ESPE2023 Poster Category 1 Fat, Metabolism and Obesity (97 abstracts)
Complications of excess weight (CEW) seen in tier-3 paediatric weight management services: A two-centre experience
Louise Apperley 1 , Katherine Hawton 2 , Jennifer Parkinson 1 , Meghan Owens 1 , Claire Semple 2 , Amy Fitzgerald 2 , Shelley Easter 2 , Kate Clark 1 , Kim Lund 1 , Ellie Clarke 1 , Dinesh Giri 2 , Senthil Senniappan 1 & Julian Hamilton-Shield 3,2
1Alder Hey Children's Hospital, Liverpool, United Kingdom. 2Bristol Royal Hospital for Children, University Hospitals Bristol and Weston NHS Foundations Trust, Bristol, United Kingdom. 3NIHR Biomedical Research Centre (Nutrition Theme), University of Bristol, Bristol, United Kingdom
Background: Children and young people living with severe obesity experience a range of complications of excess weight (CEW), however the prevalence of complications is not well defined. We have evaluated baseline clinical characteristics and CEW of patients seen in two multi-disciplinary tier-3 paediatric weight management services in different regions of the UK.
Methods: All new patients (n=185) aged 2-17 years seen in a 12-month period from March 2022 to February 2023 were included. Baseline demographic data was collected, and patients were screened for a range of CEW. PedsQL-4.0 Generic Core Scales questionnaire was used to assess quality of life (QoL).
Results: The mean age was 13.04 years (range 3.33-17.95) and 50.8% (94/185) were female. The majority of patients were white British (73.8%) and a significant excess living in the most deprived decile (41.4%). The mean BMI was 36.47kg/m2 (+8.37 SD) and BMI SDS was +3.54 (+0.70 SD). Mean body fat (n=77) was 48.6% (+8.44 SD). A combination of ASD, ADHD and learning difficulties were vastly over-represented in this cohort. Dyslipidaemia (as defined by total cholesterol >5.17mmol/l, LDL > 3.36 mmol/l, HDL < 1.02mmol/l or triglycerides >1.5mmol/l) was the most common (51.6%) complication identified, followed by hypertension (29.7%), evidence of non-alcoholic fatty liver disease [NAFLD] on ultrasound imaging (17.8%), obstructive sleep apnoea [OSA] (9.0%) and idiopathic intracranial hypertension [IIH] (4.9%) (Table 1). Mean HbA1c was 39.0 mmol/mol (+15.18 SD; NR <42). Sixteen (8.6%) patients had type 2 diabetes mellitus (T2DM), with two cases diagnosed through screening in the CEW clinics. QoL scores were low with a mean child-reported questionnaire (n=82) total score of 49.51/100 (+19.19 SD) and a mean parent-reported questionnaire (n=87) total score of 45.81/100 (+19.35 SD). Mean scores from a healthy UK paediatric reference population were 82.25 and 81.12 respectively. Mental health problems were common, with 26.2% and 7.7% having diagnoses of anxiety and depression respectively.
| Complication | Percentage of patients (number with complication/ number screened) |
| Dyslipidaemia | 51.6 (65/126) |
| Hypertension | 29.7 (43/145) |
| NAFLD on ultrasound | 17.8 (33/185) |
| OSA OSA requiring respiratory support | 9.0 (16/177) 3.4 (6/177) |
| IIH | 4.9 (9/185) |
| T2DM | 8.6 (16/185) |
Conclusion: The results from this study have demonstrated the significant and profound pathology resulting from severe obesity, highlighting the clinical necessity of CEW MDT clinics. A rigorous approach to identify and manage these physical and mental health complications at an early stage is essential to improve long-term health outcomes.
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