Childhood Obesity and Consensus Recommendations

Everyday pediatric gastroenterologists care for obese children; in fact, the prevalence is approximately 17% in the United States (JAMA 2010; 303: 242-9).  The types of problems include the entire spectrum of pediatric gastroenterology, though some problems like encopresis and gastroesophageal reflux are more prevalent in this population.  Whether during visits for other problems or at clinic visits focused on obesity, there may be opportunities to improve the health of these patients.

A recent consensus statement provides some guidance on the problems and treatment approaches (JPGN 2013; 56: 99-109).

After reviewing epidemiology and etiology, the consensus reviews common comorbidities which include

  • NAFLD/NASH
  • Cardiovascular: Hypertension, Hyperlipidemia   Screen: Blood pressure, fasting lipids
  • Pulmonary: Obstructive sleep apnea  Screen: assess snoring
  • Psychiatric: Depression, Bullying   Screen: assess clinically
  • Orthopedic: Blount disease (pain at medial aspect of knee) and difference in leg length, SCFE
  • Endocrine: Diabetes/insulin resistance, Polycystic ovarian syndrome  Screen: look for acanthosis nigricans, fasting glucose, hemoglobin A1c.  For PCOS, inquire about oligo/amenorrhea, look for hyperandrogenism, consider pelvic ultrasound

Besides looking for these comorbid conditions, the authors discuss treatment.  “Overall, multidisciplinary, behavior-based programs should be used when lifestyle modification counseling has not worked.”  Also, the authors recommend motivational interviewing, lifestyle interventions (healthy activity and diet =”mainstay of weight management”), possibly using Orlistat, and possibly bariatric surgery.

These consensus recommendations are sensible.  Will they make a difference?

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