Diagnosis of obesity in children

Anamnestic diagnostic criteria:

• diabetes mellitus (including gestational), metabolic syndrome in the mother, obesity in relatives;
• high birth weight of the child;
• birth weight less than 2500 g;
• early age of restructuring of adipose tissue (rapid increase in BMI by 5-6 years);
• high-calorie diet mainly in the afternoon, habit of overeating.

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Indications for consultations with other specialists

Obese children need a consultation with a medical geneticist and endocrinologist to rule out hereditary and endocrine diseases that require specialized treatment. If children have affective disorders, a consultation with a medical psychologist and psychiatrist is indicated. If a child has manifestations of cardiac arrhythmia, a consultation with a cardiologist is recommended.

Physical examination

Obesity in children has the following diagnostic criteria:

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

Laboratory diagnostics of obesity in children

The results of the general blood and urine tests do not show any specific changes. The biochemical blood test reveals:

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

Blood tests for hormones are performed (as indicated).

Instrumental diagnostics of obesity in children

The study includes:

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

Daily monitoring of blood pressure is carried out.

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 associated with obesity:
  • Pradera-Willi;
  • Shereshevsky-Turner;
  • Down;
  • Lawrence-Moon-Bardet-Biedl;
  • Alstroma;
  • Carpenter;
• mutation of the leptin or melanocortin 4 receptor gene;
• myodystrophy;
• myelodysplasia;
• proopiomelanocortin deficiency;
• pseudohypoparathyroidism;
• organic lesions of the central nervous system associated with damage to the nuclei of the ventromedial and lateral regions of the hypothalamus, which regulate appetite and satiety;
• consequences of traumatic brain injury;
• endocrine diseases:
  • hypothyroidism;
  • hypogonadism;
  • hypercorticism;
  • hyperinsulinism;
  • juvenile dyspituitarism;
• iatrogenic factors: the use of certain medications (eg, anabolic steroids, glucocorticosteroids).

Differential diagnostics of diffuse forms of obesity

Sign	Constitutional-exogenous (simple)	Hypothalamic	Pubertal hypothalamic syndrome (dyspituitarism)	Itsenko-Cushing syndrome
Frequency	Very often	Less often	Quite often	Very rarely
Timing of manifestation	Often in the first years of life	Depending on the time of hypothalamic damage	In pre- and pubertal periods	At any age
Hereditary predisposition	Often	Not typical	Not typical	Not typical
Body dimensions	More often tall-growing	No deviations	No deviations	Short stature
Distribution of subcutaneous fat	Uniform	Uneven (belt)	Uneven (belt)	Unevenly dimensional “kushin-goid”
Puberty	Often accelerated	Incorrect	Accelerated, often incorrect	Detained
Skeletal development	Normal	It can be sped up or slowed down.	Accelerated	Osteoporosis
Blood pressure	Normal	Increased	Increased	Increased

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