Sample Solution

. Psychiatric:
Results from several studies suggest a higher rate of depression among obese children than among children of normal weight. In addition to depression, anxiety and low-self esteem have also been found to relate to obesity in children and adolescents. A study by Grilo et al. (23) demonstrated that “the greater the frequency of being teased about weight and shape while growing up, the more negative one’s appearance is regarded, and the greater the degree of body dissatisfaction in adulthood”.

8. Miscellaneous:
Orthopedic problems, such as slipped capital epiphyses and Blount’s disease, occur in obese children. Approximately 50% to 70% of children with slipped capital epiphyses are obese. Obese children are also at a higher risk for developing gall stones, pseudotumor cerebri and obstructive sleep apnea.

EVALUATION OF THE OBESE CHILD:
Obese children often present to the Pediatrician/pediatric Endocrinologist with a concern about a hormonal cause of obesity or secondary to consequences of obesity eg. Concern about gynecomastia or embedded penis in males(pic1), irregular periods, acne or hirsutism in females and acanthosis nigricans(pic2) in both sexes.
A detailed history and physical examination is in order to elicit any cause of obesity and evaluation of consequences should be done depending on the age and degree of obesity.
1) History: It is a crucial part of evaluation of obesity and leading questions should be asked to elicit a cause as well as consequences of obesity.
A detailed history should be obtained regarding the onset (infancy/childhood), duration as well as the rapidity of weight gain. Infantile onset of obesity points towards a possibility of monogenic obesity.
A recent increase in appetite with rapid weight gain could suggest and intracranial mass especially if it is associated with headaches or visual disturbances.