Kliniği, İstanbul, Türkiye
bİstanbul Üniversitesi-Cerrahpaşa, Cerrahpaşa Tıp Fakültesi, Aile Hekimliği ABD, İstanbul, Türkiye
Article Language: TR
Pediatrik çağda obezite varlığı günümüzde giderek büyüyen küresel bir halk sağlığı sorunu hâline gelmiştir ve sağlık politikalarının önemli konularından biridir. Son dekatlarda çocukluk çağında görülen obezite oranı sürekli artmakta, ancak henüz kesin tedavi protokolü bulunmamaktadır. Obezite; gelişmiş ülkeler yanında gelişmekte olan ve gelişmemiş ülkelerde de sıkça görülmektedir. Teknolojik gelişmeler ve dijital makine kullanımının artması ile fiziksel aktivite azalmasının yanında sağlıksız diyetler ve beslenme şekilleri obezitenin giderek artmasında rol oynamaktadır.

Literatürde, çocukluk çağı obezitesinin tedavisini ele alan kanıta dayalı çalışmalar fazla değildir. Pediatrik çağda, obezite sorununun çözümüne yönelik çabalar primer koruma sağlayarak obezite oluşumunu önlemeye yöneliktir. Bugünün çocuklarının yarının yetişkinleri olacağı hatırlanmalıdır.

Obezite nedeniyle başvuran çocuklarda öncelikle detaylı anamnez ve fizik muayene yapılarak obezitenin olası nedenlerine yönelik inceleme yapılmalıdır. Obezitenin ilişkili olduğu; özellikle kardiyovasküler ve metabolik hastalıklar açısından riskler değerlendirilmeli, kapsamlı değerlendirme ile eşlik edebilecek diğer hastalıklar araştırılmalıdır.

Obezite yönetimi ve tedavisinde; klinisyen gerekli klinik değerlendirmeleri yaparak aileye sağlıklı diyet ve yaşam tarzı alışkanlıklarını kazandırmaya çalışır. Burada önemli nokta klinisyenin obezitenin erken teşhis ve tedavisinde aileye yol gösterici olmasıdır. Güncel gelişmeler ışığında obezitenin bütüncül yaklaşım ile klinik yönetimi sağlanmalıdır.

Ebeveynler, obezite ile ilgili sorunlar belirginleşene kadar fark etmeyebilirler. Pediatrik çağda obezite nedenleri ve sonuçları ile ilgili, toplumun farkındalığı sağlanmalı ve halk sağlığına yönelik girişimler sürdürülerek toplum bilinçlendirilmelidir. Ebeveynlerin farkındalığına yönelik girişimler de koruyucu önlemler arasındadır. Gerektiğinde obezitesi olan çocuklara hem erken çocukluk hem de ergenlik döneminde psikososyal destek de sağlanmalıdır.

Obezite tedavisi uzun sürelidir ve hem ailenin, hem çocuğun, hem de hekim ve multidisipliner sağlık hizmeti sunucularının büyük çabasını ve motivasyonunu gerektirmektedir. Obezitesi olan çocukların klinik yönetiminde, güncel eğitimleri almış ekipler olmalıdır.

Klinisyenler; sürekli bakımı sağlamak için gereken klinik destek ile gerektiğinde üçüncü basamağa kolaylaştırılmış sevk imkânlarına da sahip olmalılardır.

''Birinci Basamak Yaklaşımıyla Pediatrik Obezitenin Multidisipliner Yönetimi'' ile ilgili kitabımızda; birinci basamakta çocukluk çağı obezitesinin önlenmesi, tanısal yaklaşım, ayırıcı tanı, eşlik eden hastalıkların tanınması, obezitenin klinik yönetimi ile tedavi yaklaşımları için tıbbi bilgiler ve öneriler sağlanması amaçlanmıştır.

Doç. Dr. Meltem EROL
Editör

Doç. Dr. Didem KAFADAR
Editör
Obesity in pediatric period has become a growing global public health and one of the important issues of health policies. In recent decades, childhood obesity is continously increasing but there is no definite treatment protochol yet. Obesity is common in developing and underdeveloped countries as well as developed countries. Decreased physical activity due to technologic developments and increased use of digital machines along with unhealthy diets and dietary patterns play a role in the increasing prevalence of obesity.

In literature, there is not much evidence based studies about treatment of childhood obesity. Efforts towards dealing with childhood obesity are mainly for primary prevention of obesity. It should be remembered that today's children will be tomorrow's adults.

In children presenting with obesity, first of all, a detailed anamnesis and physical examination should be performed, and potential causes of obesity should be examined. The risks associated with obesity, especially in terms of cardiovascular and metabolic diseases, should be evaluated, and through a comprehensive evaluation other accompanying diseases should be investigated.

In the management and treatment of obesity, the clinician helps the family in adopting healthy diet and lifestyle habits by conducting the necessary clinical evaluations. The important point here is that the clinician guides the family in the early diagnosis and treatment of obesity. In the light of current developments, clinical management of obesity should be provided in terms of holistic approach.

Parents may not realize obesity-related problems until they are manifest. Public awareness should be raised about the causes and consequences of childhood obesity and initiatives regarding public health.should be made to increase public awareness. Initiatives to raise awareness of parents are also among protective measures. If necessary, children with obesity should be provided with psychosocial support during both early childhood and adolescence.

Treatment of obesity is long-termed and require great effort and motivation of the family, the child, the physician and multidisplinary health care providers. There should be teams with up-to-date training in clinical management of children with obesity.

Clinicians should have the clinical support in order to provide ongoing care, and also facilitated tertiary hospital referrals when needed.

In our book on ''Primary Care Approach to Multidisciplinary Management of Pediatric Obesity'', we aimed to provide medical information and recommendations for the prevention of childhood obesity in primary care, diagnostic approaches, differential diagnosis, recognition of comorbidities, clinical management of obesity and treatment procedures.

Assoc. Prof. Dr. Meltem EROL
Editor

Assoc. Prof. Dr. Didem KAFADAR
Editor

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