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?