September 26, 2019
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Pediatric obesity guidelines may miss underlying causes

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Current guidelines for assessing pediatric obesity would have missed 32% of cases with an underlying cause among a cohort of children who underwent extensive work-up for obesity, according to findings presented at the annual meeting of the European Society for Paediatric Endocrinology.

Ozair Abawi

“Diagnosing underlying causes is of vital importance for patients suffering from obesity, as it provides insight into the clinical course of obesity and thus makes tailored monitoring and treatment possible. Moreover, it helps patients and their families to battle the obesity stigma they are often confronted with,” Ozair Abawi, MD, a PhD candidate, and Erica L.T. van den Akker, MD, PhD, a pediatric endocrinologist and associate professor, both of the Obesity Center CGG in the department of pediatric endocrinology at Erasmus MC-Sophia Children’s Hospital in Rotterdam, the Netherlands, told Endocrine Today. “For some genetic obesity disorders, highly effective pharmacological treatment options are currently being investigated in clinical trials. Indeed, in our clinical experience, we often see a positive effect of diagnosis and subsequently patient-tailored treatment on the clinical course of the obesity.”

In a prospective, observational study, the researchers assessed underlying causes of obesity for 282 children with obesity (median age, 10.8 years; 59% girls) attending a pediatric obesity center. Extensive evaluation was done for all participants to identify endocrine, cerebral, medication-induced or lifestyle causes of obesity. These assessments were then compared with current guidelines from the Endocrine Society.

According to the researchers, 19% of the cohort (n = 53) had an underlying cause for obesity, including 36 with genetic, 9 with medication-induced and 8 with cerebral causes.

“We were surprised by our high yield of underlying singular causes of pediatric obesity, which is unprecedented,” Abawi and van den Akker said. “In literature, it is often stated that underlying causes of pediatric obesity are rare.”

The researchers noted that of these 53 children, only 68% (n = 36) would have been investigated for an underlying cause according to current guidelines. In an abstract, the researchers specifically noted that the guideline would have missed “patients presenting with genetic obesity syndromes with typical onset of obesity > 5 years and patients using weight-inducing medication other than antipsychotics.” Guideline recommendations for testing children younger than 5 years and those with hyperphagia would have identified underlying causes, according to the researchers.

“This study shows the value of a broad diagnostic strategy in selected patients suffering from obesity in tertiary pediatric care setting. Moreover, our study provides input to further expand our understanding of these underlying causes of obesity,” Abawi and van den Akker said. “We hope this knowledge can be used in the future to further improve guidelines and to find optimal diagnostic strategies for children and adolescents suffering from obesity.” – by Phil Neuffer

References:

Abawi O, et al. P1-46. Presented at: European Society for Paediatric Endocrinology Annual Meeting; Sept. 19-21, 2019; Vienna.

For more information:

Ozair Abawi, MD, can be reached at o.abawi@erasmusmc.nl.

Disclosures: Abawi and van den Akker report no relevant financial disclosures.