Diagnosis of obesity in children

Anamnestic diagnostic criteria:

• diabetes mellitus (including gestational), metabolic syndrome in the mother, obesity in relatives;
• large body weight of the child at birth;
• birth weight less than 2500 g;
• early age of fat reconstruction (rapid increase in BMI to 5-6 years);
• high-calorie meals mainly in the afternoon, a habit of overeating.

[1], [2], [3], [4], [5], [6], [7], [8],

Indications for consultations of other specialists

Children with obesity are required to consult a medical genetics and endocrinologist to exclude hereditary and endocrine diseases requiring specialized treatment. In the presence of affective disorders in children, a consultation of a medical psychologist and a psychiatrist is indicated. If a child has manifestations of cardiac arrhythmia, a cardiologist consultation is recommended.

Physical examination

Obesity in children has the following diagnostic criteria:

• definition of BMI;
• signs of excessive development of subcutaneous fat, a certain pattern of fat distribution;
• signs of trophic skin disorders;
• symptoms of cardiovascular damage, digestion (GERD, steatohepatitis), respiratory organs (sleep apnea), musculoskeletal system;
• symptoms of impaired sexual development: signs of false gynecomastia and hypogenitalism in boys;
• manifestations of psychopathic, neurotic and vegetative disorders.

Laboratory diagnosis of obesity in children

The results of a general analysis of blood and urine have no specific changes. Biochemical blood test reveals:

• increased cholesterol, triglycerides, low-density lipoproteins, free fatty acids;
• reduction of high-density lipoproteins;
• acidosis;
• Hyperinsulinemic type of glycemic curve.

Conduct a blood test for hormones (according to indications).

Instrumental diagnosis of obesity in children

The study includes:

• ECG, cardiointervalography;
• Ultrasound of the organs of the abdominal cavity and kidneys, thyroid gland;
• fibrogastroduodenography;
• MRI of the brain;
• examination of the function of external respiration.

Daily blood pressure monitoring is performed.

Differential diagnosis of obesity in children

Differential diagnosis of obesity in children is carried out with various forms of secondary obesity caused by:

• genetic syndromes that occur with obesity:
  • Pradera-Willy;
  • Shereshevsky-Turner;
  • Down;
  • Lawrence-Muna-Barde-Biddle;
  • Alstroma;
  • Carpenter;
• a mutation of the leptin receptor or melanocortin 4 gene;
• myodystrophy;
• myelodysplasia;
• deficiency of proopiomelanocortin;
• pseudohypoparathyroidism;
• organic lesions of the central nervous system associated with damage to the nuclei of the ventromedial and lateral regions of the hypothalamus, regulating appetite and saturation;
• consequences of traumatic brain injury;
• endocrine diseases:
  • hypothyroidism;
  • hypogonadism;
  • hypercorticism;
  • hyperinsulinism;
  • adolescent dyspititism;
• iatrogenic factors: the use of certain medications (eg, anabolic, glucocorticosteroids).

Differential diagnosis of diffuse forms of obesity

Symptom	Constitutionally-exogenous (simple)	Hypothalamic	The pubertal hypothalamic syndrome (dyspeptoralism)	Isenko-Cushing syndrome
Frequency	Often	Less frequently	Often	Rarely
Terms of manifestation	Often in the first years of life	Depending on the time of the defeat of the hypothalamus	In the pre and pubertal period	Any age
Hereditary predisposition	Often	Not typical	Not typical	Not typical
Body Dimensions	More often high-growth	Without deviations	Without deviations	Low height
The nature of the distribution of subcutaneous fat	Uniform	Uneven-dimensional (belt)	Uneven-dimensional (belt)	Unequal-dimensional "kushin-goid"
Sexual maturation	Often accelerated	Wrong	Accelerated, often incorrect	Apprehended
Skeletal development	Normal	Can be accelerated or slowed down	Accelerated	Osteoporosis
Arterial pressure	Normal	Increased	Increased	Increased

[9], [10], [11], [12],