Guidelines for Evaluation of Obesity in Children
The Pediatric Weight Management clinic provides a multidisciplinary team approach to treating obese children, following an initial evaluation with doctors and dietitians.
Included for your reference is an algorithm for the evaluation of obese children. It contains contact information for the various programs at Children’s Hospital that can assist you at any stage of evaluation or treatment.
The most widely-accepted screening tool for identifying obese children and adolescents is the Body Mass Index, or BMI. This is calculated by dividing the child’s weight (in Kg) by height (in m) squared. Helpful tools for calculating BMI using metric and English units are available on the CDC website as part of their BMI for Age Training Module.
- Children whose BMI is between the 85th and 95th percentiles are defined as "at risk for overweight," while those with a BMI greater than the 95th percentile are defined as "overweight."
- View the Body Mass Index for Age Table for BOYS 2-20 and Body Mass Index for Age Table for GIRLS 2-20 years on the CDC website.
- BMI correlates well with a child’s adiposity. Certain exceptions exist are discussed at the CDC’s helpful training module Using the BMI-for-Age Growth Charts.
- View the CDC's algorithm for the evaluation of obese children: Overweight Children and Adolescents: Screen, Assess and Manage.
Evaluation for underlying causes of obesity
- Fewer than one percent of obese children have an underlying medical cause.
- Patients with only an elevated insulin level DO NOT need to be seen by pediatric endocrinology and should be referred to the weight management clinic.
- Obese children who are tall or growing normally have an extremely low risk of endocrinopathy and do not need further endocrine evaluation.
- Routine thyroid testing in obese children is NOT recommended. Abnormal thyroid tests should be repeated with antibodies before referral, as many minor abnormalities are transient and not the cause of obesity.
Evaluation for associated concerns
- Consider liver function testing and fasting lipid panel for all patients.
- Blood pressure should be measured in all patients, with attention to cuff size.
- All patients should be screened for signs and symptoms of sleep apnea, with referral as indicated.
- Girls should be screened for presence of hirsutism or menstrual disturbances.
- Consider screening for type 2 diabetes in obese patients with two or more of the following: family history of type 2 diabetes; high risk ethnicity (e.g. African American, Asian/Pacific Islander, Native American, Hispanic); signs or symptoms such as hypertension, hyperlipidemia, acanthosis nigricans, or PCOS. Either fasting glucose or oral glucose tolerance test is acceptable. Asymptomatic patients with abnormal screens should have screening repeated before diagnosis or referral.
- Consider referral to adolescent psychology or psychiatry for suspected co-morbid conditions such as bulimia, eating disorders, depression, or anxiety.
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