The Vanderbilt Pediatric Weight Management Clinic (PWMC) provides an entry point for pediatric patients with weight concerns into the Vanderbilt system. The PWMC provides comprehensive multidisciplinary evaluation and treatment, including evaluation for possible underlying medical conditions. The PWMC should be the initial point of referral for the majority of patients, including those patients who may be interested in pursuing bariatric intervention.
Vanderbilt Pediatric Weight Management Clinic: 615.936.5326
Selected patients with weight concerns may need additional referrals as follows:
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Patient has:
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Consider referral to:
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- short stature
- slowing growth velocity
- hyperandrogenism in girls
- precocious puberty
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Pediatric Endocrinology -- 615.322.7427
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- blood glucose ≥ 200 mg/dl and symptoms of diabetes
- fasting glucose ≥ 126 on at least 2 occasions
- 2 hour oral glucose tolerance value ≥ 200
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Pediatric Diabetes -- 615.322.7842
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- snoring
- daytime sleepiness
- other signs of sleep apnea
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Vanderbilt Sleep Clinic -- 615.343.5888
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Pediatric Nephrology -- 615.322.7416
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- Family hx of premature coronary artery disease
- Fasting LDL cholesterol > 150 mg/dl
- Fasting Triglyceride Levels > 300 mg/dl
- Fasting HDL cholesterol < 35 mg/dl
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Vanderbilt Lipid Clinic -- 615.322.2465
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- AST and/or ALT >25% above upper limit of normal
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Pediatric Gastroenterology -- 615.322.7449
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Patients with elevated insulin only DO NOT need to be seen by pediatric endocrinology and should be referred to weight management clinic.
Evaluation for underlying causes of obesity
- Fewer than 1% of children with obesity will have an underlying medical cause
- Consider evaluation if patient also has short stature; declining growth velocity; dysmorphic features; developmental delay; onset of obesity at less than 2 years of age; skeletal abnormalities. The Weight Management Clinic can assist with evaluation for underlying genetic or endocrine conditions.
- Obese children who are tall or growing normally have an extremely low risk of endocrinopathy and do not need further endocrine evaluation,
- Routine testing of thyroid function in obese children is NOT recommended, and abnormal thyroid tests should be repeated with antibodies before referral as many minor abnormalities are transient and not the cause of obesity.
Evaluation for associated conditions
- Consider liver function testing and fasting lipid panel for all patients
- Blood pressure should be measured in all patients, with attention to cuff size
- All patients should be screened for signs and symptoms of sleep apnea, with referral as indicated
- Girls should be screened for presence of hirsutism or menstrual disturbances
- Consider screening for type 2 diabetes in patients with obesity and two or more of the following: family history of type 2 diabetes; high risk ethnicity (e.g. African American, Asian/Pacific Islander, Native American, Hispanic); signs or symptoms such as hypertension, hyperlipidemia, acanthosis nigricans, or PCOS. Either fasting glucose or oral glucose tolerance test is acceptable. Asymptomatic patients with abnormal screens should have screening repeated before diagnosis or referral.
- Consider referral to adolescent psychology or psychiatry for suspected co-morbid conditions such as bulimia, eating spectrum disorders, depression, or anxiety
August et al. Prevention and Treatment of Pediatric Obesity: An Endocrine Society Clinical Practice Guideline Based on Expert Opinion. J Clin Endocrinol Metab 2008, 93(12):4576-4599.
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