Background Education for Providers
Children who present with a BMI in the 85th percentile or greater are considered overweight or obese. Their elevated weight puts them at an increased risk for a variety of weight-related medical conditions. Certain medical conditions may also contribute to the child’s increased weight. Therefore, it is important that providers be aware of the possible disorders that contribute to obesity, and the weight-related medical conditions that can be a consequence of obesity. In addition, it important to understand that there is a strong genetic contribution to the development of obesity and weight-related conditions. Weight-related conditions such as high BMI, cardiovascular disease, and insulin resistance are particularly heritable and are especially prevalent in families of non-European ancestry. It is strongly recommended that clinicians obtain a family history to determine the child’s susceptibility to obesity and obesity-related conditions.
Contributing Factors to Obesity:
There are single-gene disorders that may result in extreme obesity; however, these are very rare. The most well-known disorders that may cause obesity include: Prader-Willi Syndrome, Bardet-Biedl Syndrome, Alstrom Syndrome, and Cohen’s Disease. If a genetic disorder is suspected, the child should be referred for genetic testing. Listed below are the characteristic signs of these disorders.
- Prader-Willi Syndrome: Short stature, acromicria, characteristic facies, hypotonia, developmental delay
- Bardet-Biedl Syndrome: Short stature, developmental delay, retinitis pigmentosum, polydactyl
- Alstrom Syndrome: Photophobia, sensor neural, insulin resistance
- Cohen’s Disease: Developmental delay, microcephaly, hypotonia, myopia, retinal dystrophy, hyper mobility, characteristic facial features.
Hypothyroidism is a condition that is often a concern of parents who have overweight children. However, this condition is relatively uncommon (effects 1 in 1000 children) and does not usually cause severe obesity. Hypothyroidism can be suspected if the child presents with the following symptoms: fatigue, diminished school performance, cessation of linear growth, and goiter.
Obesity can exacerbate many medical conditions and can also cause new weight-related conditions. Below are listed some of the more common weight-related issues that are seen in obese children:
- Sleep Problems: Obstructive Sleep Apnea, Obesity Hyperventilation Syndrome
- Respiratory: Asthma
- Note: Asthma often results in shortness of breath and exercise intolerance, and it should be managed in order for the child to not be limited in their physical activity.
- Gastroenterology: Nonalcoholic Fatty Liver (NAFL), Gallstones, GERD, Constipation.
- Endocrinology: Type II Diabetes, Hypothyroidism, Primary Cushing Syndrome, Extreme early onset of Puberty
- Nervous System Disorders: Pseudotumor Cerebri
- Cardiovascular: High blood pressure, Lipid level abnormalities
- Orthopedics: Blount’s Disease (Bow-Legged), Slipped Capital Femoral Epiphysis
- Acanthosis Nigricans
Screening for these conditions has not been shown to cause any harm to the child. In fact, it has been shown that obesity screening may actually increase healthy eating behaviors.
Instructions for Provider
- Complete a full family history that includes the medical history of both the parents and grandparents. Most importantly, it should focus on the presence of high BMI, Cardiovascular disease, and insulin resistance to assess for the future risks for these conditions and future comorbidities. It may be helpful to develop a checklist of symptoms and family history forms for parents to complete at the appointment.
- If a genetic disorder is suspected, providers should refer child for genetic testing.
- Complete a standard physical evaluation that covers all of the systems to assess for all weight-related conditions.
- If a specific weight-related condition is suspected and treatment is needed, the patient should be referred to a specialist in the field.
- If the child has a BMI in the 85th percentile or above, the child should be referred for a fasting lipid profile, fasting glucose test, AST, and ALT, in order to test for Type II Diabetes.