Identifying underlying medical causes of pediatric obesity: Results of a systematic diagnostic approach in a pediatric obesity center

• Published in: PloS one Vol. 15; no. 5; p. e0232990
• Main Authors: Kleinendorst, Lotte, Abawi, Ozair, van der Voorn, Bibian, Jongejan, Mieke H T M, Brandsma, Annelies E, Visser, Jenny A, van Rossum, Elisabeth F C, van der Zwaag, Bert, Alders, Mariëlle, Boon, Elles M J, van Haelst, Mieke M, van den Akker, Erica L T
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 08.05.2020; Public Library of Science (PLoS)
• Subjects: Adolescent; Ambulatory Care Facilities; Biochemistry; Biology and Life Sciences; Brain Diseases - complications; Causes of; Child; Child health; Child, Preschool; Childhood; Childhood obesity; Children; Diagnosis; Diagnostic systems; Disabilities; Diseases; Disorders; Drug-Related Side Effects and Adverse Reactions - diagnosis; Drug-Related Side Effects and Adverse Reactions - etiology; Drugs; Endocrine disorders; Endocrine System Diseases - complications; Endocrinology; Female; Genetic research; Genetic screening; Genetic Testing; Genetics; Health services; Heterogeneity; Hospitals; Humans; Hyperphagia; Infant; Infant, Newborn; Intellectual disabilities; Intellectual Disability - complications; Internal medicine; Male; Medical diagnosis; Medical treatment; Medicine; Medicine and Health Sciences; Neonates; Netherlands; Newborn infants; Obesity; Outpatient care facilities; Patients; Pediatric Obesity - diagnosis; Pediatric Obesity - etiology; Pediatric Obesity - genetics; Pediatric research; Pediatrics; Phenotype; Prospective Studies; Short stature; Teenagers; Youth; Netherlands
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0232990

Underlying medical causes of obesity (endocrine disorders, genetic obesity disorders, cerebral or medication-induced obesities) are thought to be rare. Even in specialized pediatric endocrinology clinics, low diagnostic yield is reported, but evidence is limited. Identifying these causes is vital for patient-tailored treatment. To present the results of a systematic diagnostic workup in children and adolescents referred to a specialized pediatric obesity center. This is a prospective observational study. Prevalence of underlying medical causes was determined after a multidisciplinary, systematic diagnostic workup including growth charts analysis, extensive biochemical and hormonal assessment and genetic testing in all patients. The diagnostic workup was completed in n = 282 patients. Median age was 10.8 years (IQR 7.7-14.1); median BMI +3.7SDS (IQR +3.3-+4.3). In 54 (19%) patients, a singular underlying medical cause was identified: in 37 patients genetic obesity, in 8 patients cerebral and in 9 patients medication-induced obesities. In total, thirteen different genetic obesity disorders were diagnosed. Obesity onset <5 years (p = 0.04) and hyperphagia (p = 0.001) were indicators of underlying genetic causes, but only in patients without intellectual disability (ID). Patients with genetic obesity with ID more often had a history of neonatal feeding problems (p = 0.003) and short stature (p = 0.005). BMI-SDS was not higher in patients with genetic obesity disorders (p = 0.52). Patients with cerebral and medication-induced obesities had lower height-SDS than the rest of the cohort. To our knowledge, this is the first study to report the results of a systematic diagnostic workup aimed at identifying endocrine, genetic, cerebral or medication-induced causes of pediatric obesity. We found that a variety of singular underlying causes were identified in 19% of the patients with severe childhood obesity. Because of this heterogeneity, an extensive diagnostic approach is needed to establish the underlying medical causes and to facilitate disease-specific, patient-tailored treatment.