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Obesity in Children Clinical Presentation

  • Author: Steven M Schwarz, MD, FAAP, FACN, AGAF; Chief Editor: Jatinder Bhatia, MBBS, FAAP  more...
Updated: Mar 29, 2016

History and Physical Examination

Short stature or a reduced rate of linear growth in a child with obesity suggests the possibility of growth hormone deficiency, hypothyroidism, cortisol excess, pseudohypoparathyroidism, or a genetic syndrome such as Prader-Willi syndrome.

A history of dry skin, constipation, intolerance to cold, or fatigability suggests hypothyroidism.

Polyuria and polydipsia may be noted if the adolescent with obesity develops overt diabetes.

A history of damage to the central nervous system (CNS) (eg, infection, trauma, hemorrhage, radiation therapy, seizures) suggests hypothalamic obesity with or without pituitary growth hormone deficiency or pituitary hypothyroidism. A history of morning headaches, vomiting, visual disturbances, and excessive urination or drinking also suggests that the obesity may be caused by a tumor or mass in the hypothalamus.

Selective accumulation of fat in the neck, trunk, and purple striae suggest an excess of cortisol, particularly if the rate of linear growth has declined.

The appearance of signs of sexual development at an early age suggests that the weight gain is caused by precocious puberty. However, excessive facial hair, acne, and irregular periods in a teenage girl suggest that the weight gain may be caused by cortisol excess or polycystic ovary syndrome (PCOS). Obesity itself may be accompanied by facial hair, irregular menses, and hypertension.

Clinical clues that suggest a hormonal etiology for childhood obesity include the following:

  • Weight gain out of character for the family
  • Obesity in a short child
  • Progressive weight gain without a comparable increase in linear growth
  • Dry skin, constipation, intolerance to cold, and fatigability
  • History of central nervous system (CNS) damage (eg, trauma, hemorrhage, infection, radiation, seizures)
  • Accumulation of fat in the neck and trunk but not in the arms or legs
  • Purple striae (stretch marks)
  • Hypertension
  • Inappropriate sexual development at an early age
  • Excess facial hair, acne, and/or irregular menses in a teenage girl
  • Headaches, vomiting, visual disturbances, or excessive urination and drinking
  • Treatment with certain drugs or medications
Contributor Information and Disclosures

Steven M Schwarz, MD, FAAP, FACN, AGAF Professor of Pediatrics, Children's Hospital at Downstate, State University of New York Downstate Medical Center

Steven M Schwarz, MD, FAAP, FACN, AGAF is a member of the following medical societies: American Academy of Pediatrics, American College of Nutrition, American Association for Physician Leadership, New York Academy of Medicine, Gastroenterology Research Group, American Gastroenterological Association, American Pediatric Society, North American Society for Pediatric Gastroenterology, Hepatology and Nutrition, Society for Pediatric Research

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Chief Editor

Jatinder Bhatia, MBBS, FAAP Professor of Pediatrics, Medical College of Georgia, Georgia Regents University; Chief, Division of Neonatology, Director, Fellowship Program in Neonatal-Perinatal Medicine, Director, Transport/ECMO/Nutrition, Vice Chair, Clinical Research, Department of Pediatrics, Children's Hospital of Georgia

Jatinder Bhatia, MBBS, FAAP is a member of the following medical societies: American Academy of Pediatrics, American Association for the Advancement of Science, American Pediatric Society, American Society for Nutrition, American Society for Parenteral and Enteral Nutrition, Academy of Nutrition and Dietetics, Society for Pediatric Research, Southern Society for Pediatric Research

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Gerber.


The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous author Michael Freemark, MD, to the development and writing of the source article.

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Central nervous system (CNS) neurocircuitry for satiety and feeding cycles. AGRP = Agouti-related protein; CB = cannabinoid; CCK = cholecystokinin; CRH = corticotropin-releasing hormone; GLIP = glucagonlike peptide; Mc-3 and 4 = melanocortin-3 and 4; MCH = melanin concentrating hormone; α-MSH = alpha–melanocyte-stimulating hormone; POMC = pro-opiomelanocortin; TNF = tumor necrosis factor.
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