Childhood Obesity

Childhood Obesity - Dubai Pediatric Clinic

Childhood obesity - Not all children carrying extra kilograms are overweight or obese. So you might not know just by looking at your child if weight is a health concern.

If you are worried that your child has extra weight, talk to his doctor. Your child’s doctor will consider the child's history of growth and development, family history, where your child lands, or the growth chart and his BMI. This can help determine if your child’s weight is unhealthy.

BMI: Body Mass Index is the accepted measure of overweight and obesity.

BMI = weight/kg

(Length)²/cm

BMI between 85^th – 94^th is overweight.

BMI 95^th percentile and above is obesity.

CAUSES

Most cases of obesity are the result of lifestyle issues, too little activity and lack of exercise, and regularly eating high-calorie foods such as fast food, candy and desserts, and sugar drinks.
Studies show that if the child comes from a family of overweight people he will be at risk of obesity and family stress can increase a child’s risk of obesity.
In 10% of cases of obesity, we can find a genetic or hormonal problem.

GENETIC SYNDROMES WITH OBESITY

BARDET BIEDL – Polydactyly, obesity, hypogonadism, kidney abnormalities, autosomal recessive. Diabetes, increase blood pressure, Hirschsprung disease, Speech and language problems, Behavior disorder, and dental abnormalities.
PRADER WILLIS – is a genetic condition in infancy. This condition is characterized by weak muscle tone, feeding difficulties, poor growth, and delayed development in childhood. Affected individuals develop an insatiable appetite which leads to chronic overeating and obesity. Some of them develop type 2 diabetes.

They have intellectual impairment and learning disabilities, behavior problems, sleep abnormalities, and distinctive facial features such as a narrow forehead, triangular mouth, and small hands and feet.
Both males and females have underdeveloped genitals, delayed puberty and infertility.

PSEUDOHYPOPARATHYROIDISM - is a genetic disorder in which the body fails to respond to parathyroid hormone. PTH helps control calcium, phosphorus and Vitamin D in the blood and bone. The symptoms are cataracts, dental problems, seizures, numbness, tetany, calcium deposits under the skin, round face and short neck, shorthand bone, short height, and obesity.
LAURENCE MOON SYNDROME – is a rare condition that affects many different parts of the body and includes cerebellar ataxias, eye abnormalities, peripheral neuropathy, spastic paraplegia (weakness and stiffness of the leg); intellectual disability, short stature (hypopituitarism). Mutation in PNPLA6 gene is inherited in an autosomal recessive manner.

Finger syndactyly, hand polydactyly, intellectual disability, obesity, and cryptorchidism. Hypoplasia of the penis, renal insufficiency, sensorial hearing impairment, abnormal cardiovascular system morphology.

DOWN SYNDROME – a genetic disorder caused by the presence of all parts of a third copy of chromosome 21. They have characteristic facial features, and mild to moderate intellectual disability.

The symptoms are mental impairment, increased skin back of the neck, low muscle tone, flat head, flexible ligament, abnormal outer ear, slanted eye, flat nose, congenital heart disease, obesity, problems in the thyroid gland, hypoparathyroidism.
In genetic syndrome, the diagnosis is made by genetic studies.

ENDOCRINE DISEASE AND OBESITY

HYPOPARATHYROIDISM - deficiency of thyroid hormone can cause fatigue, cold intolerance, dry skin, hair loss, sleepiness, gain weight, constipation, and depression. Diagnosis is by measuring thyroid hormones TSH and FTH and the treatment reserve most of the symptoms and help to achieve growth and weight appropriate for age.
GROWTH HORMONE DEFICIENCY – the child with GH deficiency often has short stature and are obese, and they have delayed bone age shown by hand bone x-ray.

The diagnosis is made by measuring GH hormone after stimulation by giving decreased insulin, arginine, and glucagon.
The pituitary gland produces GH in bursts. The treatment is by injection of growth hormone to increase growth rate.

CUSHING DISEASE – is caused by a tumor or hypoplasia of the pituitary gland that increases adrenocorticotropic hormone and that stimulates the production and release of cortisol from the adrenal gland.

The symptoms are weight gain, high blood pressure, excess hair growth(women), extra fat around the neck, moon face, impaired immunological function, red stretch marks, acne, and poor concentration.
Diagnosis is made first by measuring plasma cortisol, Rh adrenal CT, and dexamethasone suppression test.
Treatment is surgical resection of ACTH. Dissecting pituitary adenoma or tumor.
Precocious puberty is considered precocious if it starts in girls younger than 8 years of age and boys less than 4 years.
The cause of precocious puberty is diagnosed by hormone analysis and abdominal ultrasound and brain MRI. For central precocious puberty treatment is necessary to achieve the optimal height in the child.

POLYCYSTIC OVARY – Girls with PCO have obesity, excess hair growth in adolescents, and infrequent or absent menstruation.

The diagnosis is made by ovarian ultrasound and hormone test which includes thyroid function, prolactin, testosterone, HCG, 17 hydroxyprogesterone, insulin-like growth factor, FSH, and LH lifestyle modification. Diet and exercise and weight loss improve the case. The treatment includes contraceptive antiandrogen and hypoglycemic agents.

PROLACTIN SECRETING TUMOR- Decreased menstruation, amenorrhea, producing breast milk and diagnosed by measuring serum prolactin and pituitary CT. The treatment is surgical with dopamine agonist drugs.
TURNER SYNDROME – is a chromosomal condition that affects development in females. The patient may ask for medical advice for short stature. The doctor can find some physical features of a webbed neck, low hairline at the back of the neck, puffiness and swelling of the hand and feet and in the future, these girls have ovarian hypofunction with delayed signs of puberty.

Clinical clues that suggest a hormonal etiology of obesity:

Short stature
Dry skin, constipation, cold intolerance
Inappropriate sexual development at an early age
Headache, vomiting, visual disturbances

Obese children with these symptoms should investigate for endocrine problems.

Dysfunction of the gut-brain-hypothalamic axis via the ghrelin/leptin hormonal pathway has a role in abnormal appetite and leads to excess energy intake and obesity.

Approach consideration:

Identify any genetic or hormonal disorder that may be a cause of obesity.
Standard laboratory studies should include:
Fasting lipid panel
Liver function studies
Thyroid function test
Fasting glucose and HbAIc

Other tests are performed as indicated by clinical findings:

Serum leptin
Adrenal function test
Karyotype
Growth hormone secretion and function test
Assessment of productive hormones and prolactin
Serum Ca, phosphorus, parathyroid hormone levels.
MRI of the brain.

COMPLICATIONS OF CHILDHOOD OBESITY

Obese children have a big chance of being obese adults and have Type 2 diabetes, hyperlipidemia, accelerated growth and bone maturation, ovarian hyperandrogenism and gynecomastia, cholecystitis, pseudotumor cerebri, fatty liver, sleep apnea, sleep disorder.
Orthopedic disorder, slipped capital femoral epiphysis, tibia vara, bowing of the tibia and femur.
Emotional and psychosocial sequelae are widespread as depression, low self-esteem and social isolation.
Obesity is associated with several cardiovascular risk factors, including high glucose, high HDL and hypertension.

MANAGEMENT:

Family–based behavioral weight control is effective in severe cases of obesity and any intervention is likely to fail if it does not involve the active participation and support of family members.
Lifestyle modification, exercise and physical activity
Reduce intake of free sugars to less than 10% of total energy intake.
Reduction in total and saturated fat to 30% of total energy intake.

PREVENTION:

Identify young children who are predisposed to adolescent and adult obesity
Learning lifelong habit that incorporates exercise and healthy eating is essential

PACKAGES FOR CHILDHOOD OBESITY TREATMENT:

Package includes:

- Consultation with Dr. Taref Alabed (Consultant Pediatrician) and Ms. Suzan Trabulsi (Clinical Dietitian)

- Blood Test (Blood Test includes a bundle consisting of)

- Lipid Profile
- CBC
- Fasting Glucose
- HBA1C
- TSH
- T4

Package Cost:

AED 1700

Dubai Pediatric Clinic at Dr Rami Hamed Center provides one of the leading pediatricians in Dubai.