Pediatric obesity: etiology and treatment.

In the United States, the prevalence of pediatric overweight, defined by the Centers for Disease Control as a body mass index (BMI) ≥95th percentile for age and sex, has more than tripled during the past 4 decades.1–3 Of children and adolescents, 16.3% are now obese, and an additional 15.6% are classified as overweight (BMI in the 85th–95th percentile).3 Of all children, 11.3% have a BMI that exceeds the 97th percentile for age and sex,3 a degree of excess weight that some believe may be a reasonable cut-point for pediatric obesity.4 Some racial and ethnic minority populations, especially African American, Hispanic, and American Indian groups, are at particular risk for the development of overweight and obesity.3 The increase in obesity prevalence among children is particularly alarming because obesity-related diseases rarely seen in children in the past, including obesity-associated sleep apnea,5 non-alcoholic fatty liver disease6 with resultant cirrhosis,7 and type 2 diabetes,8,9 are increasingly diagnosed in pediatric patients. The earlier onset of chronic health conditions such as type 2 diabetes in childhood has been shown to lead to an earlier onset of related medical complications such as end-stage renal disease.10 Pediatric obesity has been shown to have a tremendous impact on later health,11 even independent of adult weight.12 In the absence of effective strategies to prevent and treat childhood obesity, millions of children will enter adulthood with the physical and psychologic consequences of excess adiposity. The current childhood obesity epidemic in the United States also has the potential to reverse the improvements in life expectancy that have been seen during the twentieth century13 and to result in more functional disability and decreased quality of life for those who survive to old age.14 This article reviews factors that contribute to excessive weight gain in children and outlines current knowledge regarding approaches for treating pediatric obesity.