Discussion: Pediatric Obesity

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The pathophysiology of obesity in children is primarily due to taking in more energy (calories) than is used up through physical activity. Genetic and endocrine-related causes do occur. but they are rare (Styne et al., 2017). Fewer that 10% of obesity cases fall into that category. Obesity, especially abdominal obesity, can cause complications including heart disease, liver and kidney damage, COPD, hypotension, dyslipidemia, and type 2 diabetes (Xu & Xue, 2016).

In the past 30 years, the prevalence of obesity has doubled in children and tripled in adolescents. This statistic applies around the world as developing countries adopt a Western diet packed with refined carbohydrates. According to Xu and Xue (2016), 16-18% of young people have abdominal obesity which is closely tied to comorbidities above.

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As part of a physical exam, observation is usually sufficient to identify obesity in children and adolescents, but calculation of the individual’s body mass index (BMI) is used to confirm the condition and to differentiate between overweight and obese. BMI is the ratio of weight (kg) to height (m) and in young people age- and gender-specific charts are used to determine percentiles. Based on these charts, the individual’s BMI can be related to age and gender norms. BMIs between the 85th and 95th percentiles indicate overweight, and BMI above the 95th percentile is defined as obesity (CDC.gov, 2016).

Differential diagnoses for childhood obesity include lifestyle-based causes, genetic causes related to adipocyte (fat cell) / hypothalamic system, hypothalamic development, and malformation syndromes. These are caused by a single gene alteration (Martos-Moreno et al., 2014). Obesity can also be secondary to another disease or its treatment. For example, hypothyroidism, hypercortisolism, and pseudohypoparathyroidism can cause obesity, and lab tests are required to detect them.

Management plans include lifestyle changes (diet and activity) and the use of medications when required to treat secondary obesity (metformin, octreotide, growth hormone, and leptin). Sibutramine and orlistat also aid weight loss in primary obesity (Xu & Xue, 2016). Referrals may be made to dieticians and physical therapists as required.

  • CDC.gov. (2016). BMI for children and teens. Retrieved from https://www.cdc.gov/obesity/childhood/defining.html
  • Martos-Moreno, G. Á., Barrios, V., Muñoz-Calvo, M. T., Pozo, J., Chowen, J. A., & Argente, J. (2014). Principles and Pitfalls in the Differential Diagnosis and Management of Childhood Obesities–. Advances in Nutrition, 5(3), 299S-305S.
  • Styne, D. M., Arslanian, S. A., Connor, E. L., Farooqi, I. S., Murad, M. H., Silverstein, J. H., & Yanovski, J. A. (2017). Pediatric obesity—assessment, treatment, and prevention: an Endocrine Society Clinical Practice guideline. The Journal of Clinical Endocrinology & Metabolism, 102(3), 709-757.
  • Xu, S., & Xue, Y. (2016). Pediatric obesity: Causes, symptoms, prevention and treatment. Experimental and therapeutic medicine, 11(1), 15-20.

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