title: [Pediatric obesity: the reality of one consultation].
abstract: BACKGROUND
  The prevalence of paediatric obesity is constantly rising. The association to cardiovascular risk, diabetes and psychosocial disturbances is a concern. Precocious identification and intervention is essential to reduce the negative impact on adult life.
  
  
  METHODS
  Evaluation of the expression of comorbidities and the multidisciplinary intervention on nutritional status and body composition in obese children and adolescents, at six months follow-up on the Paediatric Obesity consultation. Retrospective analysis from the clinical files of under 17 years-old patients, followed from January 2005 to December 2008.
  
  
  RESULTS
  We followed 67 children and adolescents, mostly female. Overweight emerged at 4.6 years and the first evaluation in our consult occurred at 9.1 years-old, on average. Primary health care colleagues referred most patients (47.8%). The commonest predictor of obesity was parental obesity (60%). Planned physical activity was poorer in the lowest school years. Severe obesity was the most prevalent type of obesity (70%). Both genders showed a different fat distribution (female: non-central; male: central). Frequent findings on physical examination were: striae, adipomastia, acanthosis nigricans and orthopedic changes. In the first evaluation, although 6% of patients have shown high blood pressure, 34.4% insulin resistance and 56.7% dyslipidemia, only 7.7% met criteria for metabolic syndrome. Other associated comorbidities were psychosocial problems (23.9%), asthma (16.4%), orthopedic (10.5%) and gastrointestinal (3%) diseases. BMI percentile reduction occurred in 51% of cases, after 6 months of intervention. The increase on physical activity was reported by 56.7% of patients. Bioelectrical impedance showed an average fat mass reduction of 0.8%. At the end of the studied period, dropout rate from this consultation was admirably high (28.4%).
  
  
  CONCLUSIONS
  Multidisciplinary involvement of all health professionals, schools and family is essential for paediatric obesity intervention. Anthropometric evaluation should always include the waist circumference and BMI estimate. Bioelectrical impedance can be used to evaluate the individual changes in body composition. Changing lifestyle habits is still the most effective treatment as success will mainly depend on the patient and family motivation.
authors.affiliation: Consulta de Obesidade Pediátrica. Serviço de Pediatria. Hospital Central do Funchal, Funchal, Madeira, Portugal.
authors.forename: Francisco
authors.initials: F
authors.lastname: Silva
authors.forename: Elena
authors.initials: E
authors.lastname: Ferreira
authors.forename: Rute
authors.initials: R
authors.lastname: Gonçalves
authors.forename: Amélia
authors.initials: A
authors.lastname: Cavaco
mesh_terms: D000293:Adolescent; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D009765:Obesity / Q000150:complications / Q000453:epidemiology / Q000517:prevention & control; D012307:Risk Factors