Child Who Is Overweight: Medical Evaluation

Topic Overview

If your child has been diagnosed by a doctor as being overweight or at risk of becoming overweight, a thorough medical exam is important to identify and treat any related health problems.

History

Your doctor will ask about:

• Your child's weight history, to see if your child has had an unusual change in rate of growth.
• What may have started the weight gain (such as an illness, family crisis or change, or medicine).
• A family history of obesity, type 2 diabetes, heart disease, high blood pressure, and gallstones.
• Sleeping problems your child may have, such as sleep apnea, which means your child stops breathing at times while asleep.
• When you noticed your child's weight gain.
• Past efforts to manage weight.
• Unhealthy eating behavior, such as binge eating or fasting.
• Your child's diet and exercise history.

Causes of overweight

Your doctor will look for physical or emotional reasons for your child's weight gain, including Prader-Willi syndrome, hypothyroidism, Cushing's syndrome (all of which are rare), or emotional causes such as depression, anxiety, and eating disorders.

Some or all of the following tests will be done to help identify the cause and complications of being overweight:

• Thyroid-stimulating hormone (TSH) and thyroid hormone. Doctors often use these tests to detect a problem affecting the thyroid gland.
• Fasting blood glucose. This test measures blood sugar levels to find out whether a person has type 2 diabetes.
• Urine free cortisol. A cortisol blood test can detect problems with the adrenal glands or pituitary gland.
• Overnight dexamethasone suppression. Doctors can use an overnight dexamethasone suppression test to screen for Cushing's syndrome, a condition in which the adrenal glands produce too much cortisol.
• Lung function tests, such as oximetry. Lung function tests (or pulmonary function tests, PFT) check how much air your child's lungs can hold, how quickly your child can move air in and out of his or her lungs, and how well your child's lungs add oxygen to the blood and remove carbon dioxide from the blood. The tests can help your child's doctor discover lung diseases and find out how bad the problem is.

Your doctor will also ask if your child is taking medicines that may result in weight gain, including:

• Antidepressants, such as amitriptyline, desipramine (Norpramin), and imipramine (Tofranil).
• Corticosteroids, such as cortisone (Cortone), hydrocortisone (Cortef), and prednisone.
• Medicines used to control seizures, such as divalproex (Depakote) and gabapentin (Neurontin).

Physical exam

During a complete physical exam, your doctor will check your child's health and look for early signs of problems, including:

• High blood pressure.
• High cholesterol.
• Type 2 diabetes or high blood sugar levels.

Your doctor may refer your child to a medical specialist or a registered dietitian.