Dr. P. RAGHUPATHY, B.Sc., MD, DCH, FRCP
Former Professor & Head of the Department of Child Health, Christian Medical College, Vellore.
Senior Consultant in Pediatric Endocrinology, Sagar Apollo Hospital, Tilak Nagar, Bangalore.

Childhood obesity is a significant public health problem. There is a significant increase in the prevalence of obesity in childhood and adolescence both in the developed and developing world.

Methods of Measuring Obesity:

BMI is defined as weight in kilograms divided by height in meters squared (kg/m2). Other methods of obesity measurement (skin fold thickness, body circumferences, dual energy x-ray absorptiometry, bioelectric impedance analysis, densitometry, computerized tomography and magnetic resonance imaging) are used on a smaller scale.

Definition:

Obesity is defined as a BMI> / =95th percentile for age and gender. Children with a BMI between the 85th to 95th percentile for age and gender are defined as being at risk of obesity.

Risk Factors:

Genetic and environmental factors are present in the majority of cases of obesity.

• Genetic factors
• Environmental factors: Increased caloric intake and decreased physical activity.
• Endocrine causes: Hypothyroidism, Cushing’s syndrome, Growth Hormone deficiency.
• Genetic Syndromes : Prader-Willi, Cohen, etc.,

Immediate Complications:

• Dyslipidemia
• Insulin resistance and type II Diabetes Mellitus
• Hypertension
• Hepatic disease
• Cholecystitis and cholelithiasis
• Polycystic ovary syndrome
• Orthopedic complications : Blount’s disease, Perthes’ disease
• Sleep apnea or hypoventilation syndrome
• Pseudotumour cerebri
• Psychosocial complications

Long-Term Complications:

• Type II diabetes
• Atherosclerosis and coronary heart disease
• Arthritis
• Liver fibrosis / cirrhosis
• Colorectal cancer
• Obese adolescent girls tend to have lower household income and less education when they are adults (Dietz, 1998).
• A doubling of the relative risk of mortality in adults who had childhood obesity (Must and Strauss, 1999).

Evaluation:

• If the obese child is not short for his / her specific age and sex and is not developmentally delayed and does not have dysmorphic features, obesity is very unlikely to be secondary to an endocrine disorder or a genetic syndrome.
• Assess for the possible complications
• Assess the family members
• Assess psychological problems

• Encourage healthy dietary practices
• Establish healthy physical activity program
• Assess patient’s and family’s routine daily activities, pay particular attention to the amount of TV viewing.
• Develop plan for increasing activities, such as family outings
• Management is a long-term process
• Pediatric obesity management programs are often multidisciplinary
• Family involvement is an essential component

Behaviour Modification forms an important part of management of obesity.
Goals of Therapy:

• Medical goals: resolution or improvement of obesity sequelae, e.g., hypertension, dyslipidemia.
• Weight maintenance: for children with BMI between 85th and 95th percentile and no complications of obesity.
• Weight loss: for children with BMI>95th percentile or for children with BMI>85th percentile and who have at least one complication of obesity; weight loss should not be more than 0.5 kg per week.
• Behavioural: acquiring and maintaining healthy weight-management behaviours.

• The duration of follow-up and the frequency of visits will vary depending on the individual patient; in general; initial follow-up should be 1 to 2 weeks following the initial visit.
• Follow-up visits should be frequent with short intervals initially, e.g., 2 weeks apart, then the interval between visits can be increased.
• Laboratory tests can be repeated in 6 months.

Drug Treatment:

Currently a few drugs are undergoing testing for their efficacy and safety in obese children and adolescents, but currently no such drugs are approved for pediatric use.

Ooty Pedicon 2005 - Conference Abstracts.Pediatric Oncall [serial online] 2005 [cited 01 October 2005];2. Available from:
http://www.pediatriconcall.com/fordoctor/Conference_abstracts/
obesity_in_children.asp