Obesity

Question 1

Define paediatric obesity

Answer 1

BMI on or above the 98th centile for their age and sex
Overweight - 91st centile

NOTE: NCMP and RCPCH redinfe as 95th and 85th respectively.

Question 2

At what waist to height ratio is a paediatric consider to have central adiposity.

Answer 2

Inc risk if above 0.5
High risk if >0.6 or more

Based on health risks such as T2DM, HTN, cardiovascular disease

Question 3

What is the relevant epidemiology of paediatric obesity?

Answer 3

Higher in boys
Higher in urban and disadvantaged areas
Higher in Black children, lowest in Chinese children

Question 4

What are the underlying aetiological factors causing childhood obesity?

Answer 4

Higher levels of deprivation
Parental obesity
High caloric diet
Low levels of physical activity
Infant birth weight high, high weight gain in early life

Less common:
Genetics = Prader-Willis syndrome
Medications = steroids
Endocrine disorders = hypothyroidism, Cushing syndrome

Question 5

What investigations should be done for childhood obesity?

Answer 5

BMI - height and weight chart
NICE - waist to height ratio.

Question 6

If the childs BMI is above the 98th centile or waist to height ratio >0.5 what additional investigations are needed?

Answer 6

BP
Fasting lipid profile, insulin and glucose levels
Liver and endocrine function
Pubertal status assessment
Psychological assessment

Question 7

What is the first line investigations for childhood obesity?

Answer 7

Increase physical activity and play
Decrease sedentary behaviour
Health eating - inc fruit and veg, reduce high sugar and fat
Local lifestyle weight management programmes - maintain weight as height increases so BMI reduces over time

Question 8

What further specialist management may be used for childhood obesity?

Answer 8

Over age 12yrs with severe physical or psychological comorbidities may add drugs such as orlistat.
Surgery is not routinely considered.