Analysis of weight gained by children whilst awaiting review at a Children’s Hospital obesity clinic

Deirdre Cahill*
University College Dublin School of Medicine*
Obesity is both a national and an international problem (1). The causes are complex and multi- factorial and the pathophysiology is poorly understood. The consequences of obesity are well researched and documented particularly in adulthood. Childhood consequences of obesity include low physical fitness, hypertension, early signs of cardiovascular disease and metabolic disease (2, 3, 4, 5) The management of obesity is challenging and requires multi- disciplinary input.
We reviewed the referral details and the initial assessment weight of 111 children referred to a tertiary referral obesity clinic. We recorded the referral weight, height and BMI where given and the weight, height and BMI at assessment. The time interval between the referral and the clinic appointment was also recorded.
Of the 111 cases reviewed, 40 were referred by their GP (36%), 55 (50%) from a consultant in the hospital, 4 (4%) from consultants in other hospitals, 3 from Mental health services, 1 from the physiotherapy department, 1 from the Dietetics department, 1 from community nurse, 1 from public health and 4 had no referral information.
Of the GP letters 19 (48%) contained weight, height and a calculated BMI.
Of the children reviewed there were 62 female and 49 male patients. 6 were under 5 years, and 105 were over 5. The average weight was 75kg, our heaviest patient was 120kg. 98% of children had a BMI in the 99th centile.
71 (64%) gained weight on the waiting list, 16 (14%) lost weight on the waiting list and 24 (22%) the weight gain/loss was not recorded.
The average waiting time from referral to review in clinic was 6.1 months and the average weight gain was 3.3 kg and the average weight loss was 2.7 kg. Weight gain during the waiting period ranged from 2.3kg with 1 month wait to 14.8kg weight gain with 26 month wait.
Of those who lost weight on the waiting list 85% had made changes to their diet.
A significant number of the referrals to the clinic come from general practice. In general, children gain weight while waiting for review. It would be helpful for the referring doctor to have resources available to give to the families while waiting review.
References :
  1. Layte et al, 2011. Growing Up In Ireland Study.
  2. O’ Malley G., High Normal fasting glucose level in Obese Youth: a marker for insulin resistance and beta cell dysregulation. Diabetologica 2010.
  3. D’Adamo E., Cali AM., Weiss R., Santoro N., Pierpont B.,Northrup V., Caprio S. Central role of fatty liver in the pathogenesis of insulin resistance in obese adolescents. Diabetes Care 2010 Aug;33(8):1817-22.
  4. Finucane FM., Pittock S., Fallon M., Hatunic M., Ong K., Costigan C., Murphy M., Nolan JJ. Elevated blood pressure in overweight and obese Irish children. Irish J Medical Sci. 2008 Dec:177(4):379-81.
  5. Tounian P., Aggoun Y., Dubern B., Varille V., Guy-Grand B., Sidi D., Girardet JP., Bonnet D. Presence of increased stiffness of the common carotid artery and endothelial dysfunction in severely obese children: a prospective study. Lancet 2001 Oct 27:358(9291):1400-4.

DOI: 10.7199/ped.oncall.2015.1S
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