Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Case Study
  • Published:

Evaluation of a child for secondary causes of obesity and comorbidities

Nature Reviews Endocrinology volume 5, pages 227–232 (2009)Cite this article

Abstract

Background. A 15-year-old boy who had been overweight since the age of 6 months was referred to an adolescent obesity clinic for further assessment of his comorbidities and management of his obesity. The patient had no history of developmental delay or abnormal growth velocity. He had previously tested negative for Prader–Willi syndrome and the melanocortin-4 receptor gene mutation. The patient had made numerous attempts at weight loss in the past, but any weight loss he achieved had been temporary. At presentation, the patient had a BMI of 52.3 kg/m2, a waist circumference of 156 cm, blood pressure of 130/85 mmHg and severe acanthosis nigricans in the cervical and axillary skin folds.

Investigations. Measurement of height, weight, waist circumference and blood pressure; screening tests, including a fasting glucose test, 2 h glucose-tolerance test, measurements of blood lipids and liver function tests.

Diagnosis. Morbid obesity, metabolic syndrome, nonalcoholic fatty liver disease, impaired glucose tolerance and dyslipidemia.

Management. The patient was assigned to an extensive lifestyle-modification and behavior-modification program, with clinic-based follow-up every 4 weeks.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2: Screening algorithm for obese children with BMI in the 95th percentile or above.

References

  1. Spear, B. A. et al. Recommendations for treatment of child and adolescent overweight and obesity. Pediatrics 120 (Suppl. 4), S254–S288 (2007).

    Article  PubMed  Google Scholar 

  2. Alberti, K. G., Zimmet, P. & Shaw, J. Metabolic syndrome—a new worldwide definition. A consensus statement from the International Diabetes Federation. Diabet. Med. 23, 469–480 (2006).

    Article  CAS  Google Scholar 

  3. Jolliffe, C. J. & Janssen, I. Development of age-specific adolescent metabolic syndrome criteria that are linked to the Adult Treatment Panel III and International Diabetes Federation criteria. J. Am. Coll. Cardiol. 49, 891–898 (2007).

    Article  PubMed  Google Scholar 

  4. Ogden, C. L. et al. Prevalence of overweight and obesity in the United States, 1999–2004. JAMA 295, 1549–1555 (2006).

    Article  CAS  PubMed  Google Scholar 

  5. Ogden, C. L., Carroll, M. D. & Flegal, K. M. High body-mass index for age among US children and adolescents, 2003–2006. JAMA 299, 2401–2405 (2008).

    Article  CAS  PubMed  Google Scholar 

  6. Butler, M. G., Theodoro, M. F., Bittel, D. C. & Donnelly, J. E. Energy expenditure and physical activity in Prader–Willi syndrome: comparison with obese subjects. Am. J. Med. Genet. 143, 449–459 (2007).

    Article  Google Scholar 

  7. Farooqi, I. S. et al. Clinical spectrum of obesity and mutations in the melanocortin-4 receptor gene. N. Engl. J. Med. 348, 1085–1095 (2003).

    Article  CAS  Google Scholar 

  8. Krebs, N. F. et al. Assessment of child and adolescent overweight and obesity. Pediatrics 120 (Suppl. 4), S193–S228 (2007).

    Article  PubMed  Google Scholar 

  9. Falkner, B. & Daniels, S. R. Summary of the fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Hypertension 44, 387–388 (2004).

    Article  CAS  PubMed  Google Scholar 

  10. Resnicow, K., Davis, R. & Rollnick, S. Motivational interviewing for pediatric obesity: conceptual issues and evidence review. J. Am. Diet. Assoc. 106, 2024–2033 (2006).

    Article  PubMed  Google Scholar 

  11. Helsel, D. L., Jakicic, J. M. & Otto, A. D. Comparison of techniques for self-monitoring eating and exercise behaviors on weight loss in a correspondence-based intervention. J. Am. Diet. Assoc. 107, 1807–1810 (2007).

    Article  PubMed  Google Scholar 

  12. Berkowitz, R. I. et al. Effects of sibutramine treatment in obese adolescents: a randomized trial. Ann. Intern. Med. 145, 81–90 (2006).

    Article  CAS  PubMed  Google Scholar 

  13. Ozkan, B., Bereket, A., Turan, S. & Keskin, S. Addition of orlistat to conventional treatment in adolescents with severe obesity. Eur. J. Pediatr. 163, 738–741 (2004).

    Article  PubMed  Google Scholar 

  14. Lawson, M. L. et al. One-year outcomes of Roux-en-Y gastric bypass for morbidly obese adolescents: a multicenter study from the Pediatric Bariatric Study Group. J. Pediatr. Surg. 41, 137–143 (2006).

    Article  PubMed  Google Scholar 

  15. Holterman, A. X. et al. Short-term outcome in the first 10 morbidly obese adolescent patients in the FDA-approved trial for laparoscopic, adjustable gastric banding. J. Pediatr. Gastroenterol. Nutr. 45, 465–473 (2007).

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

Written consent for publication was obtained from the patient's mother. Charles P Vega, University of California, Irvine, CA, is the author of and is solely responsible for the content of the learning objectives, questions and answers of the Medscape-accredited continuing medical education activity associated with this article.

Author information

Authors and Affiliations

  1. The Children's Hospital, University of Colorado Denver, Denver, CO, USA

    Robert E. Kramer & Stephen R. Daniels

Authors
  1. Robert E. Kramer
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Stephen R. Daniels
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Robert E. Kramer.

Ethics declarations

Competing interests

The authors declare no competing financial interests.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kramer, R., Daniels, S. Evaluation of a child for secondary causes of obesity and comorbidities. Nat Rev Endocrinol 5, 227–232 (2009). https://doi.org/10.1038/nrendo.2009.20

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1038/nrendo.2009.20

Search

Advanced search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing