Understanding Pediatric Obesity

Understanding Pediatric Obesity

Original article: Dr. Madhura Karguppikar

Pediatric Endocrinologist

Editing and formatting: Dr. Manoj Zalte

General Pediatrician

IAP Pune President 2025

What is pediatric obesity?

Pediatric obesity is a chronic disease characterized by excessive or dysfunctional body fat (adiposity).

It leads to impairment of health, resulting in long-term morbidity and early mortality.

It’s epidemic now.

Childhood obesity has become an epidemic in both developed and developing countries

WHO worldwide statistics 1990 to 2022

• Adult obesity has more than doubled

• Adolescent obesity has quadrupled.

• 2022: Overweight 43% and Obese 16%

• 2022: 2.5 billion adults (18 years and older) were overweight. of these, 890 million were living with obesity.

In the United States Approximately 70% of US adults and 32% of children are overweight or obese

India has the second highest rate of childhood obesity.

Childhood obesity tracks into adulthood, adversely affecting physical and psychological health of people and nation

What are the most common causes of Childhood obesity?

Many times, exact cause is not known. It is believed to be a disorder with multiple causes.

Most cases of pediatric obesity are Exogenous or Primary obesity. It is important to distinguish it from endogenous or secondary obesity, as evaluation and treatment depends on the cause.

• High caloric and fat food intake

• Too much screen time

• Too little physical activity

• Not getting enough good-quality sleep

• Personal or family stress or trauma

• Environment, culture and own and family lifestyle

How is childhood obesity diagnosed in children aged 5-18 years?

In 5-18 years, old children, BMI plotted using IAP 2015 BMI charts should be used to diagnose overweight and obesity. In children below 5 years of age, weight for length or height using WHO charts should be used for the same

Though BMI is not the most accurate method to diagnose obesity in children, still it is the most convenient and practical method to diagnose overweight and obese children. (BMI fails to distinguish between fat and fat-free mass (muscle and bone) and may exaggerate obesity in large muscular children.)

Waist circumference seems to be more accurate for children because it targets central obesity,

BMI percentile and body configuration

• Underweight: < 5th percentile.

• Healthy weight: 5th to 85th percentile.

• Overweight: 85th to 95th percentile.

• Obesity: >95th percentile.

BMI calculator link: https://www.calculator.net/bmi-calculator.html

WHO overweight and obesity definition:

Adult:

• Overweight: BMI ≥ 25

• Obesity: ≥ 30

Children < 5 years of age - SD above WHO Child Growth Standards median

• Overweight: weight-for-height > 2 SD.

• Obesity: weight-for-height > 3 SD.

Children 5 to 18 years of age - SD above IAP Child Growth Standards median

• Overweight: weight-for-height > 1 SD.

• Obesity: weight-for-height > 2 SD.

Links

WHO BMI charts for < 5 year old child

            Boys

            Girls

IAP Growth charts

https://iapindia.org/iap-growth-charts/

Things that are important in the clinical examination of overweight and obese children.

The clinical examination of overweight and obese children should include a comprehensive history, measurements, and follow-up monitoring of BMI, waist circumference, and blood pressure to recognise the etiology and associated comorbidities.

Also, watch for features of dysmorphism and developmental delay.

Routine investigations for endocrine causes are not required except in short and obese children and in those with additional diagnostic clues.

Basic investigations that may be done include - fasting blood sugar, lipid profile, liver function test and thyroid profile.

What is the recommended physical activity for children and adolescents?

Weight loss is achieved during a state of negative energy balance, or when energy expenditure is greater than energy consumption.

Physical activity for obese children should be tailored according to the age, sex, preference, socioeconomic status, and fitness/disability level of the child. They should include a combination of aerobic and strength training exercises.

Children and adolescents (age 5-18 years) should engage in age-appropriate, moderate to vigorous physical activity for at least one hour per day. Infants, toddlers, and preschoolers should be encouraged to remain active throughout the day.

Screen time should be strictly regulated. The recommended screen time is 0 - 1 - 2

• 0: no screen time up to 2 years,

• 1: maximum 1 hour from 2 - 5 years

• 2: 2 hours from 5 - 10 years, the lesser the better.

• The 10-18 age group is advised to balance screen time with other age specific developmental goals.

What are the consequences of obesity?

Overweight and obesity in childhood

• affects both physical and psychological health along with social, and emotional well-being, and self-esteem which in turn leads to more overweight and obesity and vicious cycle ensues.

• poor academic performance and a lower quality of life experienced by the child likely to stay into adulthood.

• likely to create non-communicable diseases like diabetes and cardiovascular diseases at a younger age.

• Many co-morbid conditions like metabolic, cardiovascular, orthopaedic, neurological, hepatic, pulmonary, and renal disorders are also seen in association with childhood obesity.

How should we counsel the parents and children?

Focus on overall physical, mental and social wellbeing and Health, Not Just Weight

Be Sensitive and Respective

            Avoid shaming and guilt

Focus on building, healthy habits, lifestyles and wellbeing of entire family rather than concentrating on obesity and weight loss and It will give more rewards in controlling obesity.

Involve the Entire Family for Optimum

• Screen Time 

• Quality Sleep (see below)

• Balanced healthy, nutritious diet with healthy eating patterns

• Avoid JUNCS food (Junk foods, Ultra-processed foods, Nutritionally inappropriate foods, Caffeinated/coloured/carbonated foods/beverages, and Sugar-sweetened beverages)

• Be a role model, set a good example

• Have a patience

• Set realistic goals with planned small daily actions with consistency and sincerity

• Be supportive

• Use Positive reinforcement

• Encourage family with fun and physical activities

Involve them in decision-making

• Offer accessible healthy choices.

• Involve children in meal planning and preparation

  
  

Address Underlying Issues

Consult Specialist if required

When is pharmacotherapy recommended for obese adolescents?

Pharmacotherapy may be recommended for adolescents older than 12 years with class 2 obesity and immediate or life-threatening comorbidities, or class 3 obesity with/without comorbidities, as an adjunct to comprehensive lifestyle modifications.

What is the role of stakeholders in addressing childhood obesity?

The increasing incidence and prevalence of obesity in infancy, childhood, and adolescence in India needs to be addressed critically by all stakeholders, including pediatricians, school officials, state and national medical bodies, and policymakers involved in the management and prevention of childhood obesity.

Quality Sleep

• Uninterrupted and refreshing sleep.

• Near consistent sleep schedule

• Is as important for good health as diet and exercise

• improves your brain performance, mood, and health.

Recommended Amount of Sleep for Pediatric Populations:

A Consensus Statement of the American Academy of Sleep Medicine