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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