PEDIATRIC OBESITY

Objectives

Definition.
Criteria
Etiology
Evaluation
Complication.
Management.
 Definition

A condition where excess body fat

negatively affects a child's health with
short term and long term complications .
Obesity implies excessive fat but not merely
excessive weight
The diagnosis of obesity is based
on BMI.
 CRITERIA

1.BMI
. BMI = weight in kg/height in metres2
. is expressed as a BMI centile in relation to age
and sex-matched population.
For clinical use:
. overweight is a BMI >85th centile.
. Obese is a BMI >95th centile.
BMI for Children and Teens

Age- and sex-specific

Plot BMI on growth chart to find percentile
Weight status determined by percentile

Weight Status
Percentile Range
Category
Obese 95th percentile
85th to < 95th
Overweight
percentile
5th to < 85th
Normal
2. WEIGHT FOR HEIGHT
. Comperes childs weight for expected weight
for his/her height.
. W/H more than 120% is obesity.
3. SKIN FOLD THICKNESS
. Measured over triceps,biceps and
subscapular regions.
. For a given age >85th percentile is obedity.
4. WAIST CIRCUMFERENCE
. Indicates abdominal fat, indicating metabolic
obesity.
 Causes
Childhood obesity mainly due to environmental and
genetic cause but rarely due to pathological
condition.
1. CONSTITUTIONAL
Environmental causes(95% cases)
2. PATHOLOGICAL(<1% cases)
Endocrine : cushing syndrome, hypothyroidism
Hypothalammic: head injury, infection, brain tumor,
radiation
Drugs: steroids , estrogens, anti epileptics
Genetic syndromes: prader-willi, Carpenter, Laurence moon
biedl
Monogenic disorders : leptin deficeiency
 EVALUATION

Initial step is to differentiate between constitutional and

pathological
Normal growth, no developmental delay, generalized
indicates constitutional obesity against need for
investigations.

FEATURE Constitutional Pathological

Distribution Generalized Usually central
Growth Accelerated Retarded
Bone age Advanced Retarded
Dysmorphism Absent May be present
 CLINICAL EVALUATION:
Family history
History for diet and physical actuvity
Increased appetite with recent onset = hypothalamic cause
History of neurosurgery , trauma
Drug history
Examination

Feature Etiology

Hypogonadism Prader-willi

Retinitis pigmentosa Laurence moon biedl

Polydactyly Alstrom syndrome

Buffalo hump , striae Cushing syndrome

 INVESTIGATIONS
Decided on the basis of degree of
obesity and complications:
Endocrine investigations for growth
failure, clinical features, developmental
delay
Screen for complications if BMI >95th
centile
Investigate if family h/x of DM and
cardiac disease
 Complications of obesity
Complications of obesity in children and adolescents
can affect virtually every major organ system.
Medical complications usually are related to the
degree of obesity and usually decrease in severity or
resolve with weight reduction.

Systems Complications
CNS Benign intracranial hypertension
RESPI Obstructive sleep apnoea
CVS Atherosclerosis, hypertension
Hepatobiliary Gall stones, fatty liver
Endocrine Polycystic ovary, DM, dyslipedemia
Orthopedic Osteoarthritis, blount disease
 MANAGEMENT
DIETARY MEASURES:
Calorie restriction
Avoid junk foods, carbonated drinks, saturated fats
Increase fibre ,fruit and vegetable intake.
LIFESTYLE MODIFICATION
Increase physical activity
Decrease sedentary life
Encourage outdoor games
DRUGS:
Orlistat
Metformin
Octreotide
 MANAGEMENT
SURGERY:
Indicated when other measures have failed
Laparoscopic gastric banding(procedure of choice)
Gastric bypass
Questions