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Approach To Obesity
Approach To Obesity
OBESITY
DR WARISHA IKHLAQ
CHILDHOOD OBESITY
Epidemic – Widespread in population (adults
and children)
Bardet-Biedel Syndrome
Pickwikian Syndrome
Down 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
FAMILY HISTORY
NUTRITIONAL HISTORY
PHYSICAL ACTIVITY
SOCIOECONOMIC
OBSERVATION
Introduce yourself
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 )
Anosmia
( Kallmann )
Midline dimple
( Hypopituitarism )
NECK :
Goiter
Supraclavicular fat
pad ( Cushing )
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
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 )
HEAD CIRCUMFERENCE:
Enlarged ( Intracranial tumor, hydrocephalus with spina bifida )
Pulse:
Slow ( hypothyroidism )
Temperature:
Cool ( hypothyroidism )
B.P monitoring:
Hypertension ( Cushing )
Positive with
Avascular necrosis
or SCFE
HIP EXAMINATION:
BMI >95%
Fasting lipid profile, AST, ALT, fasting glucose q 2 years
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