Childhood Obesity: Causes, Consequences, and Management

Key points

Background

Obesity prevalence has increased during the past decades in children and adolescents, leading to a significant current and future health burden.¹ In North America, approximately one-third of children are either overweight or obese.2, 3 Although the overall proportion of children with obesity may be plateauing, the rates of severe obesity in children continue to rise, particularly in very young children.2, 3, 4, 5 Furthermore, the incidence of overweight/obesity for children younger than 5 years

Etiology/Risk factors

Childhood obesity is a complex condition, influenced by genetics, nutritional intake, level of physical activity, and social and physical environment factors.11, 12 Rare pathologic causes may also lead to rapid weight gain; however, in most children, there is no single underlying cause. Red flags for pathologic obesity that may warrant further investigation include rapid onset of weight gain, very early age of onset, obesity discordant with parent weights, hypogonadism, short stature/poor

Comorbidities/Consequences of childhood obesity

There are multiple potential comorbidities associated with obesity, many of which track into adulthood.¹¹ However, not all overweight or obese children exhibit medical or psychological sequelae; a subset of individuals may exhibit no clinical complications or health risks related to their weight.³²

In adults, the metabolic syndrome is defined as a clustering of features including insulin resistance/elevated glucose, hypertension, abdominal obesity and dyslipidemia that portends risk for T2DM,

Assessment/Screening

Calculation of BMI and plotting on age- and sex-appropriate growth charts for children older than 6 years are recommended by the US Obesity Task Force as routine screening approach for use in clinical practice. There is insufficient evidence to provide a similar recommendation for children younger than 6 years,⁵⁸ although this recommendation will likely change over time given increasing obesity incidence in this age group. Although BMI is correlated with percent body fat, it is also correlated

Treatment

The goals of weight management are to prevent and reduce the risk of obesity-related sequelae, with a focus on healthy behavioral change. For growing children, weight maintenance may be a goal, and for those who have a more significantly elevated BMI, a steady, gradual weight loss (ie, not more than 0.5 kg/wk) is recommended.⁶³

A key message is that improvement of health outcomes, with reduced focus on weight loss, is the primary goal of treatment. The American Academy of Pediatrics Expert

Prevention

Prevention is a public health priority worldwide. In a 2011 Cochrane review, 37 studies of obesity prevention in 27,946 children aged 6 to 12 years demonstrated that programs were effective at reducing adiposity, although there was a high level of observed heterogeneity.⁷⁴ Overall, children in the intervention groups had a small but significant difference in mean BMI compared with the control groups (−0.15 kg/m² [95% CI, −0.21 to −0.09]). Intervention seemed to demonstrate larger effects in

Future directions

It is evident that there is no magic pill or one-size-fits-all approach to the prevention or treatment of obesity, and rarely can the cause of obesity be pinpointed to a single, modifiable cause. The underlying pathways leading to the development of the condition are unique for each patient, and a more targeted approach to treatment, based on underlying factors, including physiologic and psychosocial, at the level of the individual, family, community, and society is warranted. Research to