| Symptom | Potential significance | Additional studies or referrals to consider |
| Markers for possible underlying causes of obesity |
| Delayed development | | - Refer to pediatric geneticist and/or neurologist
|
| Short stature or reduced height velocity | - Genetic syndrome
- Endocrinologic etiology (eg, Cushing syndrome, hypothyroidism, ROHHADNET syndrome)
| - Refer to pediatric geneticist
- 24-hour urine collection for free cortisol, thyroid function tests; referral to pediatric endocrinologist
|
| Hypogonadism or delayed puberty | - Genetic syndrome
- Endocrinologic etiology (eg, Cushing syndrome, hypothyroidism, ROHHADNET syndrome)
| - Refer to pediatric geneticist
- 24-hour urine collection for free cortisol, thyroid function tests; referral to pediatric endocrinologist
|
| Symptoms suggesting an obesity-related comorbidity |
Central nervous system symptoms: - Headaches (especially morning)
- Nausea or vomiting
- Blurred vision, double vision, or decreased vision
| - Idiopathic intracranial hypertension
| - Refer to pediatric neurologist
|
Sleep symptoms: - Snoring
- Nocturnal enuresis
- Daytime sleepiness and/or inattentive behaviors
| - Sleep apnea
- Obesity hypoventilation syndrome
- Inattentive behaviors may be symptoms of insufficient or disrupted sleep
| - Polysomnogram (sleep study) and/or referral to a pediatric sleep medicine, pulmonologist, or ENT specialist
|
| Abdominal pain (generalized or right upper quadrant) | - Gallbladder disease (eg, cholelithiasis)
- Gastroesophageal reflux or constipation (common in all populations but particularly in children with obesity)
- MASLD (formerly termed NAFLD), although this is usually asymptomatic
| - AST, ALT, abdominal ultrasonography
- Refer to pediatric gastroenterologist
- For evaluation and management of MASLD, refer to related UpToDate content
|
| Hip pain, knee pain, limp | - Slipped capital femoral epiphysis
- Blount disease (tibia vara), which is apparent on physical examination but is typically painless
| - Radiographs; refer to pediatric orthopedist
|
| Menstrual abnormalities (oligomenorrhea, amenorrhea, or excessive uterine bleeding) | | - Serum testosterone, tests to exclude other causes of menstrual abnormalities (eg, hCG, LH, FSH)
- Refer to pediatric endocrinologist or adolescent specialist
- For details, refer to related UpToDate content on PCOS
|
| Urinary frequency, nocturia, polydipsia, polyuria | | - Urinalysis, fasting blood glucose, hemoglobin A1c, oral glucose tolerance test
- If abnormal, refer to pediatric endocrinologist
|
| Mental health issues |
| Binge eating or purging | | - Refer to specialist in eating disorders
|
| Anhedonia, insomnia | | - Refer to pediatric psychologist or psychiatrist
|
