Prevention
8
Figure 1. Diagnosis and Management Flowchart
BMI ≥85th Percentile
Additional evaluations
based on findings
Abnormal
Evaluate for obesity
comorbidities (Table 1)
Normal
Anti-psychotic
drug use
Attenuated
growth
velocity
CNS
injury
Reevaluate drug
therapy/choice
Initiate lifestyle
changes
and specific
treatment of
comorbidity
Initiate
lifestyle
changes
Present Absent
Endocrine
evaluation
Genetic evaluation
Hypthalamic
obesity
Weight loss/
stabilization
Continued
weight
gain
Maintain
support for
lifestyle
changes and
comorbidity
treatment
Consider
pharmaco-
therapy and/
or
surgery
Continued
weight gain
>6 months
Reevaluate pituitary
function and/or
hormone therapy
Data supporting use of these
interventions are limited to
pubertal individuals
Prader-Willi
syndrome
Yes No
Positive Negative
Congenital leptin
deficiency
PCSK1 deficiency
Positive
Molecular
genetic
studies
Negative
Bardet-Biedl syndrome
Alstrom syndrome
TUB deficiency
Positive
Albright's hereditary
osteodystrophy, BDNF,
TrkB, SIM1 deficiency
Negative
Leptin/Leptin Receptor,
POMC, MC4R, SH2B1
KSR2 Deficiency
Nuero-developmental
abnormalities or severe
hyperphagia
History and Physical Examination
Is there developmental delay?
Karyotype; DNA methylation studies
Measure leptin, insulin
a
, and proinsulin
a
Is there evidence of retinal
dystrophy, photophobia, or
nystagmus?
