Paediatrics: Obesity - management

2021-03-03 12:00 AM

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 a 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.

  • Psychological: 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 glucose 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 childhood 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 an obese individual.