CHILDHOOD OBESITY “An emerging challenge”

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Presentation transcript:

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 Short stature Energy excess 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 Cor pulmonale 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 Pharmacotherapy Bariatric surgery 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