Obesity

• Obesity is defined as: ‘An excess of body fat frequently resulting in a significant impairment of health and longevity’. • In most cases obesity is not due to an underlying endocrine disorder, although it may produce endocrine morbidity such as type 2 diabetes. • Although there are a number of different methods to assess overweight and obesity, the most common is body mass index (BMI): weight (kg)/height (m)2. • Classification is: • primary: exogenous or ‘simple’ obesity • secondary: ■ identified genetic syndromes, e.g. Prader–Willi, Bardet–Biedl, pseudohypoparathyroidism ■ monogenic disorders, e.g. leptin deficiency, leptin/melanocortin receptor defects ■ CNS disease, e.g. hypothalamic obesity ■ endocrine disorders, e.g. hypothyroidism, Cushing syndrome, growth hormone deficiency, precocious puberty ■ immobility, e.g. cerebral palsy ■ iatrogenic. • Generally, children with obesity which is: • primary often have a family history, tall stature, advanced bone age, and no dysmorphic features • secondary often have short stature, delayed bone age, dysmorphic features, and developmental delay. • Complications of obesity are multisystem: metabolic, cardiovascular, respiratory, gastrointestinal/hepatic, orthopaedic, neurological, dermatological, gynaecological, and psychological. • Therapy is aimed at modifiable factors restoring the balance between energy intake (e.g. dietary) and expenditure (e.g. exercise), and preferably a combination of both along with counselling and behaviour modification. There is currently only limited data on the benefits of pharmacotherapy and bariatric surgery.