Childhood obesity

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Iman Djarraya, BMedSci, MBChB, MPH[2]

Synonyms and keywords: obesity in kids, obesity in children, pediatric obesity


Childhood obesity is a Body Mass Index (BMI) at or above the 95th percentile for children of the same gender and age. It is a serious health problem that can result in health complications. Childhood obesity can be caused by dietary factors, lifestyle factors, underlying medical conditions, genetic causes or certain medications. Obesity may present with high blood pressure, shortness of breath, sleep apnea, gastroesophageal reflux, constipation, insulin resistance, constipation, or irregular menstruation. The presence of polyuria and polydipsia suggests possible diabetes, excess facial hair, insulin resistance and irregular menstruation in adolescent girls may be due to polycystic ovary syndrome (PCOS) and dry skin, constipation and intolerance to cold suggest hypothyroidism. laboratory tests indicated depend on the clinical presentation. Management of obesity includes the treatment of any underlying medical conditions and lifestyle modification.

Historical Perspective


  • Obesity: BMI is ≥95th percentile
  • Severe obesity: BMI ≥120% of the 95th percentile or BMI ≥35 kg/m2.



Childhood obesity may be caused by unhealthy dietary intake[7], unhealthy lifestyle [8], environmental factors[9], psychological stress [10], genetic causes [11], medication-induced [11] or cerebral injury.[11]

Dietary factors

Children and adolescents are consuming low nutrient high-calorie foods and beverages at home, school and other places. They are consuming more fast food which is low in nutrients and high in calories, fat and sodium. CDC reports that children and adolescents in the U.S. consumed an average of 13.8% of their daily calories from fast food during 2015-2018.[12] In addition, they are consuming large amounts of sugar-sweetened beverages which has been directly associated with obesity in multiple reviews.[13] [14]

Lifestyle factors

Physical inactivity, excess use of screen time and inadequate sleep also contribute to the obesity epidemic.[8] [15]

Environmental factors

Eating habits of the child are affected by demographics, lunch policies at schools and work demands on parents.[16]

Psychological stress

Chronic stress increases the risk of obesity, diabetes, heart disease, metabolic syndrome and mental health problems.[10]

Endocrine causes

There are hormonal disorders that may be associated with weight gain and obesity in children including: hypothyroidism[17], cushing's syndrome[18], polycystic ovary syndrome (PCOS)[19], precocious puberty[20], and pseudohypoparthyroidism.[21]

Genetic causes

Often, a child whose parents are overweight or obese will also be overweight or obese. Although this is often caused by shared unhealthy eating habits in the household, several genetic causes have been identified as a cause of obesity.[6] These can be divides into monogenic causes, syndromic obesity and polygenic obesity.[6] Monogenic obesity is caused of a mutation to a single gene including Leptin (LEP) mutations, Leptin Receptor (LEPR) mutations, Pro-opio melanocortin (POMC) mutations, MC4R deficiency, Proconvertase (PC1/2) deficiency, SIM1 deficiency, NTRK2/BDNF mutations and SH2B1 mutations.[6] Syndromic obesity include Prader Willi Syndrome (PWS), Cohen syndrome[6], Turner syndrome[22], down syndrome, and Laurence-Moon-Bardet-Biedl syndrome.[23]


Medications that may cause weight gain in children include second-generation antipsychotics[24], glucocorticoids[25], risperidone[26], clozapine[27], and tricyclic antidepressants[28].

Cerebral injury

Obesity can occur after acquired hypothalamic lesions following surgery, meningitis or ischemic injury.[11]

Differentiating childhood obesity due to lifestyle factors from other Diseases

Epidemiology and demographics

  • The prevalence of children who are overweight or obese worldwide is approximately 38 million in children under the age of 5 in 2019 and more than 340 million between 5 and 19 years old in 2016.[29]
  • In 2015-2016, the prevalence of Childhood Obesity in USA was estimated to be 13.9% among children aged 2 to 5 years, 18.4% among children aged 6 to 11 and 20.6% among adolescents aged 12 to 19 years.[30]


  • Children of all age groups may develop Childhood Obesity.
  • Childhood Obesity is more commonly observed among children aged 12 to 19 years old in the USA. This is followed by children aged 6 to 11 years old and then children aged 2 to 5 years of age.


  • Childhood Obesity prevalence by gender is different depending on the region.
  • Males are more commonly affected than females 5 to 19 years of age in most high and upper middle-income countries.[31]


  • Obesity prevalence was higher among Hispanics and non-Hispanic blacks than non-Hispanic whites and non-Hispanic Asians.[32]

Risk Factors

Natural History, Complications and Prognosis


Diagnostic Criteria

  • The diagnosis of childhood obesity for children age 2 and older is made when the Body Mass Index (BMI) is at or above the 95th percentile on the BMI-for-age growth chart.[36]

History and Symptoms

Physical Examination

  • Physical examination may be remarkable for:

Laboratory Findins


Medical therapy


  • Bariatric surgery are performed in some adolescents with severe obesity.[45]


See also


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