Assessment, differential diagnosis, and initial clinical evaluation of the pediatric patient with obesity: An Obesity Medical Association (OMA) Clinical Practice Statement 2022

Abstract

Background: The Obesity Medical Association (OMA) Clinical Practice Statement (CPS) on the assessment, differential diagnosis, and initial clinical evaluation of pediatric patients with obesity is intended to provide clinicians with an overview of clinical practices applicable to children and adolescents with body mass indexes greater than or equal to the 95th percentile for their ages, particularly those with adverse consequences resulting from increased body mass. The information in this CPS is based on scientific evidence, supported by the medical literature, and derived from the clinical experiences of members of the OMA.

Methods: The scientific information and clinical guidance in this CPS is based upon referenced evidence and derived from the clinical perspectives of the authors.

Results: This OMA Clinical Practice Statement on assessment, differential diagnosis, and initial clinical evaluation of pediatric patients with obesity provides clinical information regarding classification of children and adolescents with overweight or obesity, differential diagnoses to consider, and a roadmap for the initial clinical evaluation.

Conclusions: This OMA Clinical Practice Statement on assessment, differential diagnosis, and initial clinical evaluation of pediatric patients with obesity is an overview of current recommendations. Assessment of pediatric patients with obesity is the first step in determining treatments leading to the improvement of the health of children and adolescents with obesity, especially those with metabolic, physiological, and psychological complications.

Keywords: Assessment; Clinical evaluation; Differential diagnosis; Obesity; Pediatric patients.

Fig. 1

Body Mass Index Categories in Children and Adolescents Ages 2–20. BMI categories are shown for children ages 2–20 who are underweight, at a healthy weight, overweight, obese, and severely obese [6]. Note that not all patients with BMI in the 85th percentile or above have excess adiposity, and many children and adolescents with BMIs below the 5th percentile are healthy and do not need treatment. The CDC recommends using the WHO growth charts to monitor growth for infants and children ages 0–2 years of age in the U.S. and using the CDC growth charts for children ages 2 years and older [2].

Fig. 2

Body Mass Index Charts for Children and Adolescents Ages 2–20 Years with Severe Obesity. BMI vs. age is shown for children ages 2–20 years.

Fig. 3

Childhood Obesity: Differential Diagnosis. Considerations and associations are shown regarding linear growth, developmental delays, and early onset obesity in children. Abbreviations: TSH: thyroid-stimulating hormone; T4: thyroxine.

Fig. 4

Focused Review of Systems. Symptoms and associated co-morbidities for children with obesity are shown. Children may or may not complain of symptoms, so a careful assessment of symptoms associated with obesity is necessary.

Fig. 5

Diagnostic Workup: Labs and Studies. Shown are recommended diagnostics based on age ranges, BMIs, and risk factors for pediatric patients [28,29]. Abbreviations: BMI: body mass index; HbA1c: hemoglobin A1c; ALT: alanine aminotransferase; AST: aspartate aminotransferase; GGT: gamma-glutamyl transferase; 25 OH: 25-hydroxy; hs-CRP: high-sensitivity C-reactive protein.

Fig. 6

Special Populations: Turner Syndrome, Down Syndrome, and Achondroplasia. Children with Turner syndrome, Down syndrome, and achondroplasia require special considerations regarding health risks and obesity. Takeaways for each condition are shown [[30], [31], [32], [33], [34], [35], [36], [37]].