Obesity in children

Obesity in children has increased in recent decades. Causes are multifactorial including biologic, genetic disposition, behavioral and environmental influences.

Calculating body mass index (BMI) is the most widely accepted method of screening for obesity in children. Abnormal BMI cutoffs in children are determined by age- and sex-specific percentiles.

Impaired glucose tolerance and type 2 diabetes mellitus are prevalent in children with obesity.

Preventing excessive weight gain in children is of paramount importance in confronting the obesity epidemic, as obesity is difficult to treat at all ages, and children with obesity tend to become adults with obesity.

The cornerstone of treatment is lifestyle modification including dietary modification and physical activity. Pharmacotherapy and metabolic/bariatric surgery may be considered as an adjunct to lifestyle modification in patients with severe obesity and those with syndromic or monogenic obesity due to certain genetic conditions.

Obesity is a condition of excessive body fat or adiposity that exceeds healthy limits.

The most widely accepted method to screen for excess adiposity is calculation of body mass index (BMI).[1]Mei Z, Grummer-Strawn LM, Pietrobelli A, et al. Validity of body mass index compared with other body-composition screening indexes for the assessment of body fatness in children and adolescents. Am J Clin Nutr. 2002 Jun;75(6):978-85. https://academic.oup.com/ajcn/article/75/6/978/4689425 http://www.ncbi.nlm.nih.gov/pubmed/12036802?tool=bestpractice.com In the US, abnormal BMI cutoffs in children are determined by age- and sex-specific percentiles based on the Centers for Disease Control and Prevention 2000 growth charts, as the amount of body fat changes with age and differs between boys and girls.[2]Ogden CL, Kuczmarski RJ, Flegal KM, et al. Centers for Disease Control and Prevention 2000 growth charts for the United States: improvements to the 1977 National Center for Health Statistics version. Pediatrics. 2002 Jan;109(1):45-60. http://www.ncbi.nlm.nih.gov/pubmed/11773541?tool=bestpractice.com

An age- and sex-adjusted BMI between the 85th and 94th percentiles is defined as overweight, and a BMI ≥95th percentile (or ≥ to 30 kg/m², whichever is lower) is defined as obesity.[3]Hampl SE, Hassink SG, Skinner AC, et al. Clinical practice guideline for the evaluation and treatment of children and adolescents with obesity. Pediatrics. 2023 Feb 1;151(2):e2022060640. https://publications.aap.org/pediatrics/article/151/2/e2022060640/190443/Clinical-Practice-Guideline-for-the-Evaluation-and?autologincheck=redirected http://www.ncbi.nlm.nih.gov/pubmed/36622115?tool=bestpractice.com ​​[4]Centers for Disease Control and Prevention. Child and teen BMI categories. Jun 2024 [internet publication]. https://www.cdc.gov/bmi/child-teen-calculator/bmi-categories.html ​ Severe (class II and III) obesity is defined as BMI of 120% of the 95th percentile.[5]Skinner AC, Ravanbakht SN, Skelton JA, et al. Prevalence of obesity and severe obesity in US children, 1999-2016. Pediatrics. 2018 Mar;141(3):e20173459. https://pediatrics.aappublications.org/content/141/3/e20173459.long http://www.ncbi.nlm.nih.gov/pubmed/29483202?tool=bestpractice.com [6]Kelly AS, Barlow SE, Rao G, et al. Severe obesity in children and adolescents: identification, associated health risks, and treatment approaches: a scientific statement from the American Heart Association. Circulation. 2013 Oct 8;128(15):1689-712. https://www.ahajournals.org/doi/10.1161/CIR.0b013e3182a5cfb3 http://www.ncbi.nlm.nih.gov/pubmed/24016455?tool=bestpractice.com ​​​ For children ages <2 years, BMI normative values are not available. Weight-for-height values above the 95th percentile in this age group can be categorized as overweight.[7]Roy SM, Spivack JG, Faith MS, et al. Infant BMI or weight-for-length and obesity risk in early childhood. Pediatrics. 2016 May;137(5):e20153492. https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/27244803 http://www.ncbi.nlm.nih.gov/pubmed/27244803?tool=bestpractice.com

The World Health Organization 2006 growth standard is recommended in many countries for children ages 0-5 years, and for children ages 0-2 years in the US. WHO: Child growth standards Opens in new window