Mean Body Mass Index SD Score Research Articles

Semaglutide treatment for children with obesity: an observational study

ObjectiveTo assess efficacy and tolerability of semaglutide as a weight loss treatment for children living with comorbid obesity.DesignRetrospective observational study of the first 50 children from a weight management service...

Obesity and glucose metabolism abnormalities by post-disaster evacuation.

The objectives of this study were to determine the longer-term trends in childhood obesity and glucose metabolism abnormalities among residents of Fukushima Prefecture 5 years after the Great East Japan Earthquake. We evaluated the changes for height, weight, body mass index (BMI), BMI SD score, fasting plasma glucose (FPG) concentration, and hemoglobin A1c (HbA1c) in elementary and junior high school residents who had lived in the evacuation zone between 2011 and 2015. 1) Of the Residents, 11,112 received health checks, while in 2012, 2013, 2014 and 2015, 5,737, 4,522, 4,297 and 3,405 received health checks, respectively. 2) The mean BMI SD score for all participants in 2011 was 0.149, and this score gradually decreased from 2011 to 2015. 3) FPG levels and HbA1c levels for all participants with a BMI value≧+2SD in 2011 were higher than those in residents with a BMI value < +2SD. 4) The frequency of participants with a FPG level ≧126 mg/dl and the frequency of participants with a HbA1c level ≧6.5 % in 2011 were higher than those in 2012, 2013, and 2015. These results suggest that a number of pediatric residents suffered from obesity and glucose metabolism abnormalities. Furthermore, the longer-term observations indicated an improvement in obesity and glucose metabolism abnormalities. There was a strong association observed between obesity and glucose metabolism, thus, it is considered important to continue with health checks for children with obesity and strive to improve their health.

Impact of Covid-19 Lockdown Measures on Lifestyle Behavior in Children and Adolescents With Severe Obesity

Introduction: During the COVID-19 pandemic, lockdown measures were implemented with large impact on lifestyle behaviors and well-being of children (including adolescents). The impact on children with severe obesity, who plausibly are at even larger risk, has not yet been described. Aim of this study was to investigate the impact of COVID-19 lockdown on eating behaviors, physical activity, screen time and quality of life (QoL) of children with severe obesity. Methods: In this mixed-methods study, questionnaires and semi-structured telephone interviews were used to investigate impact of COVID-19 during the first wave in the Netherlands (April 2020) on children with severe obesity (adult BMI-equivalent ≥35kg/m2) treated at our obesity center. The Dutch Eating Behavior Questionnaire - Child, Pediatric Quality of Life Inventory, and Dutch Physical Activity Questionnaire were filled out by their families pre-pandemic and during lockdown. Changes over time in percentile scores, weekly physical activity and screen time were assessed. Qualitative analyses were performed according to the Grounded Theory. Results: We included 83 families, of which 75 participated in the interviews. Their children’s characteristics were mean age 11.5years (SD 4.6), 52% female, mean BMI SD score 3.8 (SD 1.0), indicating severe obesity. On group level, no changes in scores for emotional, restrained, external eating, and QoL nor in screen time were observed (Δ scores +9.2, +3.9, +0.3; and +3.0, respectively; -0.3 hr/wk; all p>0.05). Weekly physical activity decreased (Δ -1.9 hr/wk, p=0.02). Age, pre-existent psychosocial problems and pre-pandemic questionnaire scores were associated with improved or deteriorated questionnaire scores in specific subgroups. For example, children who did not fulfill WHO physical activity criteria pre-pandemic showed a further decline from 2.8 to 0.7 h/wk (p=0.001). Children with high emotional and external eating during lockdown had the lowest QoL scores (p-values <0.01). Qualitative data showed that an increased demand for food was frequently observed (n=21), mostly in children aged <10 years (19/21). This was attributed to loss of daily structure, increased stress, or emotional eating. Families who reported no changes (n=15) or improved eating behaviors (n=11) attributed this to already existing strict eating schemes that they kept adhering to. Conclusion: This study shows differential response profiles to COVID-19 lockdown in children with severe obesity. Although on group level lifestyle scores averaged out, a substantial part of families reported deterioration in physical activity and eating behaviors. Children with pre-existent psychosocial problems, high external or emotional eating scores were most at risk. Health care professionals should target these vulnerable children to minimize short- and long-term negative physical and mental health consequences.

What change in body mass index is associated with improvement in percentage body fat in childhood obesity? A meta-regression

ObjectiveUsing meta-regression this paper sets out the minimum change in body mass index-SD score (BMI-SDS) required to improve adiposity as percentage body fat for children and adolescents with obesity.DesignMeta-regression.SettingStudies were...

Continuing rise of Type 2 diabetes incidence in children and young people in the UK.

AimsTo estimate the incidence of Type 2 diabetes in children aged <17 years, compare this with similar data 10 years ago, and characterize clinical features at diagnosis in the UK and Republic of Ireland.MethodsUsing the British Paediatric Surveillance Unit reporting framework, cases of Type 2 diabetes diagnosed in children aged <17 years between 1 April 2015 and 30 April 2016 were reported each month.ResultsA total of 106 cases were reported, giving a UK incidence of 0.72/100 000 (95% CI 0.58–0.88). Children from ethnic minorities had significantly higher incidence compared with white children (0.44/100 000) with rates of 2.92/100 000 and 1.67/100 000, in Asian and BACBB (black/African/Caribbean/black British) children respectively. Sixty‐seven percent were girls and 81% had a family history of Type 2 diabetes. The mean BMI sd score at diagnosis was 2.89 (2.88, girls; 2.92, boys); 81% were obese. Children of Asian ethnicity had a significantly lower BMI sd score compared with white children (P<0.001). There was a trend in increased incidence from 2005 to 2015, with a rate ratio of 1.35 (95% CI 0.99–1.84), although this was not statistically significant (P=0.062). There was statistical evidence of increased incidence among girls (P=0.03) and children of South‐Asian ethnicity (P=0.01) when comparing the 2005 and 2015 surveys.ConclusionsType 2 diabetes remains far less common than Type 1 diabetes in childhood in the UK, but the number of cases continues to rise, with significantly increased incidence among girls and South‐Asian children over a decade. Female gender, family history, non‐white ethnicity and obesity were found to be strongly associated with the condition.

Assessment of health-related quality of life and psychological well-being of children and adolescents with obesity enrolled in a New Zealand community-based intervention programme: an observational study

ObjectiveTo describe health-related quality of life (HRQOL) and psychological well-being of children and adolescents at enrolment in a multidisciplinary community-based obesity programme and to determine association with ethnicity. This programme...

Response of Severely Obese Children and Adolescents to Behavioral Treatment

To investigate whether the degree of obesity predicts the efficacy of long-term behavioral treatment and to explore any interaction with age. A 3-year longitudinal observational study. Obese children were divided into 3 age groups (6-9, 10-13, and 14-16 years) and also into 2 groups (moderately obese, with a body mass index [BMI]-standard deviation [SD] score [or z score] of 1.6 to <3.5, and severely obese, with a BMI-SD score of ≥3.5). National Childhood Obesity Center, Stockholm, Sweden. Children 6 to 16 years of age who started treatment between 1998 and 2006. Behavioral treatment of obesity. Change in BMI-SD score during 3 years of treatment; a reduction in BMI-SD score of 0.5 units or more was defined as clinically significant. A total of 643 children (49% female children) met the inclusion criteria. Among the youngest moderately obese children, 44% had a clinically significant reduction in BMI-SD score (mean reduction, -0.4 [95% CI, -0.55 to -0.32]). Treatment was less effective for the older moderately obese children. Twenty percent of children who were 10 to 13 years of age and 8% of children who were 14 to 16 years of age had a reduction in BMI-SD score of 0.5 units or more; 58% of the severely obese young children showed a clinically significant reduction in BMI-SD score (mean reduction, -0.7 [95% CI, -0.80 to -0.54]). The severely obese adolescents showed no change in mean BMI-SD score after 3 years, and 2% experienced clinically significant weight loss. Age was found to be a predictor of a reduction in BMI-SD score (odds ratio, 0.68 units per year [95% CI, 0.60-0.77 units per year]). Behavioral treatment was successful for severely obese children but had almost no effect on severely obese adolescents.

Metformin in Obese Children and Adolescents: The MOCA Trial

Childhood obesity is increasingly associated with type 2 diabetes (T2D). Metformin reduces the risk for T2D in adult obese nondiabetic patients, but the evidence in obese children and young people is inconclusive. The objective of the study was to assess the effect of metformin on body mass index sd score (BMI-SDS), metabolic risk factors, and adipokines. This was a prospective, randomized, double-blind, placebo-controlled trial. The study was conducted at six pediatric endocrine centers in the United Kingdom. One hundred fifty-one obese children and young people with hyperinsulinemia and/or impaired fasting glucose or impaired glucose tolerance (metformin: 74, placebo: 77). The study was comprised of 67.5% females, 65.6% postpubertal individuals, and 23.8% British Asian or Afro-Caribbean participants. The age range was 8-18 yr, the mean age was 13.7 (SD 2.3) yr, and the mean BMI-SDS was +3.4 (SD 0.5). The intervention included metformin 1 g in the morning and 500 mg in the evening vs. placebo for 6 months. The main outcome measure was a reduction in BMI-SDS at 6 months. Secondary outcomes included insulin and glucose levels from oral glucose tolerance tests, alanine aminotransferase (ALT), and adiponectin to leptin ratio (ALR) at 3 and 6 months. Metformin was associated with a significant reduction in BMI-SDS compared with placebo at 6 months [mean difference -0.1 SD (95% confidence interval -0.18 to -0.02), P = 0.02]. Significant improvements at 3 months were found in the metformin group: fasting glucose, -0.16 mmol/liter (-0.31 to -0.00), P = 0.047; ALT, 19% (5-36%), P = 0.008; and ALR, 32% (4-67%), P = 0.02. Metformin therapy has a beneficial treatment effect over placebo for BMI-SDS, fasting glucose, ALT, and ALR ratio at 3 months, with changes in BMI-SDS sustained at 6 months.

Body mass index patterns over 5 y in obese children motivated to participate in a 1-y lifestyle intervention: age as a predictor of long-term success

Long-term outcome after lifestyle interventions in obese children is largely unknown but important to improving intervention. The aim was to identify predictors of long-term changes in body mass index (BMI) after lifestyle intervention. Annual changes in the BMI SD score (BMI-SDS) over 5 y in 663 obese children (aged 4-16 y) motivated to participate in an outpatient lifestyle intervention were analyzed. Child-specific longitudinal curves based on multilevel growth curve models (MLMs) over 5 y were estimated depending on patient characteristics (age and sex). The mean decrease in BMI-SDS was 0.36 (95% CI: 0.33, 0.39) at the end of the 1-y intervention and 0.46 (95% CI: 0.36, 0.55) 4 y after the intervention. Change in BMI-SDS in the intervention period predicted long-term outcome after 5 y (P < 0.001). MLMs identified age but not sex as a predictor of the outcome: the youngest children (<8 y) at the onset of the intervention had the greatest decrease in BMI-SDS over 5 y, and the oldest children (>13 y) had the least decrease in BMI-SDS (P < 0.05). Whereas there was a larger reduction in BMI-SDS during the intervention in children aged 8-10 y than in children aged 11-12 y, long-term decrease in BMI-SDS was greater in 11-12-y-old children (P < 0.001). Younger age was associated with the best long-term outcome after participation in the lifestyle intervention, which supports the need for early intervention in childhood obesity. Children aged 8-10 y may need modified intervention, because BMI-SDS increased more in the older children in the long term. However, mean BMI-SDS was significantly lower 4 y after the end of the intervention than at baseline in all age groups. This study was registered at clinicaltrials.gov as NCT00435734.

What reduction in BMI SDS is required in obese adolescents to improve body composition and cardiometabolic health?

ObjectiveTo study the impact of body mass index (BMI) SD score (SDS) improvement through lifestyle modification on metabolic risk and body composition over 12 months.DesignProspective cohort study.SettingHospital outpatient weight management...

Obese Children with Low Birth Weight Demonstrate Impaired β-Cell Function during Oral Glucose Tolerance Test

Epidemiological studies have shown an association between birth weight and future risk of type 2 diabetes, with individuals born either small or large for gestational age at increased risk. We sought to investigate the influence of birth weight on the relation between insulin sensitivity and beta-cell function in obese children. A total of 257 obese/overweight children (mean body mass index-sd score, 2.2 +/- 0.3), aged 11.6 +/- 2.3 yr were divided into three groups according to birth weight percentile: 44 were small for gestational age (SGA), 161 were appropriate for gestational age (AGA), and 52 were large for gestational age (LGA). Participants underwent a 3-h oral glucose tolerance test with glucose, insulin, and C-peptide measurements. Homeostasis model of assessment for insulin resistance, insulinogenic index, and disposition index were calculated to evaluate insulin sensitivity and beta-cell function. Glucose and insulin area under the curve (AUC) were also considered. One-way ANOVA was used to compare the three groups. SGA and LGA subjects had higher homeostasis model of assessment for insulin resistance than AGA subjects, but they diverged when oral glucose tolerance test response was considered. Indeed, SGA subjects showed higher glucose AUC and lower insulinogenic and disposition indexes. Insulin AUC was not different between groups, but when singular time points were considered, SGA subjects had lower insulin levels at 30 min and higher insulin levels at 180 min. SGA obese children fail to adequately compensate for their reduced insulin sensitivity, manifesting deficit in early insulin response and reduced disposition index that results in higher glucose AUC. Thus, SGA obese children show adverse metabolic outcomes compared to AGAs and LGAs.

Serial Plasma Concentrations of Adipocytokines during Chemotherapy in Children with Acute Lymphoblastic Leukemia

Disturbances in the production of adipocyte-derived hormones may represent a new link explaining the well-known relationship between obesity and increased prevalence of malignancies. Very few studies have evaluated adipokines concentration at diagnosis and during remission of a cancer. Purpose of our study was to investigate adipocytokines secretion, at diagnosis and during chemotherapy in children with acute lymphoblastic leukemia (ALL).Patients and Methods: Measurements were performed at diagnosis, after the induction-consolidation phase and at standard time points before each cycle in nine consecutive patients with ALL aged 2–7 years (median 4.3 yrs). All patients suffered from ≥5% BMI reduction in the 6 months before recruitment. BMI and leukemic burden were estimated at the same time points and correlated with adipocytokines levels. Nine healthy children matched for age and sex were used as controls.Results: At diagnosis, mean adiponectin levels were low (12.6±2.3 μg/ml vs. 18.2±2.4 μg/ml in controls, p<0.0001) and mean leptin and resistin levels were high (27.4±4.2 ng/ml vs. 17.8 ± 3.4 ng/ml in controls, p<0.001 and 5.2±1.2ng/ml vs. 3.2±1.1ng/ml in controls, p<0.001, respectively). Compared to baseline values, mean adiponectin levels increased significantly to 16.6±2.9 μg/ml before the end of maintenance phase (p=0.024), while leptin and resistin fluctuated and stabilized at significantly lower levels (17.1±3.9 ng/ml, p=0.018 and 3.4±0.9 ng/ml, p=0.020, respectively), after the 8th cycle of chemotherapy. Mean adiponectin was still low, compared with controls, (p<0.001), even after the 8th cycle. Delta (final-baseline) mean adiponectin was positively correlated with delta mean BMI-SD score of the patients (0.512, p=0.016), while delta mean leptin and resistin was negatively correlated with it (−0.626, p=0.009, and −0.527, p=0.013, respectively). However, when considering for lipids, LDH or leukemic burden, the positive association of adiponectin with BMI (0.087, p>0.05) and the negative association of leptin and resistin with BMI do not persist (−0.098, p>0.05 and −0.094, p>0.05 respectively). Delta mean adiponectin was negatively correlated with leukemic burden (−0.439, p=0.019), while delta mean leptin and resistin was positively correlated with it (0.581, p=0.011 and 0.375, p=0.031, respectively). Delta mean adiponectin was negatively correlated with delta mean LDH (−0.315, p=0.041), delta mean triglycerides (−0.412, p=0.025) and positively correlated with delta mean HDL-C (0.306, p=0.042), while delta mean leptin and resistin was positively correlated with delta mean LDH (0.423, p=0.028, and 0.387, p=0.032, respectively), delta mean triglycerides (0.372, p=0.035, and 0.523, p=0.022, respectively) and negatively correlated with delta mean HDL-C (−0.467, p=0.020, and −0.356, p=0.034, respectively). Finally, delta mean BMI-SD was positively correlated with delta mean HDL-C (0.502, p=0.018) and negatively with delta triglycerides (−0.420, p=0.023) and delta LDH (−0.605, p<0.010).Conclusion: Our results suggest that low serum adiponectin level and high leptin and resistin level are present in almost all patients with ALL at diagnosis. This is probably due to neuroendocrine imbalance and inflammation. The abnormalities are restored during remission. More studies are needed to substantiate associations between leukemia development and these hormones in the population of ALL children.

Does Low Birth Weight Predict Obesity/Overweight and Metabolic Syndrome in Elementary School Children?

We undertook this study to explore the relationship between birth weight (BW) and childhood overweight and obesity (OW/OB) and metabolic syndrome (MS). This was a cross-sectional assessment performed in 10 elementary public schools in Buenos Aires, Argentina. Participants were 1027 students aged 9.4 +/- 2.1 years. No interventions were done. We measured the association between BW in children and OW/OB and MS at 9 years of age. Of the total number of children, 164 (16.0%) were OB (BMI >95(th) percentile) and 169 (16.5%) were OW [(body mass index (BMI) > or =85(th), <95(th) percentile); 61% were at Tanner 1. All students came from low socioeconomic families. The prevalence of low (< or =2500 g), normal, and high BW (> or =4000 g) was 7.0% (n = 72), 83.7% (n = 860), and 9.3% (n = 95), respectively. MS prevalence was 5.5%. There was a significant difference in mean BMI sd score (SDS) between low BW (0.07), normal BW (0.54) and high BW (0.99). There was a significant difference in mean BMI, BMI SDS, waist circumference (WC), WC SDS, and systolic blood pressure between low, normal, and high BW groups. In separate logistic regression models, low BW proved to be a protective factor against OW/OB [OR 0.32 (95% CI 0.16-0.63)], whereas high BW was associated with a higher OW/OB risk adjusted for age and sex [OR 2.48 (95% CI 1.62-3.81)]. The risk of MS was high for those with high BW [OR 3.16 (95% CI 1.38-7.24)] and not significant for those with low BW adjusted for age and sex. Our data indicate that low BW is not associated with OW/OB or with MS in children, whereas high BW correlates with childhood OW/OB and MS.

Serial Plasma Concentrations of PYY and Ghrelin During Chemotherapy in Children With Acute Lymphoblastic Leukemia

To investigate peptide YY (PYY) and ghrelin secretion, at diagnosis and during chemotherapy in children with acute lymphoblastic leukemia (ALL). Measurements were performed at diagnosis, after the induction-consolidation phase and at standard time points before each cycle in 9 patients with ALL aged 2 to 7 years (median 4.3 y). Body mass index (BMI) and leukemic burden were estimated at the same time points and correlated with PYY and ghrelin levels. Nine healthy children matched for age and sex were used as controls. At diagnosis, mean PYY levels were high (P<0.0001) and mean active ghrelin were low, compared with controls (P<0.001). Compared with baseline values, PYY increased significantly after the induction-consolidation phase (P=0.033), and returned progressively to pretreatment levels after the sixth cycle, whereas ghrelin fluctuated and stabilized at significantly higher levels (P=0.024) after the eighth cycle of chemotherapy. However, ghrelin was still low, compared with controls (P<0.001), after the eighth cycle. Delta (final-baseline) mean PYY was negatively correlated with delta mean BMI SD score (-0.612, P=0.010) and positively with leukemic burden (0.529, P=0.015), whereas delta mean ghrelin was positively correlated with delta mean BMI SD score (0.626, P=0.009) and negatively with leukemic burden (-0.567, P=0.012). PYY and ghrelin play a major role in pathogenesis of anorexia-cachexia syndrome in pediatric ALL patients.

Heterozygosity for a POMC-Null Mutation and Increased Obesity Risk in Humans

Congenital deficiency of proopiomelanocortin (POMC) results in a syndrome of hypoadrenalism, severe obesity, and altered skin and hair pigmentation. The concept that subtle variation in POMC expression and/or function might contribute to common obesity is suggested by studies reporting linkage of obesity-related traits to a locus on chromosome 2p22 encompassing the POMC gene. We identified a novel homozygous frameshift (C6906del) mutation in POMC in a child of Turkish origin with severe obesity and hypoadrenalism. This mutation would be predicted to lead to the loss of all POMC-derived peptides. The availability of a large extended pedigree provided the opportunity to address whether loss of one copy of the POMC gene was sufficient to alter obesity risk. Twelve relatives were heterozygous for the mutation and 7 were wild type. Of the heterozygotes, 11 of 12 heterozygotes were obese or overweight compared with only 1 of 7 of the wild-type relatives. The mean BMI SD score was 1.7 +/- 0.5 in heterozygotes and 0.4 +/- 0.4 in the wild-type relatives. Parametric linkage analysis of the trait "overweight" provided statistically significant evidence of linkage with this locus, with a maximum "location score" (comparable with multipoint logarithm of odds scores) of 3.191. We conclude that loss of one copy of the POMC gene predisposes to obesity in humans. Thus, genetic variants having relatively subtle effects on POMC expression and function could influence susceptibility to obesity.

Changing Prevalences of Overweight and Obesity in Primary School Children - a Glimmer of Hope?

The current epidemic of childhood obesity is a growing public health concern. Estimates of the prevalence of obesity are necessary so that secular trends can be monitored and the need for preventative measures assessed. To establish the prevalences of overweight and obesity in Aberdeen primary schoolchildren and to investigate how children have been changing with respect to body fatness during their primary school years. Retrospective study of two cohorts of school entrants, using height and weight data from school nurse records. Data were collected on 1018 children. The prevalence of overweight among children in primary year 1 decreased from 28.7% in 1997/98 to 21.5% in 2001/02 (P<0.01). The mean BMI SD score also significantly decreased in boys from 0.51 in 1997/98 to 0.32 in 2001/02. For the 1997/98 school entrants, the prevalences of overweight and obesity did not change between school entry and the end of primary school. The mean BMI SD score decreased significantly during primary school in boys but not in girls. Although childhood overweight and obesity remain major public health concerns, we report a slight improvement in measures of obesity over time, particularly in boys.

Changes in Height, Weight, and Body Mass Index in Children with Craniopharyngioma after Three Years of Growth Hormone Therapy: Analysis of KIGS (Pfizer International Growth Database)

Extreme degrees of obesity may occur in association with hypothalamic tumors, usually after surgical intervention. This phenomenon has been reported to occur in as many as 25-75% of children undergoing extensive surgical extirpation of craniopharyngiomas (Cranio). Because less is known about the auxology of children with Cranio with milder alterations in growth, we undertook a 3-yr longitudinal analysis, using the KIGS database (Pfizer International Growth Database), to study their growth patterns and evolution of weight. We compared the effect of GH therapy on height, weight, and body mass index (BMI) in 199 prepubertal children with diagnosed Cranio treated by surgery and/or radiotherapy to two other groups of children with other causes of organic GH deficiency (OGHD): one with postsurgical and/or postirradiated OGHD (OGHD + S/I; n = 92) and the other with OGHD not due to Cranio and not having undergone either surgery or irradiation (OGHD - S/I; n = 85). At the start of GH therapy, 1) mean chronological (P < 0.0001) and bone (P = 0.0002) ages were youngest in OGHD - S/I and oldest in OGHD + S/I; 2) the mean height sd score (SDS) was lowest in OGHD - S/I and comparably higher in the other two groups (P < 0.0001); 3) mean weight and BMI SDS were greatest in Cranio and least in OGHD - S/I (both P < 0.0001); and 4) the mean initial GH dose prescribed was highest in OGHD - S/I and comparable in the other two groups (P < 0.0001). After 3 yr of GH therapy, 1) mean bone age remained youngest in OGHD - S/I and oldest in OGHD + S/I (P < 0.0001); 2) mean height SDS was highest in Cranio and comparably lower in the other two groups (P = 0.0159); 3) mean weight and BMI SDS remained greatest in Cranio and least in OGHD - S/I (P < 0.0001 and P = 0.0003, respectively); and 4) the mean GH dose remained highest in the OGHD - S/I group and least in the Cranio group (P = 0.0082). There were statistically significant increases within each group between the start of treatment and after 3 yr of GH therapy in height and weight, but not in BMI SDS. Lastly, after 3 yr of GH treatment, children in the Cranio group continued to have disproportionately heavier weight and higher BMI (with the greatest values in those with lower stimulated peak GH concentrations) compared with members of the other two groups, with no salutary effect of GH treatment on weight SDS and a mild improvement in BMI SDS. After S/I treatment, children with Cranio are disproportionately prone to varying degrees of weight gain compared with children with other forms of OGHD. In the present cohort of prepubertal children with Cranio, GH therapy induced excellent linear growth, but failed to have an ameliorative effect on weight gain and had only a slight beneficial effect on BMI gain. Because affected children may have resultant significant long-term medical morbidity and diminished quality of life, it is critical that the mechanism of this phenomenon be determined to devise helpful preventive or therapeutic interventions.