CHILDHOOD OBESITY “An emerging challenge”

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

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

CLINICAL APPROACH • Definitions • BMI: weight (kg)/Height (m2) Adults 25.0 to 29.9 - overweight >30.0 - obese Children BMI percentiles >85th - overweight >95th - obese

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

OBESITY • Tall stature • Energy excess • Short stature • Endocrine disorders • Syndromic disorders

ENDROCRINE DISORDERS • Hypothyroidism • Growth hormone deficiency • Cushings syndrome • Pseudohyproparathyroidism

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

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

OTHER OBESITY COMPLICATIONS • Non-alcoholic fatty liver disease • Cholelithiasis • Obstructive sleep apnoea • Corpulmonale • Psychosocial / Economic

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

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

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

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

CHILDHOOD OBESITY “An emerging challenge”