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Evaluation and Treatment of Childhood Obesity
In many obese people, the roots of their disorder can be traced back to childhood. Obesity tends to persist throughout life. While most obese infants will not remain so, they are at increased risk of becoming obese children. These children are in turn more likely to become obese adolescents, who are then very likely to remain obese.
Evaluation of obesity in childhood is important for several reasons. First, it offers the best hope for preventing disease progression with its associated morbidities into adulthood. Second, while genetic and hormonal causes of obesity are rare, they do warrant consideration in obese children.
Epidemiology
The prevalence of childhood obesity is estimated to be 25 to 30 percent.7 Furthermore, over the years encompassed by these surveys, the prevalence of obesity has increased by 54 percent in children six to 11 years of age and by 39 percent in adolescents 12 to 17 years of age. The prevalence of severe obesity jumped 98 percent and 64 percent within these groups, respectively. Hispanic, Native American and black patients tend to be more affected.
Pathophysiology
A person gains weight when energy input exceeds energy output. Energy input is food. Several studies have shown that, on average, obese children do not consume significantly more calories.
Evaluation of Obese Children
Only a small percentage of childhood obesity is associated with a hormonal or genetic defect, with the remainder being idiopathic in nature. The most common of the endogenous causes of childhood obesity.
Growth failure characterizes endogenous obesity. Children with an associated genetic or hormonal syndrome are short, usually at or under the 5th percentile of height for age.
Hypercortisolism (Cushing's syndrome) is another frequently suspected cause of endogenous obesity. Although it is usually iatrogenic in nature, it can also be secondary to adrenal tumors or primary pituitary.
Office Evaluation
Obese children must be evaluated for associated morbidity. This includes an assessment of cardiac risk factors, weight-related orthopedic problems, skin disorders.Treatment
The best way to significantly affect the prevalence of obesity is to prevent it. Therefore, the issue of obesity should be addressed during every well-child examination. Parents should know that both bottle- and breast-fed infants can be overfed, although overfeeding is more common in infants fed.