Obesity in children

The prevalence of obesity in children is rising and more evidence emerging about risks to health caused by being obese.

Causes:

Overeating and sedentary lifestyle is the commonest reason

 

Endocrine causes:

– Hypothyroidism

– Cushings disease

– Polycystic ovarian disease

– Growth Hormone deficiency

 

Syndromes associated with obesity:

– Prader Willi Synd

– Bardet- Biedl synd

– Downs Synd

– Others with Learning Disability

– Other genes being reported

 

Medications likeValproate, Resperidone, Oral contraceptives and Corticosteroids

History:

– What are family’s ideas, concerns and expectations

– When did child start putting on weight?

– What factors do parents consider responsible

– Dietary habits: types, frequency, portions, snacks

– Physical activity: average hours/ week, intensity, variety

– Screen time- which, when, average hours/ day

– Sleep- duration, difficulties

 

Enquire about associated complications:

– Breathing issues & exercise capacity

– Obstructive sleep apnoea

– Diabetes

– Joint pains, SUFE

– Menstrual problems

– Headaches/ visual issues

– Emotional issues / bullying

Examination:

– Plot Wt, Ht & BMI centile

– Record BP at each visit

– Generalised / truncal obesity?

– Stretch marks?

– Acanthosis nigricans?

– Any dysmorphism?

– Tanner stage of puberty

– Systems exam

Refer to secondary care if:

– BMI >99.6th centile (or >98th centile in under 6 months age)

– BMI >98th centile with associated comorbidities

 

Investigations:

Generally no tests required if 

– simple generalised obesity 

– of dietary origin

Test for metabolic synd:

– U&E, LFT, TSH, HbA1c

– Fasting lipids, Glucose, Insulin

If PCOS suspected:

– FSH, LH, Testosterone, Oestradiol, SHBG

– Pelvic USS

Genetic testing if dysmorphism?

Overnight sleep SaO2 for OSA?

Management:

Identify individual risk factors

– Understand motivators & beliefs

– Education on 

    – understanding BMI, 

    – possible complications

 

Involve dietician & psychologist

 

Set SMART dietary goals for healthy eating:

– Food types, 

– Total calories & 

– Food portions

 

Increase exercise:

– gradually

– variety of sports

– moderate intensity

– local clubs, sports activities

 

Psychological support to:

– Find motivations to reduce BMI

– Manage emotional difficulties

– Changes that families can adopt

 

Interventions for complications:

– CPAP for OSA?

– Metformin for prediabetes

– Monitor hyperlipidaemia

– Orlistat for selective cases

– Bariatric surgery selectively?