1. CHILDHOOD OBESITY “An emerging challenge”
S.V. DELPORT
Paediatric Endocrine and Diabetes Unit

2. OBESITY Number one public health problem Adults – origins in childhood
A paediatric concern
Prevention and treatment & paediatric goal
Pathogenesis
-genetic / environmetal

3. CLINICAL APPROACH Definitions BMI: weight (kg)/Height (m2) Adults
25.0 to overweight
> obese
Children
BMI percentiles
>85th - overweight
>95th - obese

6. DEFINITIONS: (continued)
BMI
Older than two years
Weight for height
under two
relate to stature
> 120% of expected weight for height

9. OBESITY Tall stature Short stature Energy excess Endocrine disorders
Syndromic disorders

10. ENDROCRINE DISORDERS Hypothyroidism Growth hormone deficiency
Cushings syndrome
Pseudohyproparathyroidism

11. SYNDROMIC DISORDERS Prader – Willi Syndrome Bardet – Biedl Syndrome
Carpenter/Cohen/Alstrom
Common features:
Short, MR, hypogonadism

12. METABOLIC IMPACT OF OBESITY
Insulin resistance
Hypertension
Metabolic Syndrome
PCOS
Early puberty

13. OTHER OBESITY COMPLICATIONS
Non-alcoholic fatty liver disease
Cholelithiasis
Obstructive sleep apnoea
Cor pulmonale
Psychosocial / Economic

14. DIAGNOSTIC WORKUP Clinical Parental heights / BMI Development
Growth/Pubertal staging
Acanthosis / Hirsutism BP
Hepatomegaly
Gonadal

17. DIAGNOSTIC WORKUP (cont)
Laboratory
ALT
Blood glucose/Insulin
HbA1c
Lipid profile
Genetic
Bone age
Pelvic u/s

18. TREATMENT Lifestyle modification Pharmacotherapy Bariatric surgery
Diet/exercise/family
Pharmacotherapy
Sibutramine (to reduce energy intake)
Orlistat (reduces energy absorption)
Metformin (improves insulin resistance)
Bariatric surgery

19. WHEN TO REFER Abnormalities of insulin/glucose homeostasis
Ovarian hyperandrogenism
Evidence of GHD
Cortisol excess
Hyperlipidaemia