Secondary causes of obesity in children and adolescents

Abstract

Aim of this paper is to present an overview of the major disorders associated with obesity. An increasing number of children and adolescents are overweight or obese. In developed countries, the incidence of overweight and obesity exceeds 30%. The obesity mostly results from exogenous causes, when energy intake exceeds consumption for an extended period of time. In a considerably smaller number of children and adolescents, the cause is secondary. Great attention is paid to the epidemic of exogenous obesity while secondary causes of obesity often remain unrecognized and untreated. The child can be obese due to a genetic disorder such as a mutation of the leptin gene, or the leptin receptor or melanocortin-4 receptor genes. If the obesity is the consequence of a hormonal disorder, the possibility of aetiological treatment that leads to healing is considerably higher. The most common underlying disorders are hypothyroidism, growth hormone deficiency or Cushing’s syndrome. Obesity is often an integral part of syndromes such as Prader-Willi or Bardet-Biedle. In most cases of monogenic obesity treatment is based on lifestyle changes and limited caloric intake.

Conclusion − It is important to recognise the disease as early as possible, in order to restrain the unhealthy increase in body mass that causes a number of associated disorders which dramatically affect the patient’s duration and quality of life. Secondary obesity should be considered in a child who, besides being obese, displays short stature or a reduced growth rate, delayed psychomotor development, facial dysmorphia, cryptorchidism, hypogonadism or a vision or hearing impairment. In the process of recognising the disease, the primary paediatrician plays an important role and then participates in the treatment providing support to the child and family.