EVALUATION AND MANAGEMENT OF OBESITY IN CHILDREN AND ADOLESCENTS
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.*
Introduction
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 BM I> / = 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.,
Complications
Immediate Complications:
  • Dyslipidemia
  • Insulin resistance and type II Diabetes Mellitus
  • Hypertension
  • li>Hepatic disease
  • Cholecystitis and cholelithiasis
  • Polycystic ovary syndrome
  • Orthopedic complications : Blount's disease, Perthes' disease
  • li>Sleep apnea or hypoventilation syndrome
  • Pseudotumour cerebri
  • Psychosocial complications

Longterm 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
Management

  • 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.

Follow up
  • 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.
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