Precocious Puberty

Childhood obesity is excessive adiposity associated with increased risk of type 2 diabetes, hypertension, dyslipidaemia, fatty liver disease, obstructive sleep apnoea and later cardiovascular disease.

BMI must be interpreted according to age and sex specific centiles or Z scores, rather than adult thresholds in younger children.

Most children are asymptomatic.

Assess for complications including:

• Hypertension
• Acanthosis nigricans
• Sleep disordered breathing
• Menstrual irregularity
• Joint pain
• Psychological distress
• Hepatomegaly

Poor height velocity alongside increasing weight suggests an endocrine disorder and should not be assumed to represent simple obesity.

Assess BMI trajectory and family growth pattern.

Screen according to age and risk for:

• Blood pressure
• HbA1c or fasting glucose
• Lipid profile
• ALT and AST
• Sleep apnoea

Treatment should involve the family and focus on sustainable changes in food quality, portion size, physical activity, sleep and sedentary behaviour.

Avoid stigmatizing language.

Severe obesity, significant metabolic complications or suspected endocrine or genetic obesity warrants specialist multidisciplinary care.

Pharmacological therapy and metabolic surgery are increasingly options for selected adolescents with severe obesity but require specialist programmes.