Endocrine Abstracts

Paediatric obesity, metabolic syndrome, and type 2 diabetes are on the rise worldwide and in the UK, and specialist services to address these complex and difficult problems are still in development. The definitions of obesity, diabetes and prediabetes in childhood and adolescence are not globally agreed and are affected by cultural and racial differences. In addition effective screening depends on the local availability of resources and the local population. The natural history of childhood obesity, insulin resistance, prediabetes and diabetes is becoming clearer and the associated co-morbidities are becoming better defined and described though certainly there are knowledge gaps in these areas which need to be addressed. In the UK, NICE guidance sets out the basic requirements for management of paediatric obesity but these recommendations are not being universally achieved. We will discuss the barriers to effective management of obesity and T2DM including joining up services between primary, secondary and tertiary care, multi-disciplinary working, the obesogenic environment, lack of ring-fenced resources, child protection concerns, cost-effectiveness and the modern problem of information overload. We will discuss the effective assessment and management of paediatric obesity, pre-diabetes and T2DM including the roles of diet, exercise, behavioral change, medication, bariatric procedures, and child protection procedures. Various new drugs and technologies are in development to manage obesity, and T2DM although these will only be helpful in addition to the strategies already discussed. Obesity and T2DM in childhood and adolescence can be successfully managed at the secondary and tertiary care level but this requires specialist multidisciplinary service development, and political and cultural change is also required to turn the tide. Some clinical cases will be presented to illustrate the successful factors in management.