Obesity in children

Case history #1

An 8-year-old white girl presents for further evaluation of excessive weight gain and acanthosis nigricans. She was born at term following a pregnancy complicated by gestational diabetes, and had a birth weight of 4.5 kg. Her weight was above the 95th percentile for height by 2 years of age and has been accelerating further away from the normal weight curve since. She has followed the 95th percentile for height. She has a large appetite, consuming excessive calories throughout the day. She has limited activity, and watches 5-6 hours of television daily. She had a tonsillectomy and adenoidectomy for obstructive sleep apnea at 6 years. There is an extensive family history of obesity, and her father's body mass index (BMI) is 35 and mother's BMI is 45. The child's height is 143 cm, and weight 80 kg, giving her a BMI of 38.8, which is consistent with class III obesity (BMI ≥140% of the 95th percentile).

Case history #2

A 15-year-old black girl presents for evaluation of irregular periods and acne. Excessive weight gain is not a primary concern of the family, and they feel that she is simply "big-boned." However, her weight has been above the 97th percentile since 5 years of age, with acceleration further above the normal weight curve since. Both parents have obesity with type 2 diabetes mellitus. Her father also has hyperlipidemia and had a myocardial infarction at 47 years of age. The child consumes at least five cans of regular calorie soda daily and eats at fast food restaurants several times weekly. She has limited physical activity. Her height, weight, and BMI are 168 cm, 121.2 kg, and 42.8, respectively. BMI is consistent with class III obesity (BMI ≥140% of the 95th percentile).

Other presentations

Children who have obesity associated with hormonal abnormalities (e.g., hypothyroidism, Cushing syndrome) typically present with short stature with slowing growth velocity and other symptoms specific to the condition.

Children with syndromic obesity, such as Prader-Willi syndrome and Bardet-Biedl syndrome, often have developmental delay, dysmorphic features, and hypogonadism, in addition to having short stature.

Children can also present with hypothalamic obesity following treatment for intracranial lesions such as craniopharyngioma or other tumors in the hypothalamic-pituitary region.