Obesity in children

Assessment of physical development

To objectively assess somatic health, pediatricians compare body weight with the child's height. The key tool is the calculation of BMI SDS, which is interpreted using percentile charts:

• Severe deficiency: value below -3 (values fall past the 1st percentile).
• Deficiency: value below -2 (below the 3rd percentile).
• Overweight: values range from +1 to +2 (between the 85th and 95th percentiles).
• Obesity: value exceeds +2 (goes beyond the 95th percentile).

Etiological Classification

Depending on the underlying cause, excess weight in children is divided into four main groups:

1. Primary (constitutional-exogenous). The most common variant in pediatrics. It is based on physical inactivity and a caloric surplus. Such children usually have average or tall stature and a positive family history. Their diet is dominated by easily digestible fats and carbohydrates, and overeating is frequent, including right before bedtime.
2. Hypothalamic. Develops against the background of organic CNS lesions (hypothalamic and brainstem tumors, consequences of traumatic brain injuries, strokes, or radiation therapy). It is accompanied by neurological deficits, visual field defects, rapid weight gain, and growth retardation.
3. Endocrine. Arises due to hypercortisolism—both endogenous (Cushing's disease) and iatrogenic (due to glucocorticoid therapy).
4. Genetically determined. Divided into monogenic (mutations in the leptin-melanocortin pathway with manifestation of morbid obesity in early childhood) and syndromic (part of chromosomal abnormalities, such as Down, Prader-Willi, or Alström syndromes).

Target-organ screening

Excess weight triggers a cascade of pathological changes that require mandatory diagnostic workup. The following groups of complications are distinguished:

• Metabolic disorders: carbohydrate metabolism disorders (from fasting hyperglycemia and impaired glucose tolerance to diabetes mellitus) and dyslipidemia (hypercholesterolemia, hypertriglyceridemia).
• Organ-specific pathologies: non-alcoholic fatty liver disease (steatosis and steatohepatitis), arterial hypertension.
• Reproductive and musculoskeletal systems: ovarian dysfunction and PCOS may develop in girls, and all children may experience bone and joint damage due to excessive mechanical stress.
• Psychoemotional disorders: complexes and psychological problems associated with appearance.

Therapeutic tactics and lifestyle

Unlike adults, treatment for children does not require mandatory reduction of absolute body weight. The main paradigm is weight stabilization. Since the child continues to grow taller, maintaining stable kilograms automatically leads to a decrease in BMI. Success is impossible without family involvement and the establishment of compliance.

Lifestyle modification includes two equally important areas:

• Dietary therapy: transition to frequent, small meals (3–4 hour intervals) with reduced portions. Strict limitation of sugary drinks and fast carbohydrates is mandatory. Important: restricting fat intake is only permitted for patients older than 2 years.
• Physical activity: a minimum of 60 minutes of daily moderate-to-high intensity aerobic exercise. At the same time, sedentary leisure with gadgets is strictly limited to two hours a day.

Class and exam questions

What else to study on this topic

• Clinical manifestations and phenotypes of genetic syndromes (Prader-Willi, Laurence-Moon-Bardet-Biedl)
• Pathogenesis of monogenic mutations in the leptin-melanocortin pathway
• Diagnostic algorithms for non-alcoholic fatty liver disease in children
• The relationship between obesity and the development of polycystic ovary syndrome (PCOS) in adolescent girls

Other topics in the section «Chapter 11. Endocrine Diseases in Children»

Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.