Identifying underlying medical causes of pediatric obesity: Results of a systematic diagnostic approach in a pediatric obesity center

Abstract

Background Underlying medical causes of obesity (endocrine disorders, genetic obesity disorders, cerebral or medication-induced obesities) are thought to be rare. Even in specialized pediatric endocrinology clinics, low diagnostic yield is reported, but evidence is limited. Identifying these causes is vital for patient-tailored treatment. Objectives To present the results of a systematic diagnostic workup in children and adolescents referred to a specialized pediatric obesity center. Methods This is a prospective observational study. Prevalence of underlying medical causes was determined after a multidisciplinary, systematic diagnostic workup including growth charts analysis, extensive biochemical and hormonal assessment and genetic testing in all patients.

COVID‐19 related anxiety in children and adolescents with severe obesity: A mixed‐methods study

“…During the first month, between 2 April 2020 and 23 April 2020, when these measures were in full effect, we contacted all parents of children currently under treatment at Obesity Center CGG (Erasmus MC‐Sophia Children's Hospital), a national referral centre for obesity. Patients are referred to Obesity Center CGG for diagnostic evaluation and/or personalized therapeutic advice 14 . We approached parents of all patients who had completed the diagnostic workup of our obesity centre and whose last visit to the outpatient clinic was in 2019 or 2020.…”

Clinical management of patients with genetic obesity during COVID-19 pandemic: position paper of the ESE Growth & Genetic Obesity COVID-19 Study Group and Rare Endo-ERN main thematic group on Growth and Obesity

“…Identifying genetic obesity requires a structured approach and diagnosis is crucial, not only for optimal treatment of the accompanying symptoms such as visual and hearing impairment and endocrinopathies, but also because the obesity accompanying these diseases requires a tailored and life-long approach [ 14 ]. For example, dietary expertise in the light of lowered resting energy expenditure or specific expertise on guidance of behavioural problems may be needed.…”

“…The limited available evidence, however, does show a possible link between obesity and disease severity, even in this age group [ 30 ] and the risk of a severe disease course increases with increased severity of obesity [ 7 , 31 ], as was also shown in adolescent and young adult age categories [ 3 , 5 , 28 ]. The latter finding is of specific importance for monogenic and syndromic obesity since the majority suffers from severe obesity [ 14 ]. Furthermore it should be noted weight might play a role in the suggested link between SARS-CoV-2 and Kawasaki or Kawasaki like disease (recently named Paediatric Multi-system Inflammatory Syndrome temporally associated with COVID-19, PIMS-TS or Multi Inflammatory Syndrome in Children temporally related to COVID-19, MIS-C), with an unusual high incidence in the first months of 2020 and evidence of past or present infection with SARS-CoV-2 in most patients [ 32 ].…”

“…Recently, other variants of genes involved in or regulating the melanocortin pathway and leading to early and severe obesity such as MC4R regulatory protein, melanocortin receptor accessory protein 2 (MRAP2), adenylate cyclase 3 (ADCY3), steroid coreceptor activator-1 (SRC-1) or kinase suppressor of ras 2 (KSR2) [8]. This leads to a defective LEP-melanocortin pathway in the hypothalamus, which is a key regulator of body weight, satiety and energy expenditure (14,15). Although early onset severe obesity (<5 years) and hyperphagia are the most common presenting features in these diseases, these patients can be affected by complex somatic conditions, including obesity comorbidities.…”

“…Syndromic genetic obesity differs from the non-syndromic diseases, as they have additional symptoms, apart from obesity [14][15][16], with intellectual disability, motor developmental delay and behavioural problems, such as autism being the most frequent features [14]. Both non-syndromic and syndromic obesity are more often diagnosed in children than in adult patient groups.…”