Obese Children Who Are Referred to the Pediatric Endocrinologist: Characteristics and Outcome

OBJECTIVE: The objective of this study was to characterize a population of obese children who were referred to a pediatric endocrinology clinic and to analyze the outcome of the referral. METHODS: Children who were referred for obesity and seen at least twice between January 1984 and July 2003 were included in this retrospective study. Demographic, clinical, and, when available, laboratory (fasting glucose and insulin, random cholesterol, and liver function tests) and bone age data were abstracted from the medical record at the first and last endocrine evaluations. Self-reported parental height, weight, and family history of diabetes were also entered in the database. Records from the pediatrician were used to identify the age of onset of obesity. RESULTS: The database included 587 children (mean age at referral: 9.5 years) with a preponderance of non-Hispanic white children (75.6%) and female gender (57.6%). Growth records in 251 children indicated that 80.6% of the children had become obese before the age of 6 years and were referred 4.3 +/- 2.9 years after having become obese. At follow-up, 38% of the children exhibited a decreased percentage of overweight compared with the baseline visit, but only 5 children had an age- and gender-specific BMI below the 95th percentile. Cholesterol and fasting insulin were elevated in 174 of 311 and 72 of 94 children, respectively. Bone age radiographic records for 157 patients showed significant advancement in 46%. Half of the mothers and 57.7% of fathers were obese, and type 2 diabetes was self-reported in 11.4% parents. CONCLUSIONS: In the majority of this predominantly non-Hispanic white referred sample of obese children, overweight started in the preschool years. The referral to the endocrinologist, occurring after a prolonged interval from the obesity onset, was ineffective in treating obesity. Hyperinsulinemia and hypercholesterolemia are often present also at a young age. These obesity comorbidities in association with high prevalence of parental obesity and type 2 diabetes expose these youths to high risk for developing type 2 diabetes and coronary heart disease. Our data underscore the need for early family-based behavioral-lifestyle intervention programs to be made available to pediatricians, enabling them to target the "at risk for overweight" preschool children and their likely overweight parents.