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
- obese parents
- 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
Diagnostic investigations
Investigations 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)
BMI ≥95th percentile and <120% of 95th percentile (class 1 obesity)
BMI ≥120% of 95th percentile (class 2 and class 3 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.
Peer reviewers
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
- Dietary guidelines for Americans, 2020-2025
- Guidelines on physical activity and sedentary behaviour
More GuidelinesPatient leaflets
Weight problems in children: changing unhealthy habits
Weight problems in children: improving a child's diet
More Patient leafletsLog in or subscribe to access all of BMJ Best Practice
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