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Chapter: Paediatrics: Endocrinology and diabetes

Paediatrics: Obesity: management

This includes taking a detailed clinical and family history.

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.



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.


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