The terms overweight and obesity are based on a child's weight and height, using a calculationcalled the body mass index (BMI). At the first ADOBE clinic visit, your child's height, weight and BMI will be plotted on a growth chart. Children who are above the 85th percentile for body mass index (BMI) meet the definition of overweight and those above the 95th percentile meet the criteria for obesity.Both overweight and obesity put a child at risk for other medical conditions including insulin resistance, type 2 diabetes, and high blood pressure.The safest method to lose weight is with diet modification and exercise and you will meet with a registered dietician to assist you with these goals. Occasionally, certain medication may be recommended to assist with weight loss. Certain individuals who meet strict criteria may also be referred for bariatric (weight loss) surgery.
Insulin Resistance/Acanthosis Nigricans:
Insulin resistance is a condition where the body produces more insulin than is normal. High insulin levels are commonly associated with weight gain and places a person at greater risk of developing type 2 diabetes later. Some individuals with high insulin levels may also have darkened skin on the neck, underarms, and groin areas which is called acanthosis nigricans. Treatments include lifestyle modifications and medications.
Pre-Diabetes/Type 2 Diabetes:
Pre-diabetes is diagnosed either with a fasting blood glucose test or with a glucose tolerance test. If the blood sugar is above normal but below the criteria for diabetes, then pre-diabetes is diagnosed. Patients with pre-diabetes are at signifcant risk of developing diabetes. Treatments include lifestyle modifications and medications.
Type 2 diabetes is a condition where the blood sugar is abnormally elevated and has the potential to cause other medical problems. Patients diagnosed with diabetes need intensive medical therapy and may be admitted to the hospital for initial education and medical treatment. Patients will be instructed on how to check blood sugars, proper nutrition and exercise, and medical treatment. While some patients may be able to manage type 2 diabetes with lifestyle changes also, treatments may include oral medications and/or insulin injections. Patients will also need frequent screening for associated medical conditions.
Metabolic Syndrome is a collection of conditions that are often seen together. These conditions include obesity (especially around the waist), elevated triglyceride and low HDL (good) cholesterol levels, insulin resistance or diabetes, and high blood pressure. Management includes lifestyle modifications and medications aimed at treating the associated conditions.
Different problems with cholesterol and lipid testing exist. Some patients have elevated cholesterols and triglycerides. Others have specific abnormalities of the HDL (good) and/or LDL (bad) cholesterol, or triglycerides. It is not unusual for there to be a family history of abnormal lipids. Treatments include lifestyle modifications and medications.
High Blood Pressure:
Elevated blood pressures can result in medical problems currently and in the future. At the clinic appointment, the patient's blood pressure will be compared to national norms based on age, gender and height. Patient's with blood pressure greater than the 90th percentile are considered to have pre-hypertension while those with blood pressures greater than the 95th percentile are considered to have hypertension. Management of either condition is best done with lifestyle modifications and weight loss. If necessary, medications are added to bring the blood pressure down. Often, other tests will be needed to determine the cause and effects of high blood pressure.
Polycystic Ovary Syndrome (PSOS):
PCOS is a condition seen in women associated with irregular of missed periods, acne and/or facial hair, and weight gain. Diagnosis is often confirmed with blood work and treatment includes lifestyle modifications and, if necessary, medications to address the various aspects of the syndrome.