ESPE Abstracts

Background: A third of children in the UK are obese or overweight. The majority are not in contact with medical services. Presentation to general paediatricians for unrelated condition may pose an opportunity to identify children with obesity. The UK obesity services for Children & Adolescents (OSCA) group have produced guidelines for management of obese children in secondary care.

Objective and hypotheses: Determine the prevalence of obesity in general paediatric out-patients. Describe the rate of identification of obesity. Compare practice with OSCA guidelines.

Method: Retrospective review of all patients attending general paediatric out-patient department during 1 calendar month. BMI centile was calculated for each child using British 1990 growth reference (UK90). History, investigations performed and management was compared to OSCA guideline standards.

Results: 186 patients attended out-patient clinic. 138/186 (74%) notes were available for review. 13/138 (9.4%) of children were obese (BMI >98th centile) with mean age 9.6 (±5.3) years and mean BMI SDS 3.6. Of the obese children, 5/13 (39%) were identified by clinicians; Focused history was documented in 3/13 (23%); 2/13 (15%) had the full set of investigations and 2/13 (15%) had fasting glucose, insulin & lipids measured. Secondary obesity was identified in one obese child (congenital hypothyroidism). 3/13 (23%) had co-morbidities including psychological, joint problems, abnormal glucose metabolism and precocious puberty. 1/13 (8%) of obese children were referred to a paediatric endocrinologist. In addition, 7/138 (5.1%) of children were overweight (BMI 91th−98th centile) with mean age 8.2 (±4.9) years and mean BMI SDS 1.8. 2/7 (29%) who were overweight had been identified by clinicians.

Conclusion: Around 10% of children attending general paediatrics out-patients are obese. But there is under-recognition. Investigations and management of these children is frequently incomplete.