OBESITY

• Obesity is defined as BMI > 95th percentile for age and sex or body weight > 120 % of ideal.
• Childhood obesity is now an epidemic in India. With 14.4 million obese children, India has the second-highest number of obese children in the world, next to China. The prevalence of overweight and obesity in children is 15%. In private schools catering to upper-income families, the incidence has shot up to 35-40%, indicating a worrying upward trend.

• Environmental factors: sedentary lifestyle
• Genetic factors
• Endocrine causes: hypothyroidism, Cushing’s syndrome
• Hypothalamic dysfunction: 
• CNS: encephalitis, meningitis
• Others: PCOD
• Drugs: Steroids, anticonvulsants

• Childhood obesity is mostly exogenous, due to net excess calories, either excessive intake or lack of calorie expenditure.
• Children with exogenous obesity are usually tall for age, with normal or slightly advanced bone age. 
• There may be associated comorbidities like hypertension, diabetes mellitus, cerebrovascular accidents, gall bladder diseases, slipped capital femoral epiphysis, joint problems, poor body image and hence depression.

Evaluation:

Ask for:

• Family history
• Dietary intake
• Activities of the child
• History of excessive appetite: suggest a hypothalamic lesion
• History of CNS involvement
• History of drug intake:- eg:- steroids, clonazepam, and sodium valproate give rise to obesity
• Developmental history: delayed development is a feature of hypothyroidism

Assessment of obesity:

BMI: Weight (kg)/Height (m)2

• BMI > 30 kg/m2 or children with BMI above 95thpercentile are labelled as obese

Weight for height

• If the weight for height is greater than 120% child is labelled as obese

Skin fold thickness

• Measured over subscapular, triceps, and biceps. Values greater than the 85th percentile are abnormal

 Also, assess the distribution of fat: 

• Over neck and trunk: excess cortisol
• Buffalo hump: Cushing syndrome

Constitutional obesity: tall for age

Reduced rate of linear growth in a child with obesity is seen in

• GH deficiency
• Hypothyroidism
• Pseudoparathyroidism
• Cortisol excess
• Genetic syndromes like Prader- Willi syndrome

Secondary sexual characters

• Familial/ Diet-induced: enter puberty at the appropriate age/ mature more quickly
• Hormone deficiency like hypothyroidism, cortisol excess, various genetic syndromes: growth rate and pubertal development is delayed

Facies

• Coarse facies: hypothyroidism
• Moon facies: Cushing’s syndrome
• Almond-shaped eyes: Prader- Willi syndrome

Congenital Anomalies

Thoroughly examine a child for congenital anomalies

• Polydactyl and hypogonadism: Laurence- Moon- Beidl syndrome and Alstrom syndrome

Other features:

• Presence of striae and hirsutism: Cushing Syndrome
• Hypertension: Cushing's syndrome (Record blood pressure in all cases of obesity)

Systemic Examination: 

• Hepatosplenomegaly: suggest glycogenosis
• Generalized hypotonia: Prader- Willi syndrome
• Mental subnormality: hypothyroidism, Prader- Willi syndrome, Pseudohypothyroidism

INVESTIGATIONS

A relevant investigation based on the clinical cause

• Blood: TFT, Lipid profile, serum cortisol levels
• Genetic studies to rule out any genetic conditions
• USG Abdomen

• Physical exercise
• Good dietary practices

 Ayurvedic Treatment

• Correction of Agni 

Kashayas 

• Amruthothara kashaya, Varunadi kashaya
  • 2 tsp powder boiled in 2 glass water and strained and used thrice daily

Medo kapha hara treatments 

• Lohasavam: 15ml tds
• Guggulu preparations: Gulika: Yogarajaguggulu: 1 tab tds
• Varachoornam: ½ to 1 tsp with honey twice or thrice daily
• External procedures like udvarthana