This document discusses the assessment of obesity in pediatric populations. It defines obesity and overweight, and the criteria used to classify obesity. It explores the factors that can affect childhood obesity, including genetic syndromes, medical conditions, and medications. The document outlines methods to assess obesity in children, including physical exams, BMI charts, and laboratory tests. It reviews the management of pediatric obesity, including behavioral interventions, dietary changes, medications, and surgery. Guidelines for treating and staging treatment for overweight and obese pediatric patients are also presented.

1. Assessment of obesity in
Pediatric- population.

2. Objectives of seminar.
- Able to define obesity , overweight.
- Criteria's to classify obesity and overweight.
- Able to list out factors that affect obesity in children.
- Assessment methods obesity in children.
- Obesity in pathological conditions.
- Evidence and management of obesity.

3. Epidemiology & prevalence.
• Definition- WHO defines overweight and obesity as an abnormal or
excessive fat accumulation that presents a risk to health.
• BMI (weight/height²; kg/m²) is used as an indirect measure of body fatness
in children and adolescents
• The global age-standardized prevalence of obesity in children and
adolescents aged
• 5–19 years increased Girls- 0∙7% (95% credible interval 0∙4–1∙2) to 5∙6%
(4∙8–6∙5)
Boys- 0∙9% (0∙5–1∙3) to 7∙8% (6∙7–9∙1)
Ref- Obesity in children and adolescents: epidemiology, causes, assessment, and
management- Lancet Diabetes Endocrinol 2022; 10: 351–65 Systematic review

4. Criteria to classify.
• WHO 2007 Growth Reference, recommended for those aged
• 5–19 years - overweight defined as BMI ≥1SD
- obesity as BMI ≥2SD
• United States Centers for Disease Control and Prevention (CDC)
Growth Reference for those aged
• 2 to 20 years -overweight is >85th to <95th percentile
-obesity is ≥ 95th based on CDC growth charts.
Ref- Obesity in children and adolescents: epidemiology, causes, assessment, and management-
Lancet Diabetes Endocrinol 2022; 10: 351–65 Systematic review

7. Medical Conditions factors for obesity.
• Endocrine disorders (eg, hypothyroidism, hypercortisolism, growth
hormone deficiency).
• Central nervous system damage (ie, hypothalamic-pituitary damage,
post-malignancy (eg, acute leukaemia).
• pharmacological agents are associated - glucocorticoids, antiepileptics
(eg, sodium valproate), insulin, and several atypical antipsychotics (eg,
risperidone, olanzapine, clozapine)

9. Genetic syndrome conditions.
Ref- Pediatric Obesity—Assessment, Treatment, and Prevention: An Endocrine Society
Clinical Practice Guideline- 2017 Mar 1; 102(3): 709–757.

12. Assessment includes
• History taking and physical examination.
• Laboratory tests.

13. • Detailed History taking.

14. Physical examination.
• Body Mass Index (BMI), waist circumference (WC), waist to-height ratio (WHtR), skinfold
thicknesses, bioelectrical impedance (BIA), dual X-ray absorptiometry (DXA), air
displacement plethysmography (ADP), densitometry, isotope dilutionblood pressure [using
height/age/sex percentile normalized.
• Acanthosis nigricans and skin tags
• Extreme acne and hirsutism in pubertal girls
• Fundoscopic examination for pseudotumor cerebri
• Tenderness and range of motion of the knee, leg, or foot
• Peripheral edema, thyroid examination for goiter physical findings associated with
syndromic obesity, particularly if there is a neurodevelopmental abnormality

15. BMI- chart
Ref-

16. Screening –tests.
Ref- Pediatric Obesity Algorithm: A Practical Approach to Obesity Diagnosis and Management. 2018; 6: 431

17. Management.
• Multicomponent behavioural interventions
- dietary intake, physical activity, sedentary
behaviors, sleep hygiene, and behavioral
components
• Intensive dietary interventions - A meta-
analysis of 20 studies found VLEDs to be effective
at inducing rapid short term weight loss in
children and adolescents with obesity
- Very Low Energy Diets (VLEDs), consisting of an
energy prescription of approximately 800
kcal/day or less than 50% of estimated energy
requirements, .

18. • Anti-obesity medications- there is one anti-obesity medication that is approved
by most regulatory agencies (including the United States Food and Drug
Administration and the European Medicines Agency) for chronic obesity treatment
in adolescents aged 12–18 years, which is liraglutide at 3 mg daily .
• Others- orlistat, phentermine, metformin.
• Two anti-obesity medications are currently under evaluation for the treatment
of adolescent obesity: semaglutide 2∙4 mg weekly and the combination of
phentermine and topiramate

19. • Metabolic and bariatric surgery- Until approximately 5 years ago, clinical
practice guidelines for metabolic and bariatric surgery restricted eligibility to older
adolescents having reached skeletal maturity.
• The uptake of metabolic and bariatric surgery has been extremely limited as
surgery is typically reserved for the most severe forms of obesity and for
patients with significant obesity-associated complications.
• Types-
- Sleeve gastrectomy
- RYGB.
- Adjustable gastric band. (The gastric band is not Food and Drug Administration
approved for adolescents younger than 18 years)

20. Ref- Algorithm for the Assessment and Management of Childhood Obesity in Patients 2 Years and Older This
algorithm is based on the 2017 Expert Committee Recommendations,1 new evidence and promising practices.
Management- clinical guidelines.

22. • Management and Treatment Stages for Patients with Overweight or
Obesity
• Patients should start at the least intensive stage and advance through the stages
based upon the response to treatment, age, BMI, health risks and motivation.
• An empathetic and empowering counseling style, such as motivational
interviewing, should be employed to support patient and family behavior change.
• Children age 2 – 5 who have obesity should not lose more than 1 pound/month;
older children and adolescents with obesity should not lose more than an average
of 2 pounds/week.

24. Summary
• Obesity – criteria's are applicable to classify them.
• Factors that are associated with obesity.
• Genetic syndrome and their symptoms how they appear.
• Complications of obesity
• Assessment taking – measures of Body fat mass./ clinicals tests.
• Management and recent clinical practice guidelines.

25. References.
• Obesity in children and adolescents: epidemiology, causes, assessment, and management-
Lancet Diabetes Endocrinol 2022; 10: 351–65 Systematic review.
• Review of Childhood Obesity: From Epidemiology, Etiology, and Comorbidities to Clinical
Assessment and Treatment February 2017;92(2):251-265.
• Comparison of methods to measure body fat in 7-to-10-year-old children: a systematic
review- 23 November 2015
• Ref- Pediatric Obesity—Assessment, Treatment, and Prevention: An Endocrine Society
Clinical Practice Guideline- 2017 Mar 1; 102(3): 709–757
• Pediatric Obesity Algorithm: A Practical Approach to Obesity Diagnosis and Management.
2018; 6: 431
• Algorithm for the Assessment and Management of Childhood Obesity in Patients 2 Years
and Older