• 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.
Epiphysiodesis for the treatment of tall stature and leg length discrepancy