An Approach to the Evaluation and Management of the Obese Child With Early Puberty

Christine B. Tenedero; Krista Oei; Mark R. Palmert


J Endo Soc. 2022;6(1) 

In This Article


Obese children presenting with early signs of puberty are becoming increasingly common. The mechanistic link between weight and early puberty is not fully understood, but some of these children appear to have full activation of the HPG axis while others do not. We believe available data support identifying those with HPG axis activation (true GnRH-dependent precocious puberty) and thus suggest that evaluation through measurement of LH levels remains an important first step among obese girls with early puberty. For the obese girl with early thelarche who is shown to have CPP, subsequent clinical approach should not deviate significantly from that of a girl without obesity (Figure 1). Full clinical picture, and not weight status alone, should determine the decision for or against additional investigations, such as neuroimaging. Bone age advancement has less diagnostic value among obese girls with early puberty but can still be used to estimate adult height and to inform counseling around potential use of GnRHa therapy; such therapy can increase predicted adult height in these children and is not necessarily associated with worsening of long-term weight status. It is noted that early puberty may be what brings the obese child to medical attention and hence such presentations may present an important opportunity for lifestyle counseling.