PLoS ONE (Jan 2020)

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

  • Lotte Kleinendorst,
  • Ozair Abawi,
  • Bibian van der Voorn,
  • Mieke H T M Jongejan,
  • Annelies E Brandsma,
  • Jenny A Visser,
  • Elisabeth F C van Rossum,
  • Bert van der Zwaag,
  • Mariëlle Alders,
  • Elles M J Boon,
  • Mieke M van Haelst,
  • Erica L T van den Akker

DOI
https://doi.org/10.1371/journal.pone.0232990
Journal volume & issue
Vol. 15, no. 5
p. e0232990

Abstract

Read online

BackgroundUnderlying 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.ObjectivesTo present the results of a systematic diagnostic workup in children and adolescents referred to a specialized pediatric obesity center.MethodsThis 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.ResultsThe diagnostic workup was completed in n = 282 patients. Median age was 10.8 years (IQR 7.7-14.1); median BMI +3.7SDS (IQR +3.3-+4.3). In 54 (19%) patients, a singular underlying medical cause was identified: in 37 patients genetic obesity, in 8 patients cerebral and in 9 patients medication-induced obesities. In total, thirteen different genetic obesity disorders were diagnosed. Obesity onset ConclusionsTo our knowledge, this is the first study to report the results of a systematic diagnostic workup aimed at identifying endocrine, genetic, cerebral or medication-induced causes of pediatric obesity. We found that a variety of singular underlying causes were identified in 19% of the patients with severe childhood obesity. Because of this heterogeneity, an extensive diagnostic approach is needed to establish the underlying medical causes and to facilitate disease-specific, patient-tailored treatment.