Diagnosis and Treatment of Pediatric Obesity I

Diagnosis

Obesity does not actually mean weighing a lot; it refers to a state in which excess body fat has accumulated. Therefore, it is better to measure body fat accurately. However, because accurate body fat measurement requires expensive equipment and the measurement methods are also difficult, indirect methods are used. In adults, there is an absolute value for diagnosing obesity, but in children, because they are still growing, obesity is diagnosed by comparing boys and girls by age.

There are various methods used in children, but the most commonly used and practical ones are the obesity index and body mass index.

1. Obesity index

The obesity index is calculated using sex, age, height, and standard weight (50th percentile). An obesity index of 20% or more is considered obesity, and it is classified as mild obesity at 20-30%, moderate obesity at 30-50%, and severe obesity at 50% or more.

2. Body Mass Index (BMI)

Body mass index is calculated by dividing weight by the square of height. A BMI in the 85th-94th percentile is considered at risk for obesity, and a BMI at or above the 95th percentile is considered obesity. It is useful for diagnosing obesity in children aged 6 and older, especially adolescents, and in those 18 and older, a BMI of 25 kg/㎡ or higher is diagnosed as obesity. BMI is highly correlated with body fat mass and body fat percentage, and is also known to have a meaningful correlation with complications of obesity such as hypertension, dyslipidemia, and mortality due to obesity.

3. Skinfold thickness measurement

Since about 50% of body fat exists in the subcutaneous layer, this method indirectly measures body fat by measuring skin thickness. If the skinfold thickness of the triceps or subscapular area is measured and compared by sex and age, and the result is at or above the 95th percentile, it is considered obesity. However, the disadvantage is that there can be large differences depending on the person performing the measurement.

4. Weight for height

If the weight compared with height and sex is at or above the 95th percentile, it is considered obesity.

5. Bioelectrical impedance analysis

This method directly measures body fat percentage, but its use is limited because the normal range is 12-30% and there is a wide variation depending on the individual and age. However, it is especially useful for comparing body fat percentage during the course of obesity treatment.

Treatment

The complications seen in pediatric obesity are similar to those that occur in adults, but unlike adult obesity treatment, treatment in children must take into account the fact that they are still growing. First, adult obesity treatment aims at weight loss, but in obese children, the goal should be to reduce the degree of obesity rather than body weight. Even if weight does not change, if height increases, the child becomes relatively slimmer and the obesity resolves. Second, because obese children are psychologically immature, active cooperation from parents is essential. Third, extremely low-calorie diets that may interfere with the growth of obese children should not be used. Fourth, in principle, medication is not advisable for use in obese children.

1. Guidelines for managing pediatric obesity

1. Management guidelines according to degree of obesity

(1) If the degree of obesity is mild obesity at 20-30%, or if the increase in the degree of obesity over the past 2 years has remained within 10%, there is no need to reduce the current weight; it should simply be maintained. As height increases, most children become slimmer, so care should be taken to prevent the degree of obesity from increasing further.

(2) If the degree of obesity is moderate to severe obesity at 30% or more, or if the degree of obesity has increased by more than 10% over the past 2 years, regular health checkups should be performed every 1-2 months to confirm that the degree of obesity is not increasing.

① If the degree of obesity is less than 40% and there are no complications

The target is an obesity index of 20%, and weight loss is mostly not necessary. However, for obesity that developed in late adolescence, a weight loss of about 1-2 kg per month is needed, and health checkups should be received every 1-2 months until weight management becomes a habit.

② If the degree of obesity is less than 50% and there are complications other than diabetes

The initial target is to transition to mild obesity with an obesity index of 30% or less. Regular health checkups should be received every month, weight loss of about 1-2 kg per month should be achieved, and the final target is to keep the obesity index at 20% or less.

③ If the degree of obesity is 50% or more and there are complications other than diabetes

The goal is to lose about 2-3 kg per month and transition from severe obesity to moderate obesity.

④ If the degree of obesity is close to 100% in severe severe obesity, or if diabetes is present

Treatment should be carried out in the hospital if possible. After discharge, health checkups should be received at least once a month, and guidance on weight management and diabetes management should be continued for as long as possible.

2. Management of obese children according to BMI

(1) If the body mass index (BMI) is at or above the 95th percentile compared with sex and age

A thorough examination and screening tests should be performed to check for complications of obesity, and treatment is necessary.

Obese children aged 7 and older, and those younger than 7 with complications (hypertension, hyperlipidemia, diabetes), need weight loss.

Obese children younger than 7 without complications only need to maintain their current weight.

(2) If the body mass index is in the 85th-94th percentile

Screening tests should be performed to determine whether there are secondary complications.

· Family history of cardiovascular disease, elevated total cholesterol, diabetes, or obesity · Hypertension · Total cholesterol level of 200 mg/dL or higher · If the annual increase in BMI is large: increase of 2 or more compared with last year · If there is concern about overweight or obesity

If all of the above items are negative, treatment is not necessary, and a regular checkup should be received once a year. Overweight children aged 7 and older with complications and a BMI in the 85th-94th percentile need weight loss. If there are no complications, they only need to maintain their current weight.

So far, I have explained the diagnosis and treatment of pediatric obesity I.

In the next part, we will look at the treatment of pediatric obesity II.

Source: National Health Information Portal, Korea Disease Control and Prevention Agency