Summary
Definition
History and exam
Key diagnostic factors
- body mass index (BMI) ≥95th percentile
- weight ≥95th percentile for height
Other diagnostic factors
- increased waist-hip ratio
- hypertension
Risk factors
- parents with obesity
- rapid weight gain in infancy
- weight gain in early childhood
- non-Hispanic black or Hispanic ethnicity
- poor socioeconomic status
- sedentary lifestyle
- intrauterine growth restriction
- maternal gestational diabetes
- diet high in energy-dense foods, fast foods, and high-sugar beverages
- screen time >2-3 hours/day
- sleep deprivation
- exposure to corticosteroids, antibiotics, or acid-suppressing medication
- urban environment
- maternal smoking in pregnancy
- maternal consumption of ultra-processed foods
Diagnostic tests
Tests to consider
- fasting blood glucose
- serum lipids
- liver function tests
Emerging tests
- DEXA
- bioelectric impedance analysis
- abdominal CT or MRI
Treatment algorithm
body mass index (BMI) ≥85th to 94th percentile (overweight)
body mass index (BMI) ≥95th percentile (obesity) or BMI ≥120% of 95th percentile (severe obesity)
Contributors
Authors
Dianne Deplewski, MD
Associate Professor of Pediatrics
Section of Adult and Pediatric Endocrinology
Program Director
Pediatric Endocrinology Fellowship Program
University of Chicago
Chicago
IL
Disclosures
DD declares that she has no competing interests.
Acknowledgements
We would like to acknowledge our Pediatric expert panel member, Dr Michael Cabana, for his contribution to this topic. MDC declares that he has served as a consultant and editor for McGraw Hill and Elsevier.
Peer reviewers
Eric M. Bomberg, MD, MAS
Assistant Professor of Pediatrics
Associate Director for Research Informatics, Center for Pediatric Obesity Medicine
Division of Endocrinology and Center for Pediatric Obesity Medicine
University of Minnesota Medical School
Minneapolis
MN
Disclosures
EMB declares that he has been a site principal investigator and site co-investigator for Novo Nordisk. EMB's research program is supported by the National Institutes of Health (NIH) National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).
Steven S. Rothenberg, MD
Chief of Pediatric Surgery
The Mother and Child Hospital
Associate Clinical Professor of Surgery
University of Colorado
Denver
CO
Disclosures
SSR declares that he has no competing interests.
Seema Kumar, MD
Assistant Professor of Pediatrics
Mayo Clinic
Rochester
MN
Disclosures
SK declares that she has no competing interests.
Peter Bundred, MBBS, MD
Honorary Research Fellow
Department of Health Services Research
Institute of Psychology, Health and Society
University of Liverpool
Liverpool
UK
Disclosures
PB declares that he has no competing interests.
Differentials
- Primary hypothyroidism
- Secondary hypothyroidism
- Cushing syndrome
More DifferentialsGuidelines
- Recommendations for treatment of child and adolescent overweight and obesity
- Obesity: identification, assessment and management
More GuidelinesPatient information
Weight problems in children: changing unhealthy habits
Weight problems in children: improving a child's diet
More Patient information- Log in or subscribe to access all of BMJ Best Practice
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