"childhood obesity" management

childhood obesity 2024 AAP guidelines treatment management

ls /home/daytona/workspace/ 2>/dev/null && echo "OK"

mkdir -p /home/daytona/workspace/childhood-obesity-ppt && echo "dir created"

~/childhood-obesity-ppt/create_ppt.js

const pptxgen = require("pptxgenjs");
const pres = new pptxgen();
pres.layout = "LAYOUT_16x9";
pres.title = "Childhood Obesity";
pres.author = "Paediatric Seminar";

// ─── COLOUR PALETTE ───────────────────────────────────────────────────────────
const C = {
  navy:    "0D2B45",   // dominant dark
  teal:    "0E7C7B",   // supporting
  amber:   "F4A261",   // accent / highlights
  cream:   "FDF6EC",   // light bg
  white:   "FFFFFF",
  textDark:"1A1A2E",
  textMid: "3A4A5C",
  red:     "C0392B",
  green:   "27AE60",
  slate:   "ECF0F1",
};

// ─── REUSABLE HELPERS ─────────────────────────────────────────────────────────
function slideHeader(slide, title, subtitle) {
  // dark navy banner at top
  slide.addShape(pres.shapes.RECTANGLE, {
    x: 0, y: 0, w: 10, h: 1.0,
    fill: { color: C.navy }, line: { color: C.navy }
  });
  slide.addText(title, {
    x: 0.35, y: 0.08, w: 9.3, h: 0.84,
    fontSize: 22, bold: true, color: C.white,
    fontFace: "Calibri", valign: "middle", margin: 0
  });
  if (subtitle) {
    slide.addShape(pres.shapes.RECTANGLE, {
      x: 0, y: 1.0, w: 10, h: 0.32,
      fill: { color: C.teal }, line: { color: C.teal }
    });
    slide.addText(subtitle, {
      x: 0.35, y: 1.0, w: 9.3, h: 0.32,
      fontSize: 11, color: C.white, italic: true,
      fontFace: "Calibri", valign: "middle", margin: 0
    });
  }
}

function accentBar(slide) {
  slide.addShape(pres.shapes.RECTANGLE, {
    x: 0, y: 5.35, w: 10, h: 0.28,
    fill: { color: C.amber }, line: { color: C.amber }
  });
  slide.addText("Childhood Obesity  |  Paediatric Seminar", {
    x: 0.3, y: 5.35, w: 9.4, h: 0.28,
    fontSize: 9, color: C.navy, fontFace: "Calibri",
    valign: "middle", margin: 0
  });
}

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 1 – TITLE
// ═══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  // full dark bg
  s.addShape(pres.shapes.RECTANGLE, {
    x: 0, y: 0, w: 10, h: 5.625,
    fill: { color: C.navy }, line: { color: C.navy }
  });
  // teal accent strip left
  s.addShape(pres.shapes.RECTANGLE, {
    x: 0, y: 0, w: 0.18, h: 5.625,
    fill: { color: C.teal }, line: { color: C.teal }
  });
  // amber accent strip bottom
  s.addShape(pres.shapes.RECTANGLE, {
    x: 0, y: 5.0, w: 10, h: 0.625,
    fill: { color: C.amber }, line: { color: C.amber }
  });
  // main title
  s.addText("CHILDHOOD OBESITY", {
    x: 0.5, y: 1.4, w: 9, h: 1.1,
    fontSize: 44, bold: true, color: C.white,
    fontFace: "Calibri", align: "center", charSpacing: 3
  });
  // subtitle
  s.addText("A Comprehensive Paediatric Seminar", {
    x: 0.5, y: 2.55, w: 9, h: 0.55,
    fontSize: 20, color: C.amber, italic: true,
    fontFace: "Calibri", align: "center"
  });
  // sub-line
  s.addText("Definition  |  Aetiology  |  Complications  |  Management", {
    x: 0.5, y: 3.2, w: 9, h: 0.4,
    fontSize: 13, color: "A0B8CC",
    fontFace: "Calibri", align: "center"
  });
  // date
  s.addText("July 2026", {
    x: 0.5, y: 5.05, w: 9, h: 0.45,
    fontSize: 12, color: C.navy,
    fontFace: "Calibri", align: "center", bold: true
  });
}

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 2 – EPIDEMIOLOGY
// ═══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.addShape(pres.shapes.RECTANGLE, { x:0,y:0,w:10,h:5.625, fill:{color:C.cream}, line:{color:C.cream} });
  slideHeader(s, "EPIDEMIOLOGY", "A Growing Global Health Crisis");

  // 3 stat boxes
  const boxes = [
    { val: "390M+", label: "Children & adolescents\nliving with obesity worldwide", col: C.navy },
    { val: "2-3×", label: "Prevalence has tripled\nsince the 1970s", col: C.teal },
    { val: "70%", label: "Obese children become\nobese adults", col: C.amber },
  ];
  boxes.forEach((b, i) => {
    const x = 0.4 + i * 3.2;
    s.addShape(pres.shapes.ROUNDED_RECTANGLE, {
      x, y: 1.5, w: 2.9, h: 2.4,
      fill: { color: b.col }, rectRadius: 0.12,
      shadow: { type:"outer", color:"000000", blur:8, offset:3, angle:135, opacity:0.18 }
    });
    s.addText(b.val, {
      x, y: 1.65, w: 2.9, h: 0.9,
      fontSize: 36, bold: true, color: C.white,
      fontFace: "Calibri", align: "center"
    });
    s.addText(b.label, {
      x, y: 2.55, w: 2.9, h: 1.2,
      fontSize: 13, color: C.white,
      fontFace: "Calibri", align: "center"
    });
  });

  s.addText("WHO 2022 | Lancet Child & Adolescent Health", {
    x: 0.4, y: 4.15, w: 9.2, h: 0.3,
    fontSize: 9, color: C.textMid, italic: true, align: "center"
  });
  accentBar(s);
}

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 3 – DEFINITION & CLASSIFICATION
// ═══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.addShape(pres.shapes.RECTANGLE, { x:0,y:0,w:10,h:5.625, fill:{color:C.cream}, line:{color:C.cream} });
  slideHeader(s, "DEFINITION & CLASSIFICATION", "BMI for Age – WHO / CDC Growth Charts");

  // table rows
  const rows = [
    { cat: "Underweight",    bmi: "< 5th percentile",          col: "3498DB" },
    { cat: "Healthy Weight", bmi: "5th – < 85th percentile",   col: C.green },
    { cat: "Overweight",     bmi: "≥ 85th – < 95th percentile", col: "E67E22" },
    { cat: "Obese",          bmi: "≥ 95th percentile",          col: C.red },
  ];

  // header row
  s.addShape(pres.shapes.RECTANGLE, { x:0.5, y:1.55, w:4.0, h:0.42, fill:{color:C.navy}, line:{color:C.navy} });
  s.addShape(pres.shapes.RECTANGLE, { x:4.6, y:1.55, w:5.0, h:0.42, fill:{color:C.navy}, line:{color:C.navy} });
  s.addText("BMI CATEGORY", { x:0.5, y:1.55, w:4.0, h:0.42, fontSize:12, bold:true, color:C.white, fontFace:"Calibri", align:"center", valign:"middle", margin:0 });
  s.addText("BMI FOR AGE (≥ 2 years)", { x:4.6, y:1.55, w:5.0, h:0.42, fontSize:12, bold:true, color:C.white, fontFace:"Calibri", align:"center", valign:"middle", margin:0 });

  rows.forEach((r, i) => {
    const y = 2.05 + i * 0.52;
    const bgC = i % 2 === 0 ? C.white : C.slate;
    s.addShape(pres.shapes.RECTANGLE, { x:0.5, y, w:4.0, h:0.48, fill:{color:bgC}, line:{color:"CCCCCC"} });
    s.addShape(pres.shapes.RECTANGLE, { x:4.6, y, w:5.0, h:0.48, fill:{color:bgC}, line:{color:"CCCCCC"} });
    // coloured left indicator
    s.addShape(pres.shapes.RECTANGLE, { x:0.5, y, w:0.12, h:0.48, fill:{color:r.col}, line:{color:r.col} });
    s.addText(r.cat, { x:0.68, y, w:3.82, h:0.48, fontSize:13, bold:true, color:C.textDark, fontFace:"Calibri", valign:"middle", margin:4 });
    s.addText(r.bmi, { x:4.6, y, w:5.0, h:0.48, fontSize:13, color:C.textDark, fontFace:"Calibri", valign:"middle", align:"center", margin:4 });
  });

  // note box
  s.addShape(pres.shapes.ROUNDED_RECTANGLE, {
    x:0.5, y:4.2, w:9.0, h:0.55,
    fill:{color:"FFF3CD"}, line:{color:C.amber}, rectRadius:0.08
  });
  s.addText([
    {text:"Key: ", options:{bold:true, color:C.navy}},
    {text:"< 2 yrs: use Weight-for-Length; No consensus definition for obesity  |  ≥ 2 yrs: CDC charts  |  BMI crossing 2 percentile lines upward = early warning", options:{color:C.textDark}}
  ], { x:0.6, y:4.2, w:8.8, h:0.55, fontSize:10, fontFace:"Calibri", valign:"middle", margin:4 });

  accentBar(s);
}

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 4 – AETIOLOGY
// ═══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.addShape(pres.shapes.RECTANGLE, { x:0,y:0,w:10,h:5.625, fill:{color:C.cream}, line:{color:C.cream} });
  slideHeader(s, "AETIOLOGY", "Antecedents · Triggers · Perpetuators");

  const cols = [
    {
      title: "GENETIC (Antecedents)", col: C.navy,
      items: ["Ob gene (chr 7) – leptin pathway","FTO gene (chr 16) – most studied GWAS locus","MC4R defect – most common single-gene cause (~5%)","BDNF gene – Mendelian obesity","PPAR-γ, ADRB2/3, GAD2 genes"]
    },
    {
      title: "ENVIRONMENTAL (Triggers)", col: C.teal,
      items: ["High fructose / high GI diet","Food insecurity & ultra-processed foods","Excess screen time & sedentary lifestyle","Maternal diabetes / gestational weight gain","BPA & endocrine disruptors"]
    },
    {
      title: "PERPETUATORS", col: "8E44AD",
      items: ["Poor/inadequate sleep (disrupted chronobiology)","Obstructive sleep apnoea","Psychosocial stress","Minimal physical activity","Gut microbiome dysbiosis (2025 evidence)"]
    },
  ];

  cols.forEach((col, i) => {
    const x = 0.22 + i * 3.26;
    s.addShape(pres.shapes.RECTANGLE, { x, y:1.42, w:3.1, h:0.42, fill:{color:col.col}, line:{color:col.col} });
    s.addText(col.title, { x, y:1.42, w:3.1, h:0.42, fontSize:10.5, bold:true, color:C.white, fontFace:"Calibri", align:"center", valign:"middle", margin:0 });
    s.addShape(pres.shapes.RECTANGLE, { x, y:1.84, w:3.1, h:3.0, fill:{color:C.white}, line:{color:col.col} });
    const items = col.items.map((t, j) => ({
      text: t,
      options: { bullet:{type:"bullet"}, breakLine: j < col.items.length-1, fontSize:11.5, color:C.textDark, fontFace:"Calibri" }
    }));
    s.addText(items, { x:x+0.1, y:1.9, w:2.9, h:2.85, margin:6 });
  });

  accentBar(s);
}

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 5 – SECONDARY CAUSES
// ═══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.addShape(pres.shapes.RECTANGLE, { x:0,y:0,w:10,h:5.625, fill:{color:C.cream}, line:{color:C.cream} });
  slideHeader(s, "SECONDARY CAUSES TO EXCLUDE", "Short stature + obesity = endocrine cause until proven otherwise");

  const causes = [
    { name: "Hypothyroidism", clues: "Weight gain, cold intolerance, constipation, goitre, delayed DTRs, ↑TSH" },
    { name: "Cushing Syndrome", clues: "Central adiposity, moon face, buffalo hump, striae, hypertension, ↑cortisol" },
    { name: "Prader-Willi Syndrome", clues: "Hyperphagia, hypotonia, cognitive delay, small hands/feet, chromosome 15 deletion" },
    { name: "GH Deficiency", clues: "Short stature, central adiposity, ↓IGF-1, delayed bone age" },
    { name: "Insulinoma", clues: "Hypoglycaemia, weight gain, ↑C-peptide & insulin" },
    { name: "Medications", clues: "Corticosteroids, antipsychotics, antidepressants, anticonvulsants" },
  ];

  causes.forEach((c, i) => {
    const row = Math.floor(i / 2);
    const colN = i % 2;
    const x = 0.3 + colN * 4.9;
    const y = 1.55 + row * 1.15;
    s.addShape(pres.shapes.ROUNDED_RECTANGLE, {
      x, y, w:4.55, h:1.0,
      fill:{color:C.white}, line:{color:C.teal}, rectRadius:0.1,
      shadow:{type:"outer",color:"000000",blur:5,offset:2,angle:135,opacity:0.12}
    });
    s.addShape(pres.shapes.RECTANGLE, { x, y, w:0.14, h:1.0, fill:{color:C.teal}, line:{color:C.teal} });
    s.addText(c.name, { x:x+0.22, y:y+0.04, w:4.25, h:0.32, fontSize:13, bold:true, color:C.navy, fontFace:"Calibri", margin:0 });
    s.addText(c.clues, { x:x+0.22, y:y+0.36, w:4.25, h:0.58, fontSize:10, color:C.textMid, fontFace:"Calibri", margin:0 });
  });

  accentBar(s);
}

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 6 – COMPLICATIONS
// ═══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.addShape(pres.shapes.RECTANGLE, { x:0,y:0,w:10,h:5.625, fill:{color:C.cream}, line:{color:C.cream} });
  slideHeader(s, "COMPLICATIONS & COMORBIDITIES", "Multi-system impact across all organ systems");

  const systems = [
    { sys:"Endocrine", col:"E74C3C", items:["PCOS","Precocious puberty","Pre-diabetes / T2DM","Insulin resistance"] },
    { sys:"Cardiovascular", col:"C0392B", items:["Hypertension","Dyslipidaemia","Early atherosclerosis"] },
    { sys:"GI / Hepatic", col:C.teal, items:["NAFLD / NASH","Cholelithiasis","GORD"] },
    { sys:"Neurological", col:"8E44AD", items:["Pseudotumor cerebri","OSA-related cognitive effects"] },
    { sys:"Orthopaedic", col:"E67E22", items:["Blount disease","SCFE ⚠ urgent","Legg-Calvé-Perthes disease"] },
    { sys:"Psychosocial", col:"2980B9", items:["Depression & anxiety","Binge eating disorder","Bullying / low self-esteem"] },
  ];

  systems.forEach((sys, i) => {
    const col = i % 3;
    const row = Math.floor(i / 3);
    const x = 0.22 + col * 3.26;
    const y = 1.42 + row * 1.85;
    s.addShape(pres.shapes.RECTANGLE, { x, y, w:3.1, h:0.38, fill:{color:sys.col}, line:{color:sys.col} });
    s.addText(sys.sys.toUpperCase(), { x, y, w:3.1, h:0.38, fontSize:11, bold:true, color:C.white, fontFace:"Calibri", align:"center", valign:"middle", margin:0 });
    s.addShape(pres.shapes.RECTANGLE, { x, y:y+0.38, w:3.1, h:1.4, fill:{color:C.white}, line:{color:sys.col} });
    const items = sys.items.map((t, j) => ({
      text: t, options: { bullet:{type:"bullet"}, breakLine: j < sys.items.length-1, fontSize:11, color: t.includes("⚠") ? C.red : C.textDark, bold: t.includes("⚠"), fontFace:"Calibri" }
    }));
    s.addText(items, { x:x+0.1, y:y+0.42, w:2.95, h:1.3, margin:5 });
  });

  accentBar(s);
}

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 7 – ASSESSMENT
// ═══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.addShape(pres.shapes.RECTANGLE, { x:0,y:0,w:10,h:5.625, fill:{color:C.cream}, line:{color:C.cream} });
  slideHeader(s, "ASSESSMENT", "History · Examination · Investigations");

  // Left panel – History + Examination
  s.addShape(pres.shapes.RECTANGLE, { x:0.3, y:1.42, w:4.55, h:3.7, fill:{color:C.white}, line:{color:C.navy} });
  s.addShape(pres.shapes.RECTANGLE, { x:0.3, y:1.42, w:4.55, h:0.38, fill:{color:C.navy}, line:{color:C.navy} });
  s.addText("HISTORY & EXAMINATION", { x:0.3, y:1.42, w:4.55, h:0.38, fontSize:11, bold:true, color:C.white, fontFace:"Calibri", align:"center", valign:"middle", margin:0 });

  const hxItems = [
    {text:"📋 HISTORY", options:{bold:true, breakLine:true, fontSize:11, color:C.teal, fontFace:"Calibri"}},
    {text:"Dietary history (24-hr recall, food diary)", options:{bullet:{type:"bullet"}, breakLine:true, fontSize:10.5, color:C.textDark, fontFace:"Calibri"}},
    {text:"Screen time & physical activity", options:{bullet:{type:"bullet"}, breakLine:true, fontSize:10.5, color:C.textDark, fontFace:"Calibri"}},
    {text:"Sleep (snoring, apnoeas)", options:{bullet:{type:"bullet"}, breakLine:true, fontSize:10.5, color:C.textDark, fontFace:"Calibri"}},
    {text:"Family history (obesity, T2DM, CVD)", options:{bullet:{type:"bullet"}, breakLine:true, fontSize:10.5, color:C.textDark, fontFace:"Calibri"}},
    {text:"Medications (steroids, antipsychotics)", options:{bullet:{type:"bullet"}, breakLine:true, fontSize:10.5, color:C.textDark, fontFace:"Calibri"}},
    {text:"🔍 EXAMINATION", options:{bold:true, breakLine:true, fontSize:11, color:C.teal, fontFace:"Calibri"}},
    {text:"Weight, height, BMI – plot on growth chart", options:{bullet:{type:"bullet"}, breakLine:true, fontSize:10.5, color:C.textDark, fontFace:"Calibri"}},
    {text:"Blood pressure", options:{bullet:{type:"bullet"}, breakLine:true, fontSize:10.5, color:C.textDark, fontFace:"Calibri"}},
    {text:"Acanthosis nigricans (insulin resistance)", options:{bullet:{type:"bullet"}, breakLine:true, fontSize:10.5, color:C.textDark, fontFace:"Calibri"}},
    {text:"Tanner staging (puberty)", options:{bullet:{type:"bullet"}, breakLine:true, fontSize:10.5, color:C.textDark, fontFace:"Calibri"}},
    {text:"Waist circumference (central adiposity)", options:{bullet:{type:"bullet"}, fontSize:10.5, color:C.textDark, fontFace:"Calibri"}},
  ];
  s.addText(hxItems, { x:0.4, y:1.85, w:4.35, h:3.2, margin:5 });

  // Right panel – Investigations table
  s.addShape(pres.shapes.RECTANGLE, { x:5.15, y:1.42, w:4.55, h:3.7, fill:{color:C.white}, line:{color:C.navy} });
  s.addShape(pres.shapes.RECTANGLE, { x:5.15, y:1.42, w:4.55, h:0.38, fill:{color:C.navy}, line:{color:C.navy} });
  s.addText("INVESTIGATIONS BY BMI", { x:5.15, y:1.42, w:4.55, h:0.38, fontSize:11, bold:true, color:C.white, fontFace:"Calibri", align:"center", valign:"middle", margin:0 });

  const invRows = [
    { cat:"Overweight", tests:"Fasting glucose/HbA1c/OGTT\nFasting lipids, ALT, AST\nTFTs, cortisol if indicated", col:"E67E22" },
    { cat:"Obese", tests:"All of above +\nVitamin D, fasting insulin\nConsider TFTs, cortisol", col:C.red },
    { cat:"Rising BMI\n(crossing 2 lines)", tests:"Fasting glucose/HbA1c\nLipid profile, ALT, AST\nif risk factors present", col:"F39C12" },
  ];
  invRows.forEach((r, i) => {
    const y = 1.88 + i * 1.08;
    s.addShape(pres.shapes.RECTANGLE, { x:5.15, y, w:1.5, h:1.0, fill:{color:r.col}, line:{color:r.col} });
    s.addText(r.cat, { x:5.15, y, w:1.5, h:1.0, fontSize:10.5, bold:true, color:C.white, fontFace:"Calibri", align:"center", valign:"middle", margin:4 });
    s.addShape(pres.shapes.RECTANGLE, { x:6.65, y, w:3.05, h:1.0, fill:{color:i%2===0?C.slate:C.white}, line:{color:"CCCCCC"} });
    s.addText(r.tests, { x:6.72, y:y+0.04, w:2.95, h:0.92, fontSize:10, color:C.textDark, fontFace:"Calibri", valign:"middle", margin:4 });
  });

  accentBar(s);
}

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 8 – PREVENTION (AAP)
// ═══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.addShape(pres.shapes.RECTANGLE, { x:0,y:0,w:10,h:5.625, fill:{color:C.cream}, line:{color:C.cream} });
  slideHeader(s, "PREVENTION – AAP RECOMMENDATIONS", "American Academy of Pediatrics Guidelines");

  const steps = [
    { num:"1", text:"Exclusive breastfeeding until 6 months → continue ≥12 months", icon:"🤱" },
    { num:"2", text:"Daily breakfast + regular family mealtimes", icon:"🍳" },
    { num:"3", text:"Limit sugary drinks, fast food & energy-dense foods; encourage fruits & vegetables", icon:"🥦" },
    { num:"4", text:"Screen time: <18m = none; 18–24m = co-view; 2–5yr = max 1 hr/day", icon:"📱" },
    { num:"5", text:"≥60 minutes of moderate-to-vigorous physical activity every day", icon:"🏃" },
  ];

  steps.forEach((st, i) => {
    const y = 1.45 + i * 0.75;
    s.addShape(pres.shapes.ROUNDED_RECTANGLE, { x:0.3, y, w:9.4, h:0.65, fill:{color:C.white}, line:{color:C.teal}, rectRadius:0.1 });
    s.addShape(pres.shapes.ROUNDED_RECTANGLE, { x:0.3, y, w:0.62, h:0.65, fill:{color:C.teal}, line:{color:C.teal}, rectRadius:0.08 });
    s.addText(st.num, { x:0.3, y, w:0.62, h:0.65, fontSize:18, bold:true, color:C.white, fontFace:"Calibri", align:"center", valign:"middle", margin:0 });
    s.addText(st.icon + "  " + st.text, { x:1.02, y:y+0.04, w:8.55, h:0.57, fontSize:12.5, color:C.textDark, fontFace:"Calibri", valign:"middle", margin:4 });
  });

  accentBar(s);
}

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 9 – MANAGEMENT STEPPED APPROACH
// ═══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.addShape(pres.shapes.RECTANGLE, { x:0,y:0,w:10,h:5.625, fill:{color:C.cream}, line:{color:C.cream} });
  slideHeader(s, "MANAGEMENT – STEPPED APPROACH", "Escalation based on response at each 3–6 month interval");

  const steps = [
    { step:"STEP 1", title:"Primary Care Lifestyle Counselling", col:C.green, detail:"Motivational interviewing · Dietary advice · 60 min/day exercise\nWeight maintenance goals · No media < 18 months · Family involvement" },
    { step:"STEP 2", title:"Structured Multidisciplinary Programme", col:"F39C12", detail:"Hypocaloric diet (−500 kcal/day) · High GI food restriction\nBehavioural therapy · Food diary · Family-based intervention" },
    { step:"STEP 3", title:"Pharmacotherapy (Specialist referral)", col:"E67E22", detail:"Orlistat ≥12 yr · Metformin (insulin resistance/prediabetes) · Liraglutide (GLP-1, ≥12 yr)\nAdjunct to lifestyle only — NOT a replacement" },
    { step:"STEP 4", title:"Bariatric Surgery (Tertiary centre)", col:C.red, detail:"BMI ≥40 OR ≥35 + severe comorbidity · Tanner stage 4–5\nRYGB or sleeve gastrectomy · All other steps must have failed" },
  ];

  steps.forEach((st, i) => {
    const y = 1.42 + i * 0.98;
    s.addShape(pres.shapes.RECTANGLE, { x:0.3, y, w:1.6, h:0.85, fill:{color:st.col}, line:{color:st.col} });
    s.addText(st.step, { x:0.3, y, w:1.6, h:0.85, fontSize:14, bold:true, color:C.white, fontFace:"Calibri", align:"center", valign:"middle", margin:0 });
    s.addShape(pres.shapes.RECTANGLE, { x:1.9, y, w:7.8, h:0.85, fill:{color:C.white}, line:{color:st.col} });
    s.addText(st.title, { x:2.0, y:y+0.03, w:7.6, h:0.32, fontSize:13, bold:true, color:C.textDark, fontFace:"Calibri", valign:"middle", margin:2 });
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  accentBar(s);
}

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 10 – PHARMACOTHERAPY DETAIL
// ═══════════════════════════════════════════════════════════════════════════════
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  slideHeader(s, "PHARMACOTHERAPY IN PAEDIATRIC OBESITY", "Adjunct to lifestyle — always specialist-supervised");

  const drugs = [
    { name:"Orlistat", age:"≥12 years", mech:"Pancreatic lipase inhibitor\nReduces fat absorption ~30%", se:"Steatorrhoea, faecal urgency\nFat-soluble vitamin deficiency", note:"Only FDA-approved for adolescents" },
    { name:"Metformin", age:"≥10 years", mech:"Insulin sensitiser (biguanide)\nReduces hepatic glucose output", se:"GI upset, lactic acidosis (rare)\nVitamin B12 deficiency", note:"Preferred for T2DM/insulin resistance" },
    { name:"Liraglutide", age:"≥12 years", mech:"GLP-1 receptor agonist\nIncreases satiety, slows gastric emptying", se:"Nausea, vomiting\nPancreatitis (rare)", note:"~8% weight reduction; daily SC injection" },
  ];

  drugs.forEach((d, i) => {
    const x = 0.3 + i * 3.2;
    const headerCols = [C.navy, C.teal, "8E44AD"];
    s.addShape(pres.shapes.RECTANGLE, { x, y:1.42, w:3.05, h:0.55, fill:{color:headerCols[i]}, line:{color:headerCols[i]} });
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    s.addText("Age: " + d.age, { x, y:1.77, w:3.05, h:0.2, fontSize:10, color:C.white, fontFace:"Calibri", align:"center", italic:true, margin:0 });

    const sections = [
      { label:"Mechanism", text:d.mech, col:"EAF4FF" },
      { label:"Side Effects", text:d.se, col:"FFF0F0" },
      { label:"Note", text:d.note, col:"F0FFF4" },
    ];
    sections.forEach((sec, j) => {
      const y = 2.05 + j * 1.05;
      s.addShape(pres.shapes.RECTANGLE, { x, y, w:3.05, h:1.0, fill:{color:sec.col}, line:{color:"CCCCCC"} });
      s.addText(sec.label, { x:x+0.08, y:y+0.04, w:2.9, h:0.28, fontSize:10, bold:true, color:headerCols[i], fontFace:"Calibri", margin:2 });
      s.addText(sec.text, { x:x+0.08, y:y+0.3, w:2.9, h:0.65, fontSize:10, color:C.textDark, fontFace:"Calibri", margin:2 });
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  });

  accentBar(s);
}

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 11 – WEIGHT LOSS GOALS & MONITORING
// ═══════════════════════════════════════════════════════════════════════════════
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  s.addShape(pres.shapes.RECTANGLE, { x:0,y:0,w:10,h:5.625, fill:{color:C.cream}, line:{color:C.cream} });
  slideHeader(s, "WEIGHT GOALS & MONITORING", "Safe, age-appropriate targets — avoid rapid weight loss in children");

  // 2 big goal boxes
  s.addShape(pres.shapes.ROUNDED_RECTANGLE, { x:0.4, y:1.55, w:4.2, h:1.4, fill:{color:C.teal}, line:{color:C.teal}, rectRadius:0.15 });
  s.addText("≤ 1 lb / month", { x:0.4, y:1.55, w:4.2, h:0.85, fontSize:32, bold:true, color:C.white, fontFace:"Calibri", align:"center", valign:"middle" });
  s.addText("Children aged 2–5 years with obesity", { x:0.4, y:2.4, w:4.2, h:0.55, fontSize:13, color:C.white, fontFace:"Calibri", align:"center" });

  s.addShape(pres.shapes.ROUNDED_RECTANGLE, { x:5.4, y:1.55, w:4.2, h:1.4, fill:{color:C.navy}, line:{color:C.navy}, rectRadius:0.15 });
  s.addText("≤ 2 lbs / week", { x:5.4, y:1.55, w:4.2, h:0.85, fontSize:32, bold:true, color:C.white, fontFace:"Calibri", align:"center", valign:"middle" });
  s.addText("Older children & adolescents with obesity", { x:5.4, y:2.4, w:4.2, h:0.55, fontSize:13, color:C.white, fontFace:"Calibri", align:"center" });

  // monitoring checklist
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  const monitoring = [
    "Record weight & plot on growth chart",
    "Measure blood pressure",
    "Review dietary diary & screen time logs",
    "Motivational interviewing – empathetic, non-stigmatising style",
    "Reassess labs if BMI not improving at 3–6 months",
    "Refer to specialist multidisciplinary team if no improvement by 3–6 months",
  ];
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  s.addText(mitems, { x:0.55, y:3.57, w:9.0, h:1.4, margin:5 });

  accentBar(s);
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// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 12 – HIGH YIELD EXAM TABLE
// ═══════════════════════════════════════════════════════════════════════════════
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  slideHeader(s, "HIGH-YIELD EXAM FACTS", "Quick-recall table for paediatric exams");

  const facts = [
    ["Definition (≥2 yrs)", "BMI for age ≥ 95th percentile"],
    ["Overweight (≥2 yrs)", "BMI 85th – < 95th percentile"],
    ["Most common single-gene mutation", "MC4R defect (~5% of severe obesity)"],
    ["Orthopaedic emergency", "SCFE – hip/knee pain in obese adolescent → urgent referral"],
    ["Neurological complication", "Pseudotumor cerebri (idiopathic intracranial hypertension)"],
    ["Max weight loss (2–5 yrs)", "1 lb / month"],
    ["Max weight loss (older children)", "2 lbs / week"],
    ["First-line pharmacotherapy ≥12 yrs", "Orlistat (lipase inhibitor)"],
    ["Growth chart < 2 years", "WHO International Growth Charts"],
    ["Growth chart ≥ 2 years", "CDC Growth Charts"],
    ["Screen time < 18 months", "None (except video chatting)"],
  ];

  // header
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    s.addShape(pres.shapes.RECTANGLE, { x:4.9, y, w:4.8, h:0.32, fill:{color:bg}, line:{color:"CCCCCC"} });
    s.addText(topic, { x:0.36, y, w:4.38, h:0.32, fontSize:10, bold:true, color:C.textDark, fontFace:"Calibri", valign:"middle", margin:2 });
    s.addText(fact, { x:4.96, y, w:4.68, h:0.32, fontSize:10, color:C.textDark, fontFace:"Calibri", valign:"middle", margin:2 });
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}

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 13 – CONCLUSION
// ═══════════════════════════════════════════════════════════════════════════════
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  s.addShape(pres.shapes.RECTANGLE, { x:0,y:0,w:0.18,h:5.625, fill:{color:C.teal}, line:{color:C.teal} });
  s.addShape(pres.shapes.RECTANGLE, { x:0,y:5.0,w:10,h:0.625, fill:{color:C.amber}, line:{color:C.amber} });

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    fontSize:28, bold:true, color:C.amber, fontFace:"Calibri", align:"center", charSpacing:2
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  const takeaways = [
    "Childhood obesity = BMI for age ≥95th percentile (CDC charts ≥2 yrs)",
    "MC4R defect is the most common single-gene cause — always consider genetics",
    "Always exclude secondary causes: hypothyroidism, Cushing, Prader-Willi",
    "SCFE is an orthopaedic emergency in obese adolescents — urgent referral",
    "Management is stepped: lifestyle → multidisciplinary → pharmacotherapy → surgery",
    "AAP: 60 min/day exercise + screen time limits from infancy",
    "Weight loss targets must be age-specific — slow and safe",
    "Motivational interviewing: empathy over stigma at every visit",
  ];

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// ─── WRITE FILE ───────────────────────────────────────────────────────────────
pres.writeFile({ fileName: "/home/daytona/workspace/childhood-obesity-ppt/Childhood_Obesity_Seminar.pptx" })
  .then(() => console.log("✅ PPT created successfully"))
  .catch(err => console.error("❌ Error:", err));

cd /home/daytona/workspace/childhood-obesity-ppt && node create_ppt.js 2>&1

ls -lh /home/daytona/workspace/childhood-obesity-ppt/Childhood_Obesity_Seminar.p…