Paediatrics: Obesity: management

Obesity: management

Evaluation and investigations

This includes taking a detailed clinical and family history.

·  Birth weight (note: small for gestational age).

·  Feeding habits and behaviour: particularly infancy/early childhood.

Hyperphagia: may suggest genetic cause.

·  Weight gain/growth pattern (check previous health records).

·  Physical activity.

·  Neurodevelopment and school performance.

·  Screen for comorbid factors (see Complications and comorbid conditions).

·  Family history: obesity; T2DM; cardiovascular disease.

Laboratory investigations are directed at excluding secondary causes of obesity:

·  Blood biochemistry: thyroid function test; serum cortisol; liver function test; fasting lipid profile.

·  Genetic studies (e.g. Prader–Willi syndrome).

·  Oral glucose tolerance test.

Complications and comorbid conditions

Severe obesity is associated with the following comorbid conditions, which should be screened for at the time of assessment.

·  Pyschological: low self-esteem; depression.

·  ENT/respiratory: obstructive sleep apnoea; obesity–hypoventilation syndrome; pulmonary hypertension.

·  Orthopaedic: bowing of legs; slipped femoral epiphysis; osteoarthritis.

·  Metabolic: impaired glucose tolerance/type 2 diabetes; hypertension; dyslipidaemia; polycystic ovarian syndrome.

·  Hepatic: non-alcoholic steatohepatitis.

Obesity and oral glucose tolerance testing

In children and adolescents with obesity the prevalences of impaired glu-cose tolerance (IGT) and T2DM have been estimated to be in the region of 20–25% and 4%, respectively.

An oral glucose tolerance test should be considered when one or more of the following risk factors are present.

·  Severe obesity: BMI >98th centile

·  Acanthosis nigricans.

·  Positive family history of T2DM.

·  Ethnic origin: Asian/Afro-Caribbean/African-American.

·  Polycystic ovarian syndrome.

·  Hypertension.

Management

There is currently no consensus on the best approach to treating child-hood obesity. Treatment requires a multidisciplinary approach.

·Nutrition and lifestyle education/counselling: important.

·Decreasing calorie intake/increasing exercise.

·Behaviour modification and family therapy strategies.

·Drug therapies (currently limited, not licensed for children).

·Obesity (bariatric) surgery (rarely).

Population-based intervention and prevention strategies may be more effective than approaches targeted at the obese individual.