Introduction: Despite public health interventions, paediatric obesity in the UK is increasing, with almost one third overweight or obese. The direct cost of obesity to the NHS is estimated at 4.2 billion a year. The North-East has some of the highest rates of obesity in the country. A recent clinical practice guideline (March 2017) from European and US Endocrine societies aims to inform assessment, treatment and prevention of paediatric obesity.
Aim: To evaluate current practice and improve care of obese and overweight children.
Method: Retrospective audit of obese patients attending a paediatric secondary care multidisciplinary team obesity clinic from January 2016 to May 2017.
Results: One hundred and forty patients were referred to the clinic in this period, of which 103 were seen. Patients had a median age of 8.6 years. 54% (n=56) were male. Median BMI at presentation was 32.5 kg/m2, with 34% (n=35) classed as extremely obese (BMI >35 kg/m2). The average BMI z-score at presentation was 3.72 (2.1±7.02) S.D. above the mean. Of those measured, reductions in BMI z-scores were seen in 66% (n=38), 63% (n=33) and 70% (n=14) at 3, 6 and 12 months, respectively. The average BMI z-score reduction was −0.25 S.D. and −0.41 S.D. at 6 and 12 months, respectively. There were high rates of disengagement with 51% missing at least one appointment. A third had mental health diagnoses, of which 46% had ASD/ADHD. 23% (n=32) had safeguarding involvement. Blood investigations were variable. 55% (n=63) had a HbA1c; 7% had pre-diabetes and 1% diabetes. 77% had thyroid function tests, one showing a raised TSH. 37% (n=51) had lipids checked; 16% had dyslipidaemia. 67% (n=93) had an ALT; 29% were abnormal. One patient took metformin for type 2 diabetes and another captopril for hypertension. All patients had involvement from a paediatric consultant, paediatric dietitian and clinical psychologist.
Conclusions: When children stay engaged in obesity services there are considerable BMI z-score reductions. The high prevalence of mental health problems emphasises importance of psychology input. There is wide variation in regional service provision. Investigations were variable and co-morbidities possibly missed. Guidelines should be implemented standardising care of obese children.
22 - 24 Nov 2017
British Society for Paediatric Endocrinology and Diabetes