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Pediatric Obesity

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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?

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