APPROACH TO CHILDHOOD

OBESITY

DR WARISHA IKHLAQ
CHILDHOOD OBESITY
 Epidemic – Widespread in population (adults
and children)

 Progressive – Childhood obesity becomes adult

obesity

 Alters Development – Physically, emotionally,

psychosocially

 Chronic disease – Lifelong morbidity
accelerates “adult” disease into childhood

 Increases morbidity/mortality – First

generation to have shorter lifespan than parents
EPIDEMIOLOGY
 In the past 30 years, the occurrence of overweight
in children has tripled.

 It is now estimated that one in five children in

the US is overweight
DEFINITION
 Overweight : defined as a BMI at or above the
85th percentile and lower than the 95th
percentile for children of the same age and sex.

 Obesity : defined as a BMI at or above the 95th

percentile for children of the same age and sex.

Barlow SE and the Expert Committee. Expert committee

recommendations regarding the prevention, assessment, and
treatment of child and adolescent overweight and obesity: summary
report. Pediatrics 2007;120 Supplement December 2007:S164—S192
ETIOLOGY
 Primary Obesity
 Cushing’s Syndrome

 Prader Willi Syndrome

 Bardet-Biedel Syndrome

 Pickwikian Syndrome

 Down Syndrome

 Polycystic Ovarian Syndrome

 Kallmann’s Syndrome

 Alstorm’s Syndrome
BARDET-BEIDEL SYNDROME
 Also known as Laurence-Moon-Biedl
syndrome
 It is ciliopathic human genetic disorder

 It is characterized principally by
 Obesity

 Mental Retardation

 Retinitis pigmentosa

 Polydactyly

 Hypogonadism

 Renal failure
PICKWIKIAN SYNDROME ( OBESITY
HYPOVENTILATION SYNDROME )
 It is a condition in which severely overweight
people fail to breathe rapidly enough or deeply
enough, resulting in low blood oxygen levels and high
blood CO2 levels

 The low oxygen level leads to excessive strain on the

right side of the heart, known as cor pulmonale

 The most important treatment is weight loss

 If the symptoms are significant, nighttime positive

airway pressure treatment is used
ALSTROM SYNDROME
 It is a rare Autosomal recessive disorder caused
by mutations in the gene ALMS1

 It is characterized by;
 Childhood obesity

 Blindness due to congenital retinal dystrophy

 Sensorineural hearing loss

 Early onset type 2 diabetes

HISTORY
 BIRTH WEIGHT

 FAMILY HISTORY

 NUTRITIONAL HISTORY

 PHYSICAL ACTIVITY

 SOCIOECONOMIC
OBSERVATION
 Introduce yourself

 Ask about his/her name and general questions

appropriate to his/her age

 Note any obvious sleepiness in response to your

questions ( Pickwickian Syndrome )

 Intellectual impairment ( PW, B-B, Down’s,

Untreated hypothyroidism )
INSPECTION
 OVERALL :
 Look for any
dysmorphism ( P-W, B-
B)

 FACE:
 Signs of androgen
excess in girls such as
hirsutism or acne
( PCOS )
 Moon face
 Coarse features
 Down Facies
 EYES:

 Eyebrows ( loss of outer

third in hypothyroidism)
 Almond shaped eyes
( PW )
 Squint ( PW )
 Visual acuity impaired
( B-B, Down )
 Visual field defects
( Pituitary tumor )
 NOSE :

 Anosmia
( Kallmann )

 Midline dimple
( Hypopituitarism )
 NECK :

 Goiter

 Supraclavicular fat
pad ( Cushing )

 Elevated JVP ( RVF

in Pickwikian )
 ABDOMEN:

 Striae ( Cushing )

 Hepatomegaly ( RVF
in Pickwikian )

 Adrenal mass
( Adrenal tumor )
 LOWER LIMB:

 Small feet ( PW )
 Skin: striae, bruises,
poor wound healing (
Cushing )
 Limb shortning ( SCFE
or avascular necrosis of
femoral head )
 External rotation at hip
( SCFE )
 Ankle edema ( RVF in
Pickwikian )
GROWTH PARAMETERS
 BMI : Weight in kg / Height in m2

 BMI-for-age percentile charts

 Waist-circumference-for-age percentile

 Weight-to-height ratio
SHORT OBESE CHILD
 Five Well known endocrine causes:

1. Cushing’s syndrome
2. Hypopituitarism
3. Hypothyroidism
4. Growth hormone deficiency
5. Pseudohypoparathyroidism
EXAMINATION
EXAMINATION
 Height:
 Short ( endocrine )
 Tall ( Simple obesity, Klinefelter )

 HEAD CIRCUMFERENCE:
 Enlarged ( Intracranial tumor, hydrocephalus with spina
bifida )

 Pulse:
 Slow ( hypothyroidism )
 Bounding ( CO2 retention in Pickwikian )

 Temperature:
 Cool ( hypothyroidism )
 Warm ( CO2 retention in Pickwikian )
 Respiratory rate:
 Hypoventilation ( Pickwikian )

 B.P monitoring:
 Hypertension ( Cushing )

 Eye Examination ( Fundoscopy ) :

 Visual acuity ( B-B )
 Visual field ( Pituitary tumor )
 Retinitis Pigmentosa ( B-B )
 Papilledema ( Pituitary tumor )
MANEUVERS
 Measure Limb Lengths
( for shortening )

 Hold arms up against

resistance ( proximal
myopathy in Cushing )

 Walk: Look for limp

with;
 Avascular necrosis (
Cushing )
 SCFE ( complication of
obesity )
 TRENDELENBERG’s
TEST :

 Positive with
Avascular necrosis or
SCFE
 HIP EXAMINATION:

 Limitation of internal rotation or abduction

( SCFE )

 Ankle jerks : Delayed in Hypothyroidism

INVESTIGATIONS:
 BMI >85% <94%
 Fasting lipid profile, AST, ALT q 2 years

 BMI >95%
 Fasting lipid profile, AST, ALT, fasting glucose q 2
years

 Urinalysis : Glucose ( PW, Cushing's )

 Laboratory evaluation as always depends on

clinical assessment.

American Academy of Pediatrics. Pediatric Obesity Clinical Decision Support Chart. Elk Grove Village, IL: American
Academy of Pediatrics; 2008.
 American Academy of Pediatrics. Pediatric Obesity Clinical Decision Support Chart. Elk Grove Village, IL:
American Academy of Pediatrics; 2008.
ADVICE TO PARENTS