16. OBESITY
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CAUSES AND COMPLICATIONS
Childhood obesity is an epidemic in the US
Many of these obese children become obese adults and the risk of remaining obese increases with
age and degree of obesity
It runs in families but genetic influences are rare
Environmental factors such as watching TV as well as
excessive dietary intake have been proven to play a huge
factors
Another important factor, is maternal obesity during
pregnancy
o Children born to obese mother are three to five
times more likely to be obese
o Women who gain much more weight than
recommended during pregnancy have children
who have a higher BMI than normal in adolescence
Other causes(aka complicated/secondary obesity) include
o CNS and hypothalamus disorders leading to
appetite disorder
 Trauma, encephalitis, craniopharyngioma, hypothalamic syndrome etc.
o Endocrine disorder
 Hypothyroidism, GH deficiency and Cushing syndrome
o Psychiatric disorders such as depression
o Chromosomal abnormalities
 Down syndrome, Prader-Willi syndrome & Laurence-Moon-Biedle syndrome
Complications can affect various organ systems
o Obesity increases the risk of metabolic and cardiovascular diseases and some cancers
o The different systems and their complications are mention in the table
o There are also diseases associated with childhood obesity such as
 Cushing syndrome, muscular dystrophy, Prader-Willi syndrome etc.
DIAGNOSIS
By measuring excess body fat
BMI (body mass index; BMI = wt (kg) ÷ Ht2 (m)) correlates
fairly strongly with body fatness in children and adults
BMI age-specific and gender-specific percentile curves (for
2- to 20-year-olds) allow an assessment of BMI percentile
Skinfold callipers measure subcutaneous fat thickness
For children younger than 2 years of age, weight-for-length
measurements greater than 95th percentile may indicate
overweight and warrant further assessment
Early recognition of excessive rates of weight gain allows
earlier interventions
BMI interpretation is noted as underweight, normal,
overweight and obese
Degree of obesity using weight for height standards
o 1st degree (+ 15 - 30% overweight)
o 2nd degree (+ 30 - 50% overweight)
o 3rd degree (+ 50 - 100% overweight)
o 4th degree (> 100% overweight)
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Diagnostic steps
1. Anthropometric data including weight, heights and calculation of BMI and compared to gender
and age appropriate charts
2. Dietary and physical activity history
3. Physical examination
o BP, adiposity distribution (central or generalised), markers of comorbidities (acanthosis
nigricans, hirsutism, hepatomegaly, orthopaedic abnormalities such as advanced bone age
and flat foot )
o Physical stigmata of genetic syndromes
4. Lab studies
o For obese children or children with comorbidities
o Children between 9-11 should be screened for cholesterol
o Other tests include haemoglobin A1c, fasting lipid profile, fasting glucose levels, liver
function tests, and thyroid function tests
PREVENTION AND TREATMENT
Therapy depends on risk factors, including age, severity of overweight and obesity, and
comorbidities, as well as family history and support
Healthy eating and activity are the primary goal for all
children with uncomplicated obesity and fast-rising
weight for height
In complicated obesity cases or if any comorbidities
exist, specific treatment of the complication is necessary
Obesity treatment programs can lead to sustained
weight loss and decreases in BMI when the focus lies
behavioural changes is family centred and simple
straight-forward instructions are necessary like the ones
suggested in the table
Goals needs to be specific and realistic such as
walking/biking to school two or three days a week or
watching no v on school days rather than just saying
“stop watching TV” or “do more sports“
o It needs to be comprehensive and it is necessary
to discuss it with the family as they also need to
make healthy life style changes including:
 Promotion of breast feeding
 Appropriate transition to complementary and table foods
 Important age-appropriate portion sizes for meals and snacks
 Use of smaller bowls and not eat directly form a bag or a box
 Little juice and no soda
 Less refined sugars found in sweets, chocolate, biscuits etc. and higher fibre content
e.g. fruits, vegetables and cereals
 Food as reward should be avoided
 Physical activity should be emphasises especially organised sports as well as
increase activities of daily living such as using stair, walking etc.
 TV in a child’s room should be avoided
Treatment
o More aggressive therapies are considered for those patients where the above mentioned
have not worked
o Treatment options may include
 Enrolment in a weight loss program
 In severe cases surgical treatment is considered