6. BMI
● 85th to 95th centile - overweight
● >95th centile - obese
● Weight for height (weight for length): Till 2 years of
age (>97.7th percentile suggest obesity).
7.
8. Majority (~98%) do not have a pathological cause (exogenous
or constitutional obesity).
● Exogenous obesity: Normal growth, development, and
puberty are suggestive.
● Monogenic obesity: Early-onset obesity (before 5 years of
age) with extreme hyperphagia (food-seeking behavior-
stealing food, eating food leftover by others; impaired
satiety).
● Obesity syndromes:Distinct features (abnormal facies,
digits, vision) and systemic involvement, with hyperphagia.
9.
10.
11.
12. ● Hypothalamic obesity: Neurological features (headache,
irritability, seizures) and/or neuro-logical insult with rapid
weight gain, hyperphagia. Neuroimaging is essential to
identify a hypothalamic lesion.
● Drug-induced obesity: Associated with glucocorticoids,
antipsychotics (risperidone and olanzapine), and antiepileptic
drugs (valproate and carbamazepine).
● Endocrine causes (hypothyroidism, Cushing syndrome,
pseudohypoparathyroidism). Associated short stature is the
hallmark of underlying endocrine cause.
16. A family history of any of the following is an indication to
screen for dyslipidemia.
• Either parent, grandparent, aunt, uncle or sibling aged < 55
years (males) and < 65 years (females) having any of these:
myocardial infarction, stroke, angina, coronary artery by-pass,
stent, angioplasty or sudden cardiac death
• Parents with total cholesterol > 240 mg/dL or known lipid
abnormalities in parents.
17. Antenatal and perinatal history.
● High preconcetional weight
● Maternal smoking
● IUGR
● What is thrifty gene hypothesis?
18. Diet history
● 24h dietary recall
Special attention to intake of fruits,
vegetables and water, as well as high
caloric food and high carbohydrate beverages.
20. Hypertension in obesity is multifactorial
● altered renal sodium handling
● increased systemic vascular resistance
● activation of the sympathetic nervous system
21. Body mass index-
It is an age independent index.
● Erroneous diagnosis of obesity in
short stature.
● It cannot locate the site of fat.
● It cannot differentiate between obese and muscular.
● Lower reliability in pubertal age.
22.
23.
24.
25. Skin fold thickness
● It measures body fat %.
Disadvantages
● Significant inter and intra
observer variation.
● Affected by gender and
ethnicity.
● No Indian reference data.
● No significant advantage
over BMI
26. Waist circumference
● Highly sensitive and specific for
central obesity.
● Cutoff - 102cm for adult males
88cm for adult females
71cm for prepubertal
children
● No Indian data.
27. It must be measured with a stretch resistant tape, applied
horizontally just above the upper lateral border of right ileum at
the end of normal expiration and recorded to the nearest 0.1 cm.
28. Waist - Hip ratio
● >0.95 in males and >0.8 in females shows significant
health risk.
29.
30. Head to toe examination
One must examine the adolescent for features of
complications of obesity like insulin resistance
● acanthosis nigricans
● skin tags and
● furunculosis
31. ● tonsillar enlargement and typical facies of obstructive sleep
apnea syndrome (OSAS)
● hepatomegaly (fatty liver in non-alcoholic fatty
liver disease - NAFLD)
● abnormal gait (slipped capital femoral epiphyses)
papilledema and VI cranial nerve palsy (pseudotumor cerebri).
● Tanner staging and Examine all adolescents for pubertal
gynecomastia (resulting from increased estrogen levels from
aromatase in adipose tissue).
32. ● One must look for features of an underlying endocrinopathy
like goitre and delayed relaxation of reflexes (hypothyroidism)
● abdominal striae and truncal obesity (Cushing's disease)
● midline defects and cherubic facies (GH deficiency)
● short 3rd and 4th metacarpals (pseudohypoparathyroidism).
● optic fundus features of retinitis pigmentosa and polydactyly
(Bardet Biedl syndrome).
33.
34.
35. Investigations
Step-1:
The endocrine society recommends endocrine work-up of
obesity, only, if the height velocity is attenuated with respect to
the family or pubertal status OR child has markers of specific
endocrine dysfunction.
36. Commonly recommended screening tests include
● a fasting thyroid profile (Free T4 and TSH)
● overnight dexamethasone suppression test (ONDST)
(Cushing's disease screen).
37. Step-2:
● All overweight and obese adolescents must have their
fasting blood sugar, liver function test and fasting lipid
profile estimated.
38. A practical definition of adolescent metabolic syndrome is
the presence of three out of the following five criteria:
1. Abdominal obesity (waist circumference >90th percentile)
2. Hyper-triglyceridemia ≥ 110 mg/dL
3. High density lipoprotein (HDL) cholesterol ≤ 40 mg/dL
4. Blood pressure ≥ 90th percentile according to age, gender
and height
39.
40. Step-3:
Adolescents, classified to have metabolic syndrome, or, with
even one of the five criteria positive or clinical features of insulin
resistance, need to undergo a detailed evaluation of the
metabolic profile
47. Prevention
● Exclusive breastfeeding till 6 months of age.
● Regular meal timings, including breakfast.
● At-least 7–8 hours of sleep daily at night.
● Lifestyle intervention should precede and should be
maintained during pharmacotherapy.
48.
49. Obesity prevention guidelines from American Academy of
Pediatrics recommend Fight Childhood Obesity by ‘5-2-1-0’ rule .
Accordingly, children can consume above 5 servings of fruits and
vegetables, screen time below 2 hours, participate in one hour of
physical activity, and consume 0 sugar-sweetened beverages
daily.
50. Targets
● Gradual and sustained loss.
● Body mass index (BMI) SD score (SDS) reduction of 5%
roughly translating to 7–10% weight loss over 6 months.
● Avoid loss over 1.5 kg per month.
52. Metformin:
Approved in Type 2 DM after 8 years of age. May consider in
causes related to antipsychotic medication, polycystic ovarian
disease, and steatohepatitis.
53. Surgery -
● Should be discouraged as it carries more significant
complications than adults.
● Indicated only with severe obesity (BMI >40 kg/m2 or >35
kg/m2 with complications) and only after completion of
linear growth.
● A multidisciplinary obesity team with long-term follow-up is
essential to maintain compliance with nutritional
recommendations.
● Extreme motivation, strict diet, and activity schedule must
be maintained after surgery.
