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Observational Study
. 2020 May 8;15(5):e0232990.
doi: 10.1371/journal.pone.0232990. eCollection 2020.

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

Lotte Kleinendorst  1   2   3 , Ozair Abawi  1   4 , Bibian van der Voorn  1   4   5 , Mieke H T M Jongejan  6 , Annelies E Brandsma  7 , Jenny A Visser  1   5 , Elisabeth F C van Rossum  1   5 , Bert van der Zwaag  8 , Mariëlle Alders  2 , Elles M J Boon  2   3 , Mieke M van Haelst  2   3 , Erica L T van den Akker  2   3
Affiliations
Observational Study

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

Lotte Kleinendorst et al. PLoS One. .

Erratum in

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.

Results: The 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 <5 years (p = 0.04) and hyperphagia (p = 0.001) were indicators of underlying genetic causes, but only in patients without intellectual disability (ID). Patients with genetic obesity with ID more often had a history of neonatal feeding problems (p = 0.003) and short stature (p = 0.005). BMI-SDS was not higher in patients with genetic obesity disorders (p = 0.52). Patients with cerebral and medication-induced obesities had lower height-SDS than the rest of the cohort.

Conclusions: To 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.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Study flow chart.
Flow chart indicating the inclusion of participants and diagnoses established in our cohort. Abbreviations: CGG, Dutch: Centrum Gezond Gewicht; English: Centre for Healthy Weight; ID, intellectual disability.
Fig 2
Fig 2. Diagnostic approach.
Systematic diagnostic approach for children and adolescents with obesity and a suspicion of an underlying medical cause. Abbreviations: OGTT, oral glucose tolerance test; IGF-1, Insulin-like growth factor 1; GP, general practitioner.
See this image and copyright information in PMC

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