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Pediatric obesity with elevated blood pressure — USMLE Step 3 MCQ

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HardPediatricsPediatric obesity with elevated blood pressureUSMLE Step 3

A 10-year-old has BMI at the 97th percentile, BP above the 95th percentile on repeated visits, acanthosis nigricans and fasting glucose 108 mg/dL. What is the best initial longitudinal management plan?

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Correct answer: A — Initiate family-based treatment and evaluate cardiometabolic comorbidity

The best answer is “Initiate family-based treatment and evaluate cardiometabolic comorbidity”. Pediatric obesity with repeated hypertension, acanthosis, and impaired fasting glucose warrants intensive family-based behavioral treatment plus evaluation for dyslipidemia, diabetes, and other comorbidities. Adult-dose antihypertensive treatment, fasting-based weight loss, delaying care, or bariatric surgery before structured treatment are inappropriate initial strategies.

Reference: American Academy of Pediatrics, Pediatric Obesity Clinical Practice Guideline: https://publications.aap.org/pediatrics/article/151/2/e2022060640/190442/Clinical-Practice-Guideline-for-the-Evaluation-and