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Gary Butler

and Jeremy Kirk

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date: 31 July 2021

Obesity is defined as: ‘An excess of body fat frequently resulting in a significant impairment of health and longevity’.

In most cases obesity is not due to an underlying endocrine disorder, although it may produce endocrine morbidity such as type 2 diabetes.

Although there are a number of different methods to assess overweight and obesity, the most common is body mass index (BMI): weight (kg)/height (m)2.

Classification is:

primary: exogenous or ‘simple’ obesity


identified genetic syndromes, e.g. Prader–Willi, Bardet–Biedl, pseudohypoparathyroidism

monogenic disorders, e.g. leptin deficiency, leptin/melanocortin receptor defects

CNS disease, e.g. hypothalamic obesity

endocrine disorders, e.g. hypothyroidism, Cushing syndrome, growth hormone deficiency, precocious puberty

immobility, e.g. cerebral palsy


Generally, children with obesity which is:

primary often have a family history, tall stature, advanced bone age, and no dysmorphic features

secondary often have short stature, delayed bone age, dysmorphic features, and developmental delay.

Complications of obesity are multisystem: metabolic, cardiovascular, respiratory, gastrointestinal/hepatic, orthopaedic, neurological, dermatological, gynaecological, and psychological.

Therapy is aimed at modifiable factors restoring the balance between energy intake (e.g. dietary) and expenditure (e.g. exercise), and preferably a combination of both along with counselling and behaviour modification. There is currently only limited data on the benefits of pharmacotherapy and bariatric surgery.

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