Background: Childhood obesity is a growing problem worldwide, with serious effects on child health. Obese children are at a higher risk of developing metabolic co-morbidities earlier in life (WHO, 2013). Manchester has worse than national average levels of obesity, with an estimated 14 000 obese children (PHE, 2014).
Aims and methods: A retrospective case note analysis of 117 obese paediatric patients, seen in our service between March 2012 and 2014, was conducted, aimed at reviewing monitoring standards, frequency of metabolic co-morbidities and treatment outcomes.
Results: In our cohort, 38.5% were male (national average 55.2% in year 6). 90.6% of patients had a BMI centile ≥ 99.6th (BMI SDS ≥2.7) with median age 9.87 (range 0.5816.88) years. 7.7% had a genetic diagnosis of obesity (excluding PraderWilli syndrome). 70.1% had ≥2 metabolic co-morbidities, with insulin resistance (IR), dyslipidaemia and hypertension being the most prevalent (n=75, 65 and 38 respectively). 38 patients with IR were treated with metformin. In those rescreened within 24 months of treatment, 72% (13/18) demonstrated improved IR. For BMI SDS change analysis, 28 patients were excluded (nine genetic diagnosis, four hypothyroidism, 15 incomplete data). 80.9% of patients demonstrated BMI SDS loss or maintenance. In these patients, mean maximum BMI SDS loss achieved on lifestyle interventions (LI) (n=36) and LI and medication (n=36), were 0.38 (0.041.47) and 0.28 (0.001.16) SDS respectively.
Conclusions: Obese male children are likely to be under referred to paediatric services hence attention should be given to this cohort in the community. The high prevalence of co-morbidities within our cohort suggests that metabolic screening is indicated in children with severe obesity. Metformin treatment for up to 24 months in those with IR may improve longer term metabolic outcomes.
12 - 14 Nov 2014
British Society for Paediatric Endocrinology and Diabetes