The first thing that should come to mind is to have weight awareness, and preventing a child or adolescent from becoming overweight or obese. If the problem of being overweight or the obesity already exists, then the child or adolescent needs to be evaluated for associated health and emotional problems. This includes a primary assessment by a detailed history and physical exam, including a review of heart risk factors, weight-related orthopedic problems, skin disorders and potential psychiatric ramifications.
This evaluation process starts with a thorough history of diet and activities, and a social history. Next the family history should be taken, looking at the family obesity and heart risk factors. The heart risk factors include evidence of early cardiovascular (heart) disease, high cholesterol and blood pressure levels, cigarette smoking, the presence of diabetes and decreased physical activity in the family. Tobacco use should be ascertained in all adolescents, as this represents an independent risk for cardiovascular (heart) disease. Following this stage of the evaluation, is the physical examination and then the necessary blood chemistry evaluation.
Obese children have increased average blood pressure, and heart rate when compared to non-obese similarly aged children. The National Cholesterol Education Program Expert Panel on Blood Cholesterol Levels in Children and Adolescents recommends that physicians consider screening all obese children over two years of age for elevated cholesterol levels, because obesity in childhood is known to be associated with high cholesterol levels, high triglyceride levels and low levels of high-density lipoprotein.
The presence of diabetes should be considered in all morbidly obese children. While overt type 2 diabetes mellitus is rare in childhood, elevated blood insulin levels and glucose intolerance are very common in morbidly obese children.
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