www.albertahealthservices.ca/8353.asp

http://www.albertahealthservices.ca/7468.asphttp://www.albertahealthservices.ca/cgm.asp

http://www.obesitynetwork.ca/http://hc-sc.gc.ca/fn-an/food-guide-aliment/index-eng.php

www.cps.ca/active-actifs

http://www.physicalliteracy.ca/play

http://myhealth.alberta.cawww.healthyalberta.ca

http://pediatrics.aappublications.org/content/120/Supplement_4/S164.full.pdf+html

http://pediatrics.aappublications.org/content/114/Supplement_2/555.full.pdf+html

http:www.albertahealthservices.ca/frm-18328.pdf

http:www.albertahealthservices.ca/frm-18328.pdf

*Lifestyle Modification: includes healthy eating and regular physical activity, decreased sedentary behavior, stress reduction and effective sleep hygiene

***Please consult the DSM-5™ for full criteria

Acanthosis nigricans

Hirsutism, virilization, excessive acne

Short stature, slowing of height velocity, goiter

Xanthomata, xanthelasmata, corneal arcus, arterial bruits

Usually none; may have hepatomegaly, jaundice

3 BP’s obtained with adequate sized cuff, all over 95th percentile + 5mm Hg for age, sex and height

Decreased range of motion in hip

Increased BP, tonsillar hypertrophy

Restricted range of affect

Muscle tension, restlessness

Impulsivity and hyperactivity: (fidgets, restless, interrupts, can appear as ‘non-compliant’ or appears ‘not to listen’)

Damaged teeth or gums, calluses or scars on the knuckles, going to the bathroom during or after meals

Type 2 Diabetes Mellitus

Polycystic Ovary Syndrome

Hypothyroidism

Dyslipidemia

Non-Alcoholic Fatty Liver Disease (NAFLD)

Hypertension

Slipped Capital Femoral Epiphysis (SCFE)

Sleep Apnea, Hypoventilation Syndrome

Major depressive episode***

Generalized Anxiety Disorder***

ADHD***

Disruptive Mood Dysregulation Disorder***

Binge Eating Disorder***

Bulimia***

Fasting Glucoseor 2 hr oral glucose tolerance test

Free androgen index, SHBG, LH, FSH, estradiol, DHEAS and Testosterone

TSH

Fasting Lipid Profile

ALT

First am urine for urine protein/creatinine ratio or microalbuminuria, plasma lytes, osmolality, urine lytes and osmolality, renal U/S, ECG +/- Echocardiogram

Hip X-ray, (TSH)

Overnight oximetry, sleep study

SNAP IV test, Connor’s

Potential Electrolyte imbalances (potassium)

Impaired fasting glucose 6.1-6.9Impaired glucose tolerance (2hr) 7.8-11.0Diabetes: Fasting glucose >7.0 2hr glucose >11.1

abN

6.1-10.0mU/L

>10.00 mU/L

LDL 3.35-4.0 mmol/LTG 1.5-5.0 mmol/LPersistent: LDL > 4.1 mmol/LTG> 5.0 mmol/L

Persistent elevation >1.5x upper limit of normal for >6mo warrants further investigation/consultation

Urine protein creatinine ratio >30Microalbumin> 2.4Evidence of dyskalemia associated with acidosis or alkalosisAny abnormality on renal ultrasoundLeft ventricular hypertrophy on ECHO or left ventricular strain on ECG

abN

Repeat in 6 months

Refer for treatment

R/O other causes of hyperandrogenemia &menstrual irregularity (prolactin, 17-OH-P, TSH)

Repeat in 3 months with free T4, thyroid antibodies

Assess free T4 and thyroid antibodies

Repeat in 6-12 months

Refer for further assessment

AST, ALP, GGT, Total Bili, Albumin, INR,Abdominal US, (investigations to exclude competing liver disease**)

Decrease salt intakeRefer for 24 hour BP monitoring

Referral to Pulmonology, Sleep Clinic, ENT

Refer to Psychiatry if moderate or severe

Refer to Psychiatry if moderate or severe

Endocrinology, Diabetes Clinic

Pediatrics, Gynecology or Endocrinology

Endocrinology

Lipid Specialist or Endocrinology

Gastroenterology

Nephrology, Cardiology

Orthopedics, Rehabilitation; Endocrinology if abN TSH

Pulmonology, ENT, Pediatric Sleep

Psychiatry Psychology

Psychiatry Psychology

Psychiatry Psychology

Psychiatry Psychology

Psychiatry, Psychology. Clinic specializing in eating disorders.

Psychiatry, Psychology.Clinic specializing in eating disorders.

Polyuria, polydipsia, recurrent yeast infection, unexpected weight loss

Menstrual irregularity, oligomenorrhea

Cold intolerance, constipation, lethargy

Usually none

Usually none; may have abdominal pain

Usually none; may have headache, fatigue, flushing

Hip/knee pain, limp

Snoring, behavior disturbances, headaches, daytime somnolence, poor school performance, enuresis

Low mood, anhedonia

Sleep disturbance, easy fatigue, excessive worry, school refusal, evidence of panic disorder

Inattention: forgetful, messy, poor concentration, poor organization Impulsivity: disruptive Hyperactivity: ‘on the go’

Severe recurrent temper outbursts that are out of proportion and inconsistent with developmental level, mood between outbursts is persistently angry or irritable

Sense of lack of control over eating, eating more than another person would eat in a discrete period of time

Binge eating: recurrent and inappropriate compensatory behaviour, for example: purging, misuse of laxatives or excessive exercise

Disclaimer: Other obesity-related conditions may include, but are not limited to, Prader-Willi Syndrome (and other genetic conditions), Asthma, Blout’s Disease, Cushing Disease and Idiopathic Intracranial Hypertension. This document is provided as a REFERENCE only and SHOULD NOT replace physician discretion or clinical judgment.

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