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Childhood and adolescent obesity

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Defined as body mass index at or above the 95th percentile for children of the same age and sex, and affects approximately 15% of children and adolescents in the U.S.

Often obesity begins in childhood, with the highest rates among minority populations.

Obesity rate of increase in children and adolescents nearly doubled during the first 9 months of Covid-19 epidemic.

Infancy is a critical period of development with long lasting metabolic and behavioral consequences demonstrating associations between overweight and rapid weight gain during infancy with increased risk for obesity and comorbidities later in life.

Pediatric obesity is associated with comorbid conditions affecting the cardiovascular, pulmonary, endocrine, gastrointestinal, and muscular skeletal systems and is a predominant cause of hypertension, type two diabetes, dyslipidemia, insulin resistance, inflammation, and steatohepatitis.

The persistence of obesity from childhood to adulthood has social, psychological impact on the individuals affected and increases medical costs, limits productivity, and reduce life expectancy and promotes myocardial infarction, kidney disease, cirrhosis, and liver cancer.

16% of children between 6 and 19 ys are overweight.

Global prevalence is greater than 5.6% in girls and 7.8% in boys (2016).
in 2017–2020, 19.7% of US children and adolescents age 2 to 19 years had obesity.
Childhood obesity results in elevated risks of cardio metabolic disorders and potential long-term health effects of increased risk of chronic diseases and mortality in adulthood.
Approximately 19% of children ages 6-11.Has increased in epidemic proportions.

In 2015-2016: among children 2 to 5 years old 14% were obese and 2% severely obese; among children 6 to 11 years old, 18% were obese and 5% severely obese; and among adolescents 12 to 19 years old, 21% were obese and 8% severely obese (Hales, CM).

More prevalent in black, Mexican Americans and Native Americans than other ethnic groups.

Has increased in both sexes, all racial, ethnic and socioeconomic populations.

Risk increased among persons with birth weight greater than 4000 g and parental obesity.

Risk factors for coronary artery disease, hypertension, diabetes and vascular problems already present in overweight children.

In a study of 276,835 Danish children higher BMI values increased the risk of having coronary heart disease in adulthood (Baker).

Childhood obesity is associated with the long term increasing cardiovascular disease, threatening both individual and the population health.

Childhood obesity predicts adult obesity and is associated with increased risk for cardiovascular disease and type two diabetes.

Obese children who are obese as adults have increased risks of type 2 diabetes, hypertension, dyslipidemia, and carotid atherosclerosis, but for those who become non obese by adulthood these risks are similar to those who were never obese (Juonala M et al).

Tracks strongly into adulthood, but particularly those with severe obesity, and/or strong family history of obesity.

Maternal body weight during pregnancy is related to an increased risk of offspring obesity, especially during childhood.
A high maternal body mass index is significantly related to higher offspring birth weight, a risk factor for childhood obesity.

Gestational diabetes affects not only the mother’s  body weight but it also offspring’s risk of obesity.

BMI may slightly overestimate fatness in children who are short or who have relatively high muscle mass and may underestimate adiposity in children with reduced muscle mass due to low levels of physical activity.

In a Chinese study children trunk fat mass and abdominal fat mass are positively associated with all cardiometabolic risk factors and their clustered risk independent of fat mass in other regions (Yan Y).

Leg fat mass gynoid and fat mass are negatively associated with most cardiometabolic risk factors (Yon Y).

Significant association exists between family divorce and children’s overweight: status.

Divorce remains a significant predictor of a higher BMI, along with older age, higher father’s and mother’s BMI, less children in the family, and more minutes of daily screen time for children.

In a  sample of fifth and sixth graders, unfavorable family circumstances have been associated with children’s overweight, as well as with aspects of their eating behavior, namely eating style in relation to conditions around food consumption and hunger, independent of other socioeconomic factors.

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