TABLE 6

Physical Examination Findings in Obesity Assessment and Possible Causes

SystemFindingsPossible Explanations
Anthropometric featuresHigh BMI percentileOverweight or obesity
Short statureUnderlying endocrine or genetic condition
Vital signsElevated blood pressureHypertension if systolic or diastolic blood pressure >95th percentile for age, gender, and height on ≥3 occasions
SkinAcanthosis nigricansCommon in obese children, especially when skin is dark; increased risk of insulin resistance
Excessive acne, hirsutismPolycystic ovary syndrome
Irritation, inflammationConsequence of severe obesity
Violaceous striaeCushing syndrome
EyesPapilledema, cranial nerve VI paralysisPseudotumor cerebri
ThroatTonsillar hypertrophyObstructive sleep apnea
NeckGoiterHypothyroidism
ChestWheezingAsthma (may explain or contribute to exercise intolerance)
AbdomenTendernessGastroesophageal reflux disorder, gallbladder disease, NAFLDa
HepatomegalyNAFLDa
Reproductive systemTanner stagePremature puberty in <7-y-old white girls, <6-y-old black girls, and <9-y-old boys
Apparent micropenisMay be normal penis that is buried in fat
Undescended testesPrader-Willi syndrome
ExtremitiesAbnormal gait, limited hip range of motionSlipped capital femoral epiphysis
Bowing of tibiaBlount disease
Small hands and feet, polydactylySome genetic syndromes
  • a These conditions are usually without signs.