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Childhood obesity — DCH MCQ

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HardGrowth and nutritionChildhood obesityDCH

A 10-year-old boy has a BMI above the 98th centile. He snores most nights and has daytime tiredness. His blood pressure remains above the 95th centile on repeat auscultatory measurement, and examination shows acanthosis nigricans. Which investigation strategy is most appropriate now?

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Correct answer: C — Fasting lipids, glucose assessment and liver function tests, with evaluation for obstructive sleep apnoea

The correct answer is C. A BMI above the 98th centile meets the NICE threshold at which obesity-related comorbidities should be assessed. Acanthosis nigricans suggests insulin resistance, while persistently raised blood pressure indicates a cardiovascular complication. Fasting lipids, glucose assessment—using fasting glucose or an oral glucose tolerance test as clinically appropriate—and liver function tests screen for dyslipidaemia, dysglycaemia and metabolic liver disease. Snoring with daytime tiredness warrants evaluation for obstructive sleep apnoea. Genetic investigation is reserved for selected presentations, particularly early-onset severe obesity, hyperphagia or syndromic features; it should not precede complication screening here. Pancreatic investigations, chest radiography and catecholamine testing are not routine obesity investigations without additional features suggesting pancreatitis, intrinsic respiratory disease or a catecholamine-secreting tumour.

Reference: NICE guideline NG246, Overweight and obesity management, sections 1.10.12–1.10.14 and 1.12.13–1.12.14, updated 2026. https://www.nice.org.uk/guidance/ng246/chapter/Identifying-and-assessing-overweight-obesity-and-central-adiposity