essay on childhood obesity causes and effects

Causes and Consequences of Childhood Obesity

Introduction, related effects, obesity control.

Children obesity is an acute problem that is frequently met in the modern society. An unhealthy diet and the abundance of the junk food in the children’s menu leads to their gaining weight rapidly (Scherer, 2011). In order to address this problem properly, it is essential to examine its roots as well as to identify the ways of performing a positive change. A particular focus of the paper will be put on determining the ways school menus can be improved as the major part of children meals is consumed at school.

This disorder is brought about with varied combination of factors. First and foremost, it can be retrieved hereditary from the parents (Haerens, 2012). Family environment and genetics may influence a child’s condition largely in terms of obesity. Childhood obesity is a result of intertwine between environmental factors and genetics. The possession of two similar samples of alleles also recognized as FTO increases largely the risks of obesity.

There is a strong probability that parents’ obesity will be further transmitted to their children (Haerens, 2012). Other factors contributing to this condition is the lack of exercise, the child’s body type, psychological issues and unhealthy eating habits. The consumption of large quantities of junk food may likewise contribute to the development of obesity because most of the junk food always contains a large scope of calories and cholesterol (Scherer, 2011).

Most of the obese children from African and Hispanic communities lack exercise as their parents do not let them go outside in the fear of the dangers their children are always exposed to in the streets. It would be unfair to claim that these fears are ungrounded – these areas show high risks of being kidnapped by gangs as well as being abused sexually or hooked on drugs. Another factor that contributes to the increase in children’s obesity is the development of technologies (Haerens, 2012). Hence, the variety of the online games prevents children from going outside. In fact, they no more experience the need for live communication as their gadgets enable them to maintain virtual contacts. As a result, the physical activity of the modern children is evidently insufficient.

Family practices are another serious factor that leads to obesity in children (Haerens, 2012). Most mothers in these days do not exclusively breastfeed infants and introduce them to formulas very early. Parents are too concerned about their children’s safety. As a result, they prefer their children travelling by bus whatever short the destination (Scherer, 2011). The excessive care prevents children from the natural development, making them more exposed to the development of obesity (Haerens, 2012).

Another critical scope of factors is psychological triggers. Thus, psychological factors that lead to obesity include stress and anxiety (Koplan, Liverman & Kraak, 2007). Some people tend to overeat when being stressed or upset, and children are not an exception. When exposed to stress they tend to eat a lot to reduce stress hence their bodies absorb an excessive amount of energy which is further stored – as a result, a child is getting gradually obese (Scherer, 2011).

Obesity implies a series of associated effects. Some of the effects might reside in such health disorders as high blood pressure, strokes, heart diseases and even diabetes 2 (Haerens, 2012). These diseases reduce the children’s life span to five years. In most cases, children with obesity turn into obese adults in future. As long as children are always extra big physically, they tend to have low self-esteem and are commonly discriminated by other children (Haerens, 2012).

As a consequence, children get depressed because they see assume themselves to be different from other children and they are also teased by their classmates (Haerens, 2012). It is also empirically proved that children with obesity tend to age faster because of the distorted balance. In addition, they are more likely to have skin related diseases and get infected easily. Finally, it is the market policy that contributes to the growth of obese children. Hence, the availability of cheap foods in the market prompts families to compose unhealthy menus (Scherer, 2011).

Obesity can be controlled by changing unhealthy eating patterns into the healthy habits (Haerens, 2012). This can be done by eating balanced diet foods and reducing the number of the unhealthy products consumed. Exercise also help to reduce the excessive weight as they assist individuals in burning out the extra fats in their bodies (Haerens, 2012). Those children who are obese due to their genetics should also seek medical attention so that they can learn which type of obesity they have and what kind of lifestyle they should adopt.

Parents should be consulted on exclusive breastfeeding of their babies up to six months to eliminate any chances of children getting obese from the early childhood (Haerens, 2012). These formulas have a lot of chemicals and introducing babies to them does not only expose them to the risk of being obese but also implies other diseases.

At school, playgrounds should be made available for children to play. In addition, teachers should encourage children to perform some physical activity during the breaks. Most importantly, school caterers should focus on composing healthy menus rather than providing the largest quantities of food at the lowest price possible. It is assumed that the problem of childhood obesity should be treated complexly. Otherwise stated, both families and school staff should be involved in resolving it.

Haerens, M. (2012). Obesity . Detroit: Greenhaven Press.

Koplan, J., Liverman, C., & Kraak, V. (2007). Preventing childhood obesity . Washington, D.C.: National Academies Press.

Scherer, L. (2011). Obesity . Farmington Hills, MI: Greenhaven Press.

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• Causes and Effects Essay

IELTS Causes and Effects Essay: Obesity in Children

This causes and effects model essay is about  obesity in children.

You specifically have to talk about the  causes  (reasons) of the increase in overweight children, and explain the  effects  (results) of this.

Here is the question:

The percentage of overweight children in western society has increased by almost 20% in the last ten years.

Discuss the causes and effects of this disturbing trend.

Thinking about Coherence & Cohesion

This particular essay is organized as follows:

• Body 1: Causes
• Body 2: Effects

Of course it is also possible to have a 3 body paragraph essay. For example

However, remember not to write too little on one part.

For example, if you wrote one very short paragraph about 'causes' with little support and most of your essay on 'effects', you may then be seen to have not fully answered both parts of the question.

Another possible way of organizing it is to put each cause and its effect within a separate paragraph:

• Body 1: Cause 1 - Effect
• Body 2: Cause 2 - Effect

If you do this though, each particular cause must relate to that specific effect.

Example Child Obesity Essay

You should spend about 40 minutes on this task.

Write about the following topic:

Give reasons for your answer and include any relevant examples from your own experience or knowledge.

Write at least 250 words.

Causes and Effects Essay - Model Answer

Over the last ten years, western societies have seen close to a 20% rise in the number of children who are overweight. This essay will discuss some reasons why this has occurred and examine the consequences of this worrying trend.

The main cause of this problem is poor diet. Over the last decade there has been a prolific increase in the number of fast food restaurants. For example, on nearly every high street there is a MacDonald’s, Kentucky Fried Chicken and Pizza Hut. The food in these places has been proven to be very unhealthy, and much of the advertising is targeted at children, thus ensuring that they constitute the bulk of the customers of these establishments. However, it is not only due to eating out, but also the type of diet many children have at home. A lot of food consumed is processed food, especially with regards to ready-made meals which are a quick and easy option for parents who are working hard.

The effects of this have been and will continue to be very serious. Firstly, there has been a large increase in health related diseases amongst children, especially diabetes. This debilitating illness means a child has to be injected with insulin for the rest of their life. Not only this, very overweight children often experience bullying from other children, which may affect their mental health. The negative stigma of being overweight may also affect self-esteem.

To sum up, it is evident that there are several causes of obesity amongst children, and a variety of negative effects. Society must ensure steps are taken to prevent this problem from deteriorating further.

(275 words)

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Obesity in Children: Causes and Effects

Introduction.

Obesity can be described as a medical condition in which an individual’s body fat accumulates to a level that it may cause adverse health effects (Barnes par. 5). Obesity usually leads to decreased life expectancy and increased incidences of associated health problems. Body mass index (BMI) measurement which compares an individual’s body weight to height is used to determine obesity status. Normally, one is considered to be obese if the BMI value is greater than 30 kg/m2 (Gonzalez 13). This paper seeks to describe obesity in children with an emphasis on the causes and various health effects.

Causes of obesity in children

There are several factors that predispose children to obesity. Generally, the condition develops when a child consumes calories that are beyond his/her body’s requirements. There are diverse factors that contribute to the imbalance between calorie intake and body nutrient requirements. These factors may include:

Genetic factors

Obesity is frequently observed to run in families. If a child is born in a family whose members are obese then he/she is likely to become obese. The likelihood of developing obesity increases with the increase in the number of family members/relatives who are obese. However, genetics alone does not result in obesity. Obesity will only occur if the child consumes more calories than his/her body requirements even with a genetic predisposition.

Dietary Habits

Children and adolescents are increasingly relying on fast foods, processed snacks and sugary drinks more than the traditional healthy foods such as fruits, vegetables and whole grains (Kushner 55). Most of these junk foods tend to have high fat/calorie content and provide minute levels of other important nutrients. There are several lifestyle patterns in which these foods are consumed. Some of the unhealthy habits associated with the consumption of such foods include: eating when one is not hungry; eating while doing some other activities such as doing homework or watching TV; and taking high-energy drinks during sedentary activities like watching movies (Ferry 2). If such habits are not controlled they often result into obesity and the risk of developing other associated health problems.

Socioeconomic status

Children born in families that have low incomes or have jobless parents are likely to consume more calories to maintain a certain levels of activity. In addition, low income or jobless parents may not afford regular balanced and thus result into overreliance on high calorie junk food. Children raised in such families are more likely to develop obesity.

Physical inactivity

The changes in lifestyles that are attributed to rapid urbanization have led to more and more people leading inactive lifestyles. The increased popularity of computers, video games and TV has caused many children to lead inactive lifestyles (Joseph, Loscalzo and Fauci 32). This trend is more commonly observed in developed nations such as the United States. Statistics indicate that children and teenagers in the US spend approximately three hours a day watching TV. This does not only result in the utilization of less energy but also results into increased intake of snacks and soft drinks.

Most children in the developed nations are also raised in families whose lifestyles are predominantly sedentary. For instance, more than half of all children in the United States are raised by parents who do not conduct regular physical exercises.

Many children are also not taken through physical education. For instance, in the US only one third of all children are provided with daily physical training in schools. Parents are largely to blame as they are more concerned with busy schedules and some even fear for the public safety of their children, consequently denying them a chance to get involved in sports, dance and other school activities. In some cases schools prevent students from entering their campuses after hours to avoid potential liability risks (Ferry 1).

There are some rare occasions when pediatric obesity can result from medical instances. This may be due to hormonal or other imbalances and inherited metabolic disorders. Many children who show linear growth are usually not affected or at risk of developing conditions associated with pediatric obesity (Ferry 1). Additionally, there are certain medications that result into weight gain particularly by altering the way the body processes or stores food (Gonzalez 41).

Effects of obesity in children

Obesity is a growing problem in the US and many other regions of the world. Current statistics indicate that one in every five children and adolescents are overweight and the numbers are still increasing at an alarming rate (Barnes par. 4). Scientists have predicted that the coming generations will live for shorter periods compared to their parents due to obesity. There are several physical and mental effects of childhood obesity both of which can be medically described.

Physical effects of obesity

The medical effects of obesity in children are similar to those observed in adults and include high cholesterol levels, hypertension, type 2 diabetes, metabolic syndrome, and sleep apnea (Joseph, Loscalzo and Fauci 29).

There are some conditions that are more likely to occur in adults compared to children. For instance, the risk of developing heart ailments is not as clear in obese children as it is in adults, especially those who do not have any of the previously mentioned conditions. An individual might be overweight as a child and be of normal weight as an adult. Such a individual may not be at risk of developing heart diseases as a result of an obesity episode that was experienced during childhood. The number of obese children who remain with the condition in their adult life is however very high and therefore they continue to carry the risk of developing heart diseases and other obesity associated conditions (Kushner 8).

Psychological effects of childhood obesity

Besides the physical effects of childhood obesity, there are some psychological effects that might be observed. In a certain study, it was established that severely obese children had low quality of life scores that are comparable to those undergoing chemotherapy for cancer (Gonzalez 45). Severely obese children tend to have a low self esteem that is associated with the different forms of social discrimination they experience. In some cases obese children and adolescents tend to get depressed due to loneliness or constant teasing from their peers.

Conclusions and recommendations on how to control childhood obesity

This paper has established that childhood obesity develops due to various factors that may include genetic, poor eating habits and inactive lifestyles. Obesity results into various physical and psychological health effects such as low self esteem, depression, hypertension and type 2 diabetes. Childhood obesity can be controlled by proper feeding habits and leading active lifestyles. This includes consumption of low calorie high nutrient foods and more involvement in physical activities (Joseph, Loscalzo and Fauci 65).

Works Cited

Barnes, Brook. Limiting ads of Junk food to children. 2007. Web.

Ferry, Robert. Obesity in Children and adolescents. 2012. Web.

Gonzalez, Berrington. “Body-Mass Index and Mortality among 1.46 Million whites.” NJ  Engl. J. Med (2010): 363 (23): 2211-9. Print.

Joseph, et al. Harrison’s principles of internal medicine. New York: McGraw-Hill Medical, 2008. Print.

Kushner, Robert. Treatment of the Obese patient. Totowa: Humana Press, 2007. Print.

Home — Essay Samples — Nursing & Health — Childhood Obesity — The Main Causes Of Childhood Obesity: Child’s Environment

The Main Causes of Childhood Obesity: Child's Environment

• Categories: Child Obesity Childhood Obesity Obesity

About this sample

Words: 746 |

Published: Feb 9, 2022

Words: 746 | Pages: 2 | 4 min read

Works Cited

• Berall, G. (2002). Walking to school: a step to healthy children. Canadian Medical Association Journal, 166(3), 322-323.
• Ogden, C. L. (2011). Genetics of childhood obesity. Pediatrics, 128(Supplement 2), S152-S155.
• Rosenfield, S. (2007). Perspectives on the prevention and treatment of childhood obesity. Journal of School Health, 77(3), 124-128.
• Sahoo, K., Sahoo, B., Choudhury, A. K., Sofi, N. Y., Kumar, R., & Bhadoria, A. S. (2015). Childhood obesity: causes and consequences. Journal of Family Medicine and Primary Care, 4(2), 187-192.
• Singh, A. S., Mulder, C., Twisk, J. W., van Mechelen, W., & Chinapaw, M. J. (2008). Tracking of childhood overweight into adulthood: a systematic review of the literature. Obesity Reviews, 9(5), 474-488.
• Swinburn, B. A., Sacks, G., Hall, K. D., McPherson, K., Finegood, D. T., Moodie, M. L., & Gortmaker, S. L. (2011). The global obesity pandemic: shaped by global drivers and local environments. The Lancet, 378(9793), 804-814.
• U.S. Department of Health and Human Services. (2018). Physical Activity Guidelines for Americans, 2nd Edition. U.S. Department of Health and Human Services. https://health.gov/our-work/physical-activity/current-guidelines
• Vogels, N., Posthumus, D. L., Marang-van de Mheen, P. J., & Renders, C. M. (2018). Behavioral factors related to the development of healthy and unhealthy habits in overweight preschool children: a cross-sectional study. International Journal of Behavioral Nutrition and Physical Activity, 15(1), 1-9.
• Ward, D. S., Welker, E., Choate, A., Henderson, K. E., Lott, M., Tovar, A., & Wilson, A. (2015). Strength of obesity prevention interventions in early care and education settings: A systematic review. Preventive Medicine, 78, 23-33.
• Whitaker, R. C., Wright, J. A., Pepe, M. S., Seidel, K. D., & Dietz, W. H. (1997). Predicting obesity in young adulthood from childhood and parental obesity. New England Journal of Medicine, 337(13), 869-873.

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Childhood Obesity – Causes and Potential Long-Term Effects

How it works

• 2.1 Causes and Potential Long-Term Effects
• 2.2 Causes of Childhood Obesity
• 2.3 Long-Term Effects of Childhood Obesity
• 2.4 Potential Solutions

There is growing concern about the state of children’s health. Every year there is an increase in the number of overweight and obese children. What causes this and what does it mean for them long-term? There are many contributing factors to children’s weight issues. Some of these factors are limited access to healthy food, more time spent in front of a screen, and less physical activity. Long-term health affects include a rising risk of Type 2 diabetes, coronary heart disease, and some forms of cancer.

The implications are that children are becoming unhealthier every year which raise the cost of medical care and reduce their life expectancy.

Childhood Obesity:

Causes and potential long-term effects.

A stunning number of pre-school aged children are overweight or obese and those numbers are growing every year. One study, conducted over the course of 30 years, has shown childhood obesity rates have risen steadily and show no sign of stopping. “The percentage of children and adolescents affected by obesity has more than tripled since the 1970s” (CDC, 2017). How did the American and Global populations rise to the obesity rates that we are seeing today? Historically, weight issues only seemed to affect the upper echelons of society, those who could afford food in abundance. Yet today we are seeing rising numbers of obese children in every demographic. What causes childhood obesity and what are the long-term effects? This essay will cover four areas of interest in the growing epidemic that is childhood obesity. There are:

• The causes of childhood obesity
• The cost of medical treatment of childhood obesity and its attendant long-term effects
• The long-term effects of childhood obesity
• Potential solutions for the treatment and prevention of childhood obesity

With an understanding of these areas, we can hope to find solutions that will help current and future generations deal with this growing trend. Childhood obesity effects every area of that child’s life and will continue to affect that child as he or she grows to adulthood.

Causes of Childhood Obesity

There are several causes of childhood obesity from genetics, to a lifestyle of convenience, to ease of access in acquiring healthy foods, among others. While the causes of obesity based on genetics is still being studied, there is some evidence that genetics play a role in childhood obesity. According to Sahoo et al. (2015) “Some studies have found that BMI is 25-40% heritable.” Unfortunately, this means that some children are predisposed to having a higher BMI. They go on to say only 5% of childhood obesity cases can be attributed to this genetic factor and that “Females are more likely to be obese as compared to males, owing to inherent hormonal differences.” These hormonal differences can also be genetically passed down from mother to daughter and father to son.

Another area for concern, in terms of childhood obesity, is the lifestyle of convenience. It is far easier for people to find food in this day and age. Glenn Berall, in his article Obesity: A crisis of growing proportions states that “Never before in the history of civilization has a population had such plentiful food sources without interruption of famine” (2002). This may have led some children to develop a “thrift metabolism” states Rolland-Cachera et al. (2006). A thrifty metabolism is the theory that thrifty genes allow for the storage of food as fat that the body can then use during a famine to continue to give needed energy to the individual. This could explain some of the obesity epidemic as there is rarely ever a famine in this abundant food culture. The lifestyle of convenience goes past readily available to food to available food choices. During the times of hunter-gatherers, food was hard to come by and was considered, by today’s standards, to be healthy. There were no sugary, fatty foods available to these people. They ate what they could find, such as berries, roots, and meat that they caught or killed. Today the food choices are overwhelming. One can simply drive to McDonald’s on the way home to pick up dinner for the family rather than spending time at the grocery store buying healthier options then going home to prepare the meal. In the increasingly busy lifestyle convenience has become the norm, not the atypical go-to for meals.

However, it needs to be mentioned that healthy food is not always easily available to certain demographics. Ashlesha Datar (2017) states that disadvantaged families have higher obesity rates. According to Howlett, Davis, and Burton (2014), “the majority of food deserts in the U.S. are found in low-income neighborhoods.” They state that “food deserts” are areas without “immediate access to fresh, healthy, and affordable food.” There is a high percentage of convenience stores in these areas and a lack of grocery stores or supercenters that would allow for the purchase of healthy foods. Howlett, Davis, and Burton (2014) go on to say:

“only 5 to 10% of convenience stores had fresh produce. In addition, the top selling food items sold at convenience stores include energy-dense foods such as sweet snacks, candy/gum/mints, and salty snacks.”

They continue on to compare the cost of meals. They estimate that it costs roughly $18.16 per 1000 calories for low-calorie meals compared to the $1.76 per 1000 calories of high-calorie foods. This makes it more expensive for low income families to eat healthier and thus could contribute to the rising rates of childhood obesity.

Along with convenience, comes a sedentary lifestyle. Children spend more time in front of a screen, whether it be television, tablet, computer, or phone, than in the past. This leads to less physical activity. Every hour of television a day increases the risk of obesity by 2% (Sahoo et al. 2015). According to the CDC (2017), “Energy imbalance is a key factor behind the high rates of obesity seen in the United States and globally.” Children are consuming more calories today than ever before but are not getting the needed activity to burn those extra calories. This creates a positive energy balance which leads to the storage of excess energy as fat. Convenience extends beyond food. Some of these contributing trends are the increased use of vehicles, more hazards for cyclists and walkers, increased food and drink choices, and media promotion of energy-dense foods (Lobstein et al. 2004).

Rising Cost of Medical Care

Childhood obesity has contributed to the rising cost of health care. Statistically, children who are obese will remain obese in adulthood. This creates the need for long-term medical treatment for a variety of issues. Long-term medical costs for a single obese child come in at approximately $12,660 per year according to Finkelstein et al (2014). In their article, medical for males ranged from $9,640 to $38, 680 with a mean of $24,160. Medical for females ranged from $14,440 to $49,230 with a mean of $31,835. However, some of these numbers do not account for weight fluctuations over a lifetime. By accounting for the fluctuations, they came to an approximate amount of $12,660 a year for both sexes and across each demographic. What time means long-term is that children are obese will pay, on average, more medical expenses than a person who becomes obese as an adult.

Long-Term Effects of Childhood Obesity

There is some controversy over the long-term effects of childhood obesity. Some studies show very little long-term effects while others show an astounding number of effects. However, there are some undisputed long-term risks involved with childhood obesity. Park, Falconer, Viner, and Kinra (2012) have compiled a list of six potential long-term risks associated with childhood obesity. These risks are:

• Type 2 Diabetes
• Hypertension
• All-cause mortality

They state that the higher the BMI (body mass index) of the child the greater the risk of developing one or more of the above diseases. “There is a consistent body of evidence for associations between childhood overweight and cardiovascular outcomes and mortality in adulthood” (Park et al. 2012).

Other studies have listed even more potential health problems for obese children. Glenn Berall (2002) lists “sleep apnea, slipped capital femoral epiphyses, nonalcoholic steatohepatitis, polycystic ovarian disease, and metabolic syndrome” as potential problems for overweight children as the reach maturity. Sahoo et al. (2015) list vitamin deficiencies as a current and potential long-term problem for obese children.

What one must also consider is the emotional ramifications of childhood obesity. Sahoo et al. (2015) looked at the relationship between eating disturbances and psychological effects on obese children. They found that obese children are more likely to suffer from self-esteem issues, body dissatisfaction, depression and anxiety, and eating disorder symptoms. They continue on to say that “Childhood obesity effects children’s and adolescent’s social and emotional health.” Overweigth children are more likely to be bullied or teased due to their weight. They are also more likely to be discriminated against. “These negative social problems contribute to low self-esteem, low self-confidence, and a negative body image in children and can also affect academic performance” (Sahoo et al. 2015).

Potential Solutions

What can society do to help treat or prevent childhood obesity? There are several things that society can do including changing governmental policies on food distribution and promotion, promote healthier food choices at schools, and advocate for healthier food options in the media.

Governmental policies could create incentives for schools to promote healthier food options. If a school is willing to participate, there could be a financial advantage to that school so that they could help offset the cost of healthier food. The government could offer incentives to grocery stores to build in low-income neighbors to help provide better food options to low-income families. They could also create policies aimed at the media to promote healthy food over junk food.

Schools could help promote better eating by offering students fruits and vegetables rather than high-fat foods. They could also limit or ban the use of vending machines on the property which give students less access the energy-dense foods. Schools could also promote education on the long-term effects of obesity and increase the amount of time spent on physical activity.

The media could promote healthier food options and more realistic body ideals. This would help with the perception that all women must be skinny and all men must be buff which create an unrealistic ideal for children to live up and may contribute to increased eating.

There are several contributing factors to why childhood obesity rates have grown exponentially over the last 40 years. A sedentary and convenient lifestyle, increased access to all types of food, and genetics all play a role. These can lead to long-term habit creation, as in the lack of consistent physical activity and eating a high fat diet, as well as long-term health effects such as Type 2 diabetes, heart disease, and increased risk of cancer. Childhood obesity also leads to higher long-term medical and emotional costs. Change needs to become a priority. The government, media, and schools need to lead the charge in promoting healthier food and education on the long-term risk factors associated with childhood obesity. Change won’t happen overnight, but it can happen.

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Obesity in children and adolescents: epidemiology, causes, assessment, and management

Hiba jebeile.

a Sydney Medical School, The University of Sydney, Sydney, NSW, Australia

b Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, NSW, Australia

Aaron S Kelly

d Department of Pediatrics and Center for Pediatric Obesity Medicine, University of Minnesota Medical School, Minneapolis, MN, USA

Grace O'Malley

e School of Physiotherapy, RCSI University of Medicine and Health Sciences, Dublin, Ireland

f Child and Adolescent Obesity Service, Children's Health Ireland at Temple Street, Dublin, Ireland

Louise A Baur

c Weight Management Services, The Children's Hospital at Westmead, Westmead, NSW, Australia

This Review describes current knowledge on the epidemiology and causes of child and adolescent obesity, considerations for assessment, and current management approaches. Before the COVID-19 pandemic, obesity prevalence in children and adolescents had plateaued in many high-income countries despite levels of severe obesity having increased. However, in low-income and middle-income countries, obesity prevalence had risen. During the pandemic, weight gain among children and adolescents has increased in several jurisdictions. Obesity is associated with cardiometabolic and psychosocial comorbidity as well as premature adult mortality. The development and perpetuation of obesity is largely explained by a bio-socioecological framework, whereby biological predisposition, socioeconomic, and environmental factors interact together to promote deposition and proliferation of adipose tissue. First-line treatment approaches include family-based behavioural obesity interventions addressing diet, physical activity, sedentary behaviours, and sleep quality, underpinned by behaviour change strategies. Evidence for intensive dietary approaches, pharmacotherapy, and metabolic and bariatric surgery as supplemental therapies are emerging; however, access to these therapies is scarce in most jurisdictions. Research is still needed to inform the personalisation of treatment approaches of obesity in children and adolescents and their translation to clinical practice.

Introduction

Obesity in children and adolescents is a global health issue with increasing prevalence in low-income and middle-income countries (LMICs) as well as a high prevalence in many high-income countries. 1 Obesity during childhood is likely to continue into adulthood and is associated with cardiometabolic and psychosocial comorbidity as well as premature mortality. 2 , 3 , 4 The provision of effective and compassionate care, tailored to the child and family, is vital. In this Review, we describe current knowledge on the epidemiology and causes of child and adolescent obesity, considerations for assessment, and current management approaches.

Epidemiology

Definitions of overweight and obesity in children and adolescents.

WHO defines overweight and obesity as an abnormal or excessive fat accumulation that presents a risk to health. For epidemiological purposes and routine clinical practice, simple anthropometric measures are generally used as screening tools. BMI (weight/height 2 ; kg/m 2 ) is used as an indirect measure of body fatness in children and adolescents 5 and should be compared with population growth references adjusted for sex and age. The WHO 2006 Growth Standard is recommended in many countries for children aged 0–5 years, and for children aged 0–2 years in the USA. 6 For older children and adolescents, other growth references are used, including the WHO 2007 Growth Reference, recommended for those aged 5–19 years (overweight defined as BMI ≥1SD and obesity as BMI ≥2SD of the median for age and sex), and the United States Centers for Disease Control and Prevention (CDC) Growth Reference for those aged 2 to 20 years (overweight is >85th to <95th percentile and obesity is ≥95th percentile based on CDC growth charts). 6 , 7 The International Obesity Task Force tables for children aged 2 to 18 years are used for epidemiological studies. 8

Abdominal or central obesity is associated with increased cardiometabolic risk in children and adolescents. 9 For waist circumference there are regional and international growth references allowing adjustment for age and sex. 10 , 11 , 12 A waist-to-height ratio of more than 0·5 is increasingly used as an indicator of abdominal adiposity in clinical and research studies, with no need for a comparison reference. 13

Various definitions have been suggested to identify more extreme values of BMI in children and adolescents. The International Obesity Task Force defined morbid obesity as equivalent to age-adjusted and sex-adjusted BMI of 35kg/m 2 or more at age 18 years, a definition specifically for epidemiological use. 14 The American Heart Association characterises severe obesity as a BMI of 120% or more of the 95th percentile of BMI for age and sex (based on CDC2000 growth charts), a definition that can be used in both clinical practice and research. 15 There are marked limitations in transforming very high BMI values to z-scores, particularly when using CDC2000 growth charts because reductions in BMI can be underestimated. 15

The prevalence of paediatric obesity 16 has increased worldwide over the past five decades. From 1975 to 2016, the global age-standardised prevalence of obesity in children and adolescents aged 5–19 years increased from 0·7% (95% credible interval [CrI] 0·4–1·2) to 5·6% (4·8–6·5) for girls and from 0·9% (0·5–1·3) to 7·8% (6·7–9·1) for boys. 17 Since 2000, the mean BMI has plateaued, usually at high levels, in many high-income countries but has continued to rise in LMICs. In 2016, obesity prevalence in this age group was highest (>30%) in many Pacific Island nations and was high (>20%) in several countries in the Middle East, north Africa, Micronesia (region of the western Pacific), Polynesia (subregion of Oceania), the Caribbean, as well as in the USA. 17

In 2019, the World Obesity Federation estimated there would be 206 million children and adolescents aged 5–19 years living with obesity in 2025, and 254 million in 2030. 1 Of the 42 countries each estimated to have more than 1 million children with obesity in 2030, the top ranked are China, followed by India, the USA, Indonesia, and Brazil, with only seven of the top 42 countries being high-income countries.

The prevalence of severe obesity in the paediatric population has grown in many high-income countries, even though overall prevalence of obesity has been stable. 18 , 19 , 20 , 21 In a survey of European countries, approximately a quarter of children with obesity were classified with severe obesity, a finding that has implications for delivery of obesity clinical services, because such children will need more specialised and intensive therapy. 19

There are socioeconomic disparities in paediatric obesity prevalence within countries. In lower-income to middle-income countries, children of higher socioeconomic status are at greater risk of being affected by overweight or obesity than children of a lower socioeconomic status, whereas in high-income countries, it is children living in socioeconomic disadvantage who are at higher risk. 22 , 23 , 24

Reports from China, Europe, and the USA have documented increased weight gain among children and adolescents during the COVID-19 pandemic compared with the rate before the pandemic, 25 , 26 , 27 , 28 , 29 an apparent consequence of decreases in physical activity, increased screen time, changes in dietary intake, food insecurity, and increased family and individual stress. 30

Development and perpetuation of obesity: a bio-socioecological framework

The development and perpetuation of obesity in modern society can largely be explained by a bio-socioecological framework that has created the conditions for a scenario in which biological predisposition, socioeconomic forces, and environmental factors together promote deposition and proliferation of adipose tissue and resistance to efforts of obesity management. A high degree of biological heterogeneity exists in bodyweight regulation and energy dynamics such that some individuals can maintain healthy levels of adipose tissue with little effort while others face a lifelong struggle with regulating levels. Further, adipose tissue is heterogeneous such that white, brown, and beige forms exist with a variety of physiological functions. 31 The anatomical sites where adipose tissue is stored can translate into varying health risks (eg, central accumulation of adipose tissue is associated with cardiometabolic disease compared to peripheral stores). 32 At a fundamental level, the relative function of the energy regulatory system (the complex interplay of central and peripheral pathways driving appetite, satiety, pleasure-seeking behaviours, and metabolic efficiency) strongly influences body composition. More specifically, the bodyweight set point theory posits the existence of a tightly regulated and complex biological control system, which drives a dynamic feedback loop aimed at defending a predetermined relative or absolute amount of adiposity. 33 Support for this theory comes from evidence in adults demonstrating immediate and sustained alterations in levels of hormones driving appetite and satiety, perceptions of food palatability, and resting energy expenditure following attempts at weight loss. 34 , 35 Other biobehavioural factors such as poor sleep quality, adversity, stress, and medications (causing iatrogenic weight gain) can also serve to exacerbate dysfunction of the energy regulatory system favouring weight gain.

Environmental and behavioural associations of obesity

Over the past few decades the rise in obesity prevalence has been profoundly influenced by changes in the broader obesogenic environment. 36 These changes operate at the level of the family (eg, family modelling of physical activity, food habits, sleep, screen use), local community (eg, child care and schools, parks, green space, public transport and food outlets), or the broader sociopolitical environment (eg, government policies, food industry, food marketing, transport systems, agricultural policies and subsidies). Such influences have been described as having the ability to exploit people's biological, psychological, social, and economic vulnerabilities. 37 Figure 1 depicts a socioecological model incorporating some of the personal and environmental factors influencing paediatric obesity. 38

A socioecological model for understanding the dynamic interrelationships between various personal and environmental factors influencing child and adolescent obesity.

Adapted from the Centers for Disease Control and Prevention social-ecological model framework for prevention. 38 *Defined as being traversable on foot, compact, physically enticing, and safe.

Dietary factors contributing to obesity risk in children and adolescents include excessive consumption of energy-dense, micronutrient-poor foods; a high intake of sugar-sweetened beverages; and the ubiquitous marketing of these and fast foods. 39 , 40 The relative effect of other factors such as specific eating patterns (eg, frequent snacking, skipping breakfast, not eating together as a family, the window of time from first to last daily meal), portion sizes, the speed of eating, macronutrient intake, and glycaemic load on obesity development remain unclear, although all might be important. 41 , 42

The link between screen time and obesity in childhood and adolescence was initially documented through cross-sectional and longitudinal studies of television viewing. 43 , 44 The past two decades have seen the increase of mobile and gaming devices. Screen exposure influences risk of obesity in children and adolescents via increased exposure to food marketing, increased mindless eating while watching screens, displacement of time spent in more physical activities, reinforcement of sedentary behaviours, and reduced sleep time. 44 , 45

Children's physical activity levels decline around the age of 6 years and again at age 13 years, with girls usually exhibiting more marked declines than boys. Overall, children with obesity tend to engage in lower levels of moderate-vigorous activity than leaner peers. 46 , 47 , 48 Sedentary time increases from the age of 6 years in general, although accelerometery studies report no differences between children with obesity compared with leaner peers. 48 Lower levels of physical activity and increasing sedentary behaviours throughout childhood in all children contribute to obesity development. 49 In most countries, children and adolescents are not sufficiently active due to the loss of public recreation space, the increase in motorised transport and decrease in active transport (eg, cycling, walking, public transport), perceptions of lack of safety in local neighbourhoods leading to less active behaviour, as well as an increase in passive entertainment. 39 , 49

There is growing evidence that short sleep duration, poor sleep quality and a late bedtime are associated with a higher obesity risk, sedentary behaviours, poor dietary patterns, and insulin resistance. In addition, there is a possible link with increased screen time, decreased physical activity, and changes in ghrelin and leptin levels. 50 Many of these obesity-conducive behaviours co-occur. For example, increased screen time is associated with delayed sleep onset and shortened sleep duration, and insufficient sleep is associated with increased food intake and lower levels of physical activity. 50

Early life factors

Several factors in early life put children at increased risk of developing obesity. These factors include maternal obesity before pregnancy, excessive gestational weight gain, and gestational diabetes, all associated with increased birth weight. 51 , 52 Infant and young child feeding practices have variable influences on childhood obesity. Meta-analyses from systematic reviews suggest that breastfeeding has a modest but protective effect against later child obesity. 53 , 54 There is some evidence suggesting that the very early introduction of complementary foods and beverages, before the age of 4 months, especially in formula-fed babies, is associated with higher odds of overweight and obesity. 55 Parental approaches to feeding, especially in the preschool age group (aged 1–4 years), might influence obesity risk, with a systematic review showing a small but significant association between controlling child feed practices (eg, restriction of specific foods or the overall amount of food) and higher child weight. 56 Studies of the role of responsive feeding, whereby the caregiver attends to the baby's cues of hunger and satiety, show that non-responsive feeding is associated with increased child BMI or overweight or obesity. 57 , 58 By contrast, a responsive feeding style that recognises the child's cues of hunger and satiety appears to support healthy weight gain trajectories. 58 , 59 However, in all such studies of infant and young child feeding, the effect of residual confounding on child weight status cannot be discounted.

Other environmental exposures in early life that influence child obesity risk include maternal smoking during pregnancy, 60 second-hand exposure to smoke, and air pollution. 61 Antibiotic exposure in infancy is associated with a slight increase in childhood overweight and obesity, especially if there are repeated treatments, an association that might be mediated by alterations in the gut microbiome. 62 Importantly, there is increased recognition that adverse childhood experiences, such as abuse, family dysfunction and neglect are associated with the development of childhood obesity. This association appears to be especially the case for sexual abuse and for co-occurrence of multiple adverse experiences. 63

Medical conditions associated with obesity

Obesity might occur secondary to a range of medical conditions including several endocrine disorders (eg, hypothyroidism, hypercortisolism, growth hormone deficiency), central nervous system damage (ie, hypothalamic-pituitary damage because of surgery or trauma) and post-malignancy (eg, acute leukaemia). Several pharmacological agents are associated with excess weight gain, including glucocorticoids, some anti-epileptics (eg, sodium valproate), insulin, and several atypical antipsychotics (eg, risperidone, olanzapine, clozapine). 64 The rapid and large weight gain associated with the latter class of drugs suggests that anticipatory weight management strategies should be formally used when commencing such therapy, although evidence is largely from adult studies. 65

Weight stigma

Weight stigma refers to the societal devaluation of a person because they have overweight or obesity, and includes negative stereotypes that individuals are lazy and lack motivation and willpower to improve health. 66 , 67 Higher body mass is associated with a greater degree of weight stigma, although longitudinal studies have shown associations between weight stigma and BMI to be bidirectional. 68 Stereotypes manifest in different ways, leading to discrimination and social rejection, often expressed as teasing, bullying and weight-based victimisation in children and adolescents. 66 , 67 Bodyweight is consistently reported to be the most frequent reason for teasing and bullying in children and adolescents, with a quarter to half of youth reporting being bullied based on their bodyweight. 69 Parents and health-care providers can also be sources of weight stigma. 69 , 70 Weight stigma is associated with poor mental health, impaired social development and education, and engagement in disordered eating behaviours including binge eating. 69 Of concern, youth who have experienced weight related teasing or bullying have higher rates of self-harm behaviours and suicidality compared with peers of the same weight who have not felt stigmatised. 67

Experience of weight stigma is a barrier to accessing health care. 67 Health professionals have a responsibility to help reduce weight stigma experienced by children, adolescents, and families through the use of supportive, compassionate, and non-stigmatising language while providing care. 69 In 2020, an international consensus statement was endorsed by more than 100 organisations pledging to reduce weight stigma. 66 Additionally, the American Academy of Paediatrics recommends paediatricians help mitigate weight stigma within clinical practice by role-modelling professional behaviours, using non-stigmatising language, using patient-centred behaviour change counselling, creating a safe and welcoming clinical environment accommodating of all body sizes, and conducting behavioural health screening for signs of weight-based bullying including emotional comorbidities. 67

Health complications

All body systems can be affected by obesity in the short, medium, or longer term, depending upon age and obesity severity. Figure 2 depicts the possible complications of obesity that can occur anywhere from childhood and adolescence to adulthood. It is important that complications are assessed in childhood and treated alongside obesity to prevent progression of both. Recent reviews provide additional detail regarding complications. 2 , 3 , 4 , 48 , 72 , 73 , 74 , 76 , 77 , 78 , 79 , 84 , 85 , 86 , 87 , 88 , 91 , 92 , 94 , 95

Short-term and long-term health complications and comorbidities associated with child and adolescent obesity

Health complications and comorbidities include neurological, 71 dental, 72 cardiovascular, 2 , 73 , 74 , 75 psychosocial, 2 , 4 , 76 , 77 , 78 respiratory, 79 , 80 , 81 , 82 , 83 endocrine, 73 , 84 , 85 musculoskeletal, 80 , 86 , 87 , 88 renal, 89 , 90 gastrointestinal, 90 , 91 skin, 92 function, and participation. 48 , 93

Clinical assessment

A detailed clinical examination screens for underlying causes of obesity, and assesses for possible obesity-related complications, risk of future disease, and whether potentially modifiable behavioural factors exist. Adapted from various national or regional level clinical practice guidelines, 96 , 97 , 98 , 99 , 100 , 101 , 102 , 103 summaries of the main aspects to be explored in history taking and physical examination are included in the panel and table . Laboratory tests can complement clinical assessment, looking for cardio-metabolic complications and some underlying causes of obesity. These tests are appropriate in most adolescents with obesity, and in all patients with severe obesity, with clinical signs or history suggestive of complications (eg, acanthosis nigricans), or with a family history of cardio-metabolic disease. Investigations would generally include liver function tests, lipid profile, fasting glucose, and glycated haemoglobin, and might include an oral glucose tolerance test and additional endocrine or genetic studies. 96 , 97 , 98 , 99 , 100 , 101 , 102

Elements of history taking

General history

• • Prenatal and birth history, including gestational obesity, gestational diabetes, maternal smoking, gestational age, birth weight, and neonatal concerns
• • General medical history, including psychiatric or behavioural diagnoses and previous malignancy
• • Developmental history, including any delays in motor, speech, or cognitive developmental, and therapy received
• • Infant feeding, including breastfeeding and duration and timing of introduction of complementary foods
• • Current medications, including glucocorticoids, anti-epileptics (eg, sodium valproate), and antipsychotics (eg, clozapine, risperidone, and olanzapine)

Growth history

• • Height and weight growth trajectories
• • Onset of obesity and timing of weight concerns of child or adolescent and family
• • Previous obesity management, whether supervised or self-initiated
• • Previous and current dieting and exercise behaviours or use of supplements

Complications history

• • Psychological impacts of obesity, including bullying, poor self-esteem, anxiety, depression, and disordered eating
• • Sleep routines, presence of snoring or possible sleep apnoea (eg, poor refreshment after sleep, daytime somnolence, and witnessed apnoea)
• • Exercise tolerance, exercise-induced bronchoconstriction, dyspnoea, hypertension, and fatigue levels
• • Specific symptoms including acne and hirsutism (girls), morning headache and visual disturbance, nocturnal enuresis, daytime dribbling, constipation, hip and knee joint pain, and gastrointestinal complaints (vomiting, abdominal pain, constipation, and gastrointestinal reflux)
• • Menstrual history (girls)

Family history

• • Ethnicity (high risk groups for cardiometabolic complications include First Nations peoples, Latin American, south Asian, east Asian, Mediterranean, and Middle Eastern)
• • Family members with a history of obesity; type 2 diabetes and gestational diabetes; hypertension, dyslipidaemia, and cardiovascular disease; obstructive sleep apnoea; polycystic ovary disease; bariatric surgery; eating disorders; and mental health disorders
• • Home environment including household members, parental relationship, parental employment, hours, and home supervision

Social history, including welfare, and safety

• • Housing or accommodation situation (stable or homeless) and residential care
• • Family income (or proxy) and food insecurity
• • Previous social services involvement
• • School attendance, additional educational assistance, learning difficulties, and behavioural difficulties
• • Hobbies and interests
• • Friends in school or neighbourhood
• • Use of tobacco, alcohol, or recreational drugs
• • Parenting style and child–parent interactions

Behavioural risk factors

• • Nutrition and eating behaviours: breakfast consumption; eating patterns including snacking, grazing, sneaking or hiding food, fast-food intake, binge-eating; beverage consumption (sodas, juices, other sugary drinks); family routines around food and eating; and active dieting
• • Physical activity: transport to and from school; participation in physical education class; participation in organised sport, dance, or martial arts; gym membership; after-school and weekend recreation; and family activities
• • Sedentary behaviours: time spent sitting each day; screen-time per day (television, video game, mobile phone, tablet, computer use); number of devices in the household and bedrooms; patterns of screen viewing (eg, during meals, at night); and use of social media
• • Sleep behaviours: bedtime routines; sleep and wake times on weekdays and weekends; and daytime napping

Clinical findings on examination by organ system

Obesity treatment in children and adolescents aims to reduce adiposity, improve related physical and psychosocial complications, and prevent the development of chronic diseases. The degree of BMI reduction needed to improve obesity related complications is currently unknown. However, some evidence suggests that BMI z-score reductions greater than 0·25 and 0·5 might represent clinically important thresholds. 104 Several high-quality clinical practice guidelines are in use internationally. 96 , 97 , 98 , 99 , 100 , 101 , 102 Treatment type and intensity depends upon obesity severity, the age and developmental stage of the child, needs and preferences of the patient and family, clinical competency and training of the clinician(s), and the health-care system in which treatment is offered. 105 Treatment integrates multiple components including nutrition, exercise and psychological therapy, pharmacotherapy, and surgical procedures. It should be delivered by suitably qualified paediatric health professionals who incorporate behavioural support and non-stigmatising child-focused and youth-focused communication into their practice. 69

Multicomponent behavioural interventions

Behavioural support strategies in obesity management include a combination of addressing dietary intake, physical activity, sedentary behaviours, sleep hygiene, and behavioural components within the context of a family-based and developmentally appropriate approach aiming for long-term behaviour modification. 106 , 107 , 108 Tailoring of interventions to various subgroups based on age, gender, and culture might be needed. For example, with young children the therapy might be largely parent-focussed 109 and for adolescents a greater degree of autonomy might be required. 107

Dietary intervention

Dietary interventions might include dietary education alone or combined with a moderate energy restriction, 110 with structured dietary plans or advice preferred over broad dietary principles, particularly for adolescents. 111 Principles of dietary education focus on adoption of dietary intake patterns consistent with local dietary guidelines—eg, increased intake of vegetables and fruit, reductions in energy-dense nutrient-poor foods and sugar sweetened beverages, and improvement in dietary behaviours such as encouraging mealtime routines and family meals. 110 , 112 One common approach, the traffic light diet, categorises foods by energy density, with green low-energy foods that can be eaten freely, yellow foods eaten moderately, and red foods eaten occasionally due to a higher energy-density. 107 Dietary approaches aim to be nutritionally complete and to address and prevent nutritional deficiencies. 113 , 114 However, children and adolescents might present for obesity treatment with relatively poor diet quality; 115 therefore, an initial goal of improving the baseline diet might be appropriate. Selection of dietary strategies should be informed by individual preference and circumstances, family environment, and available support.

Physical activity

Physical activity components might include provision of education or a structured exercise programme, or both, in line with local guidelines. The goals of exercise interventions should be to offer a safe, supportive, fun, and non-judgemental environment for children with obesity to engage in active play. It can also enable socialisation with peers and facilitate motor competence, confidence, and optimisation of fundamental motor skills. The aims of exercise itself are to increase physical fitness, reduce or attenuate obesity-related complications, improve quality of life, and support the child to reach age-appropriate physical activity levels. 116 , 117 Studies have found that the most effective exercise interventions consist of sessions lasting 60 min or more on at least 3 days per week for at least 12 weeks duration. 118 Training programmes should be tailored to the child's physical abilities and fitness level evaluated at baseline using standardised and age-appropriate outcome measures. Intervention should be fun, leverage the preferences of the child while following frequency, intensity, duration, type, volume, and progression principles. 119

Children with obesity often experience personal barriers to movement and exercise. Therefore tailoring and adapting paediatric exercise interventions will often be necessary, particularly for those that report musculoskeletal pain, high rates of fatigue, urinary incontinence, skin chafing, or have impaired motor skills. Additionally, the presence of intellectual or physical disabilities should be considered. As such, the type of exercise intervention offered will vary according to the child's clinical presentation and the desired outcome (eg, improvements in aerobic fitness, increased enjoyment, or reduction of fat-mass). The health professional might need to consider whether the intervention incorporates weight-bearing or non-weight bearing games, aerobic, proprioceptive and resistance exercises, individual or group-based work, or whether specific physiotherapy approaches might also need to be integrated to address underlying impairments. Appropriate monitoring and evaluation of the exercise intervention is recommended and should include the perspective of the child in addition to psychometrically robust outcome measurement. Additional guidance is available elsewhere. 120 , 121 , 122

Screen time and sedentary behaviours

Sedentary behaviours, including screen time, are distinct from physical activity and need to be addressed as part of a comprehensive behavioural change programme. Interventions that are successful in decreasing screen time in the short term include strong parental engagement, structural changes in the home environment (eg, removing or replacing home or bedroom electronic games access), and e-monitoring of time on digital devices. 123 These interventions tend to be more effective in young children.

There are few trials targeting sleep in the treatment of paediatric obesity, especially in older children and adolescents. Sleep interventions in preschool-aged children are associated with reduced weight gain. 124 Improvements in sleep hygiene, such as a consistent bedtime routine, regular sleep-wake times, and reduced screen times in the evening, are likely to have many co-benefits and positive effects on other weight-related behaviours.

Behavioural support strategies

Changes in dietary intake, physical activity, sedentary behaviours, and sleep are underpinned by strategies supporting behaviour change with the vast majority of interventions using a form of behavioural therapy. Common behaviour change techniques include goal setting, stimulus control (modifying the environment), and self-monitoring. 107 , 125 Motivational interviewing techniques such as reflective listening and shared decision making might also be used by healthcare workers to improve motivation for behaviour change. 126 , 127

The effectiveness of behaviour change interventions are well described, with modest reductions in weight-related outcomes 128 , 129 and improvements in cardiometabolic health. 130 The 2017 Cochrane reviews 128 , 129 found that behaviour changing interventions were more successful than no treatment or usual care comparators in reducing BMI (–0·53 kg/m 2 [95% CI –0·82 to –0·24], low-quality evidence in children; –1·18 kg/m 2 [–1·67 to –0·69], low-quality evidence in adolescents), and BMI z score (–0·06 units [–0·10 to –0·02], low-quality evidence in children; –0·13 [–0·21 to –0·05], low quality evidence in adolescents). 128 , 129 Effects were maintained at 18 to 24 months' follow-up for both BMI and BMI z-score in adolescents. 128 In children and adolescents aged 5–18 years, behavioural interventions are also associated with reductions in total cholesterol, triglycerides, fasting insulin, and HOMA-insulin resistance 130 as well as increased sleep duration and a reduced prevalence of obstructive sleep apnea. 131

A systematic review of 109 randomised controlled trials (RCTs) found that dietary interventions achieve a modest reduction in energy intake, reduced intake of sugar sweetened beverages, and increased intake of fruit and vegetables in children and adolescents aged 2–20 years. 132 The beneficial effects of supervised exercise in children and adolescents with obesity on measures of anthropometry and adiposity include reductions in BMI, bodyweight, waist circumference, and percent body fat. 133 Improvements in obesity-related complications are also observed, independent of changes in anthropometry including increased cardiorespiratory fitness, 134 improved muscle performance 80 and fundamental motor skills, 135 reductions in insulin resistance, reductions in fasting glucose and insulin levels, 136 improved lipid profile, 137 and reductions in blood pressure. 138 , 139 Exercise might also yield additional benefits related to appetite and response to food cues.

Behavioural obesity treatment is also associated with improved psychosocial health, including improved quality of life, 128 , 140 and body image 141 compared with no treatment or usual care comparators post-intervention and improvements in self-esteem at latest follow-up in those aged 4–19 years at baseline. 141 In assessing mental health, no difference between intervention and no-treatment comparator groups have been seen for the changes in symptoms of depression, 142 anxiety, 142 and eating disorders, 143 during the intervention period. However, symptoms of depression, anxiety, and eating disorders are reduced post-intervention or at follow-up in intervention arms, with no worsening of symptoms within groups. 142 , 143 , 144 , 145 Adverse effects of lifestyle interventions are poorly reported. 128 , 129 Where reported, no significant differences in adverse events between intervention and control groups are seen. 146

Psychological interventions

Psychological interventions, incorporated alongside traditional behavioural obesity treatment strategies, or as stand-alone interventions, target psychological factors that might contribute to eating behaviours and obesity, including distorted body image, negative mood, and stimulus control. 125 , 147 A core objective of psychological interventions is to reduce barriers for behaviour change. 147 Cognitive behavioural therapy (CBT) is the most frequently used approach, and addresses the relationship between cognitions, feelings, and behaviours using behavioural therapy techniques to modify behaviours and cognitive techniques to modify dysfunctional cognitions. 125 CBT-based interventions have been shown to result in healthier food habits, improved psychosocial health, quality of life, self-esteem, and anthropometric variables including BMI and waist circumference in children and adolescents. 125 Acceptance and commitment therapy (ACT), which encourage acceptance rather than avoidance of internal experiences (eg, food cravings), have shown to be effective in the management of obesity in adults and are an emerging area of research in adolescence. Pilot studies have found ACT-based interventions to be feasible and acceptable in adolescents with obesity, 148 , 149 with further research underway. Weight-neutral interventions, aiming to promote healthy behaviours and improve physical and psychosocial health without promoting weight loss, are an emerging area of practice in adults. There is currently insufficient evidence to guide the use of weight-neutral approaches in paediatrics.

Mode of intervention delivery

Evidence for behavioural change programmes encompass a variety of modes of delivery including group programmes, one-on-one therapist sessions, and various forms of e-health support. 128 , 129 , 150 , 151 No one form is necessarily superior to another, although a combination of such approaches might be used in a comprehensive integrated programme. Availability of resources; time constraints for health professionals, patients, and families; and appropriate health professional training will influence treatment provided alongside the child's developmental stage and patient or parent preferences. The COVID-19 pandemic has highlighted the need for effective interventions that can be delivered remotely without exacerbating existing social and technological disparities. 152 A 2021 review describes the considerations for successful implementation for such telemedicine approaches. 153

Eating disorders risk management

Children and adolescents with obesity are vulnerable to the development of eating disorders because obesity and eating disorders have several shared risk factors. 76 , 154 Disordered eating attitudes and behaviours, as precursors to eating disorders, are also elevated in children and adolescents with obesity. 155 Although obesity treatment helps improve eating disorder symptoms, including binge eating and loss of control in most youth with obesity, 143 , 144 a small number undergoing obesity treatment might develop an eating disorder during or after an intervention. 143 Although whether this low risk of developing eating disorders differs in youth who do not present for clinical treatment remains unclear, it is an important consideration for clinicians providing obesity care. For over a decade, it has been recommended that there be screening of disordered eating attitudes and behaviours before obesity treatment, 76 , 154 particularly with the use of dietary interventions, 112 to identify undiagnosed eating disorders. However, guidance on how this should occur in practice is scarce. Screening tools that assess for binge eating disorder specifically in children 156 and adolescents 157 with obesity are available but a self-report screening tool to assess for the broad spectrum of eating disorders for those with obesity and with adequate diagnostic accuracy is lacking. Eating disorder symptoms should not prevent the provision of obesity care; 158 rather, a combination of self-report questionnaires and clinical assessment might be needed to assess and monitor eating disorder risk in practice. 76

Intensive dietary interventions

Use of intensive dietary interventions is an emerging area of research and practice, particularly in post-pubertal adolescents with obesity related comorbidity or severe obesity. 110 , 159 Prescriptive dietary approaches may be delivered within the context of a multicomponent behavioural intervention, by experienced paediatric dietitians with medical supervision. 159 Very Low Energy Diets (VLEDs), consisting of an energy prescription of approximately 800 kcal/day or less than 50% of estimated energy requirements, often involving the use of nutritionally complete meal replacement products, are one such option. A meta-analysis of 20 studies found VLEDs to be effective at inducing rapid short term weight loss in children and adolescents with obesity (–10·1kg [95% CI 8·7 to 11·4] over 3 to 20 weeks), though follow-up beyond 12-months is scarce. 160 Data on VLEDs in the treatment of youth with early onset type 2 diabetes are limited to a small pilot study 161 and a medical chart review, 162 however, they have shown early short-term success and the possibility of reducing the requirement for medication, including insulin, and inducing remission of diabetes. 163 However, there is need for further research. 163 Variations in macronutrient distribution have been widely studied due to hypothesised effects on satiety, particularly higher protein (20–30% of energy intake from protein) approaches and very low carbohydrate diets (<50g per day or <10% energy from carbohydrate) aiming to induce ketosis. Although lower carbohydrate approaches show a significantly greater reduction in weight-related outcomes in the short-term (<6 months), dietary patterns with varied macronutrient distribution do not show superior effects in the longer term in children and adolescents. 164 Pilot studies on the use of various regimens of intermittent energy restriction in adolescents with obesity have shown these to be feasible and acceptable. 165 , 166 Larger trials are underway.

Anti-obesity medications

Anti-obesity medications are an important part of comprehensive obesity treatment. Pharmacotherapy, when combined with behavioural change interventions, can be particularly useful in patients for whom behavioural approaches alone have proven suboptimal or unsuccessful in reducing BMI and improving obesity-related complications. Although regulatory approval and availability varies by country and region, there is one anti-obesity medication that is approved by most regulatory agencies (including the United States Food and Drug Administration and the European Medicines Agency) for chronic obesity treatment in adolescents aged 12–18 years, which is liraglutide at 3 mg daily. Liraglutide, delivered via subcutaneous injection, belongs to the glucagon-like peptide-1 receptor agonist class, which acts on its receptors in the hypothalamus to reduce appetite, slow gastric motility, and act centrally on the hind brain to enhance satiety. 167 In the largest RCT of liraglutide 3 mg among adolescents (12 to <18 years old) with obesity, whereby all participants also received lifestyle therapy, the mean placebo-subtracted BMI reduction was approximately 5% with one year of treatment. 168 More participants in the liraglutide versus placebo group had a decline in BMI by 5% (43·3% liraglutide vs 18·7% placebo) and 10% (26·1% liraglutide vs 8·1% placebo). Importantly, no new safety signals were observed in the adolescent trial in relation to previous adult trials. The most reported adverse events were gastrointestinal and were more frequent in the liraglutide group (64·8% liraglutide vs 36·5% placebo). No statistically significant improvements in cardiometabolic risks factors or quality of life were observed between groups.

Other medications have been evaluated for the treatment of paediatric obesity yet are not approved in the EU and many other countries. These medications include orlistat (mean placebo-subtracted BMI reduction <3%), phentermine (no randomised, controlled trials conducted in children or adolescents), topiramate (mean placebo-subtracted BMI reduction <3%), and metformin (mean placebo-subtracted BMI reduction of around 3%). 169 , 170 , 171 , 172 Two anti-obesity medications are currently under evaluation for the treatment of adolescent obesity: semaglutide 2·4 mg weekly ( {"type":"clinical-trial","attrs":{"text":"NCT04102189","term_id":"NCT04102189"}} NCT04102189 ) and the combination of phentermine and topiramate ( {"type":"clinical-trial","attrs":{"text":"NCT03922945","term_id":"NCT03922945"}} NCT03922945 ). Results from these clinical trials are expected in 2022 with regulatory review and perhaps approval in 2022–23. Additional therapies are available for monogenic forms of obesity, 173 details of which are beyond the scope of the current Review.

Metabolic and bariatric surgery

Metabolic and bariatric surgery is the most effective and durable treatment for inducing weight loss in adolescents with obesity, with average BMI reductions in various longitudinal studies of the Roux-en-Y gastric bypass and vertical sleeve gastrectomy ranging from approximately 25–40% at 1–9 years post-surgery. 174 , 175 , 176 , 177 , 178 Beyond weight loss, metabolic and bariatric surgery leads to clinically meaningful improvements in obesity-related complications, cardiometabolic risk factors, musculoskeletal pain, and functional mobility. 174 , 178 , 179 , 180 Importantly, although the relative degree of weight loss with metabolic and bariatric surgery is similar between adults and adolescents, emerging data suggest that serious complications like type 2 diabetes and hypertension might be more likely to remit in adolescents than in adults. 177 Improved quality of life and reduced symptoms of depression are also seen following metabolic and bariatric surgery in the short term. 181 , 182 However, incidence and remission of mental health problems are highly variable following metabolic and bariatric surgery; a proportion of youth will continue to experience mental health concerns post-surgery that can persist long-term, with a subset experiencing suicidal ideations and behaviours. 183 , 184 , 185 , 186 Pre-surgical and post-surgical psychological support is recommended 187 and is associated with improved psychosocial health and weight loss maintenance. 188 Mortality rates 5 years following metabolic and bariatric surgery in adolescents (1·9%) appear to be similar to that of adults (1·8%) but adolescents tend to require abdominal reoperations more frequently than adults and have a higher incidence of low levels of ferritin, 177 requiring monitoring of nutritional status. 189 Until approximately 5 years ago, clinical practice guidelines for metabolic and bariatric surgery restricted eligibility to older adolescents having reached skeletal maturity. However, contemporary guidelines have now suggested that there need not be any lower age limit for consideration of metabolic and bariatric surgery as long as other medical eligibility requirements are met (detailed rationale and other considerations such as pubertal progression, linear growth, and pregnancy). 190 , 191 The uptake of metabolic and bariatric surgery has been extremely limited as surgery is typically reserved for the most severe forms of obesity and for patients with significant obesity-associated complications. 192 Other factors probably contributing to the low use of metabolic and bariatric surgery among adolescents include the perceived invasiveness and irreversibility of the procedures, lingering concerns regarding long-term safety, lack of access to surgical centres, poor insurance coverage, and referral bias.

Treatment selection

Treatment outcomes for paediatric obesity are highly variable 193 , 194 , 195 and a thorough baseline assessment guides the health professional on the appropriate treatment at a given time for a given patient. Baseline factors known to negatively predict weight-related outcomes with treatment include high levels of picky eating in preschool age children, 196 poor family functioning, or low self-concept 193 in the child and maternal psychological distress. 197 Positive predictors of treatment effect on weight include younger age, lower baseline BMI, higher global self-esteem, and adherence 198 to follow up. Predictors of treatment response represents a critically important area of future research as the ultimate goal is to match the appropriate patient to the treatment most likely to provide benefit and minimise potential risks from a non-suitable treatment plan.

Barriers to obesity treatment

Despite its growing evidence base, there remain many barriers to delivery of effective obesity treatment. For example, most RCTs have not been undertaken in culturally diverse populations, in people with complex health needs or disabilities, nor in those living with social disadvantage, all of which might make adherence to standard therapies more challenging. 199 Further, there are failures in implementing the known evidence into routine service delivery. An audit of adult and paediatric obesity services in 68 countries revealed poor resourcing and staffing of clinical services; a lack of integration of services across primary, secondary and tertiary level care; inadequate health professional training; widespread health system stigma towards people with obesity; and frequent unaffordability and inaccessibility of services. 200 Future research is needed to both develop the evidence base for obesity treatment in priority populations and in LMICs, as well as bring an implementation science perspective to obesity service delivery.

Conclusions

Structured, supported and life-long care for children and adolescents with obesity and their families is essential. The provision of care will change over time based on growth, development, life stage, and available support. More research is needed on management of obesity in disadvantaged communities and in those from LMICs, and on the real-world implementation of management approaches. Importantly, clinical care needs to be underscored by modifications to the social, commercial, and built environments which currently promote, rather than protect against, obesity, together with associated policy changes.

Search strategy and selection criteria

References for this Review were identified through searches of Medline (PubMed) and the Cochrane Database of Systematic Reviews for articles published up to Nov 1, 2021, using combinations of terms such as “child”, “adolescent”, “obesity”, “epidemiology”, “aetiology”, “complications”, “co-morbidity”, “treatment”, “behaviour change”, “prevention”, “bariatric surgery”, “metabolic surgery”, “pharmacotherapy”, and “BMI”. Articles published in English were included. We also reviewed reference lists of published manuscripts, clinical guidelines, and other relevant reviews and meta-analyses.

Declaration of interests

ASK serves as an unpaid consultant for Novo Nordisk, Vivus, Eli Lilly, and Boehringer Ingelheim; and receives donated drug and placebo from Vivus for a National Institutes of Health funded clinical trial. LAB serves on the Advisory Committee of the ACTION Teens study, sponsored by Novo Nordisk, for which an honorarium is paid to her hospital research cost centre. All other authors declare no competing interests.

Acknowledgements

HJ was supported by the Sydney University Medical Foundation. GO was supported by funding from the Royal College of Surgeons in Ireland StAR programme (grant number 2151).

Contributors

All authors contributed to the literature search, writing, reviewing, and editing of the manuscript.

• Patient Care & Health Information
• Diseases & Conditions

Obesity is a complex disease involving having too much body fat. Obesity isn't just a cosmetic concern. It's a medical problem that increases the risk of many other diseases and health problems. These can include heart disease, diabetes, high blood pressure, high cholesterol, liver disease, sleep apnea and certain cancers.

There are many reasons why some people have trouble losing weight. Often, obesity results from inherited, physiological and environmental factors, combined with diet, physical activity and exercise choices.

The good news is that even modest weight loss can improve or prevent the health problems associated with obesity. A healthier diet, increased physical activity and behavior changes can help you lose weight. Prescription medicines and weight-loss procedures are other options for treating obesity.

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Body mass index, known as BMI, is often used to diagnose obesity. To calculate BMI , multiply weight in pounds by 703, divide by height in inches and then divide again by height in inches. Or divide weight in kilograms by height in meters squared. There are several online calculators available that help calculate BMI .

See BMI calculator

Asians with a BMI of 23 or higher may have an increased risk of health problems.

For most people, BMI provides a reasonable estimate of body fat. However, BMI doesn't directly measure body fat. Some people, such as muscular athletes, may have a BMI in the obesity category even though they don't have excess body fat.

Many health care professionals also measure around a person's waist to help guide treatment decisions. This measurement is called a waist circumference. Weight-related health problems are more common in men with a waist circumference over 40 inches (102 centimeters). They're more common in women with a waist measurement over 35 inches (89 centimeters). Body fat percentage is another measurement that may be used during a weight loss program to track progress.

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If you're concerned about your weight or weight-related health problems, ask your health care professional about obesity management. You and your health care team can evaluate your health risks and discuss your weight-loss options.

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Although there are genetic, behavioral, metabolic and hormonal influences on body weight, obesity occurs when you take in more calories than you burn through typical daily activities and exercise. Your body stores these excess calories as fat.

In the United States, most people's diets are too high in calories — often from fast food and high-calorie beverages. People with obesity might eat more calories before feeling full, feel hungry sooner, or eat more due to stress or anxiety.

Many people who live in Western countries now have jobs that are much less physically demanding, so they don't tend to burn as many calories at work. Even daily activities use fewer calories, courtesy of conveniences such as remote controls, escalators, online shopping, and drive-through restaurants and banks.

Risk factors

Obesity often results from a combination of causes and contributing factors:

Family inheritance and influences

The genes you inherit from your parents may affect the amount of body fat you store, and where that fat is distributed. Genetics also may play a role in how efficiently your body converts food into energy, how your body regulates your appetite and how your body burns calories during exercise.

Obesity tends to run in families. That's not just because of the genes they share. Family members also tend to share similar eating and activity habits.

Lifestyle choices

• Unhealthy diet. A diet that's high in calories, lacking in fruits and vegetables, full of fast food, and laden with high-calorie beverages and oversized portions contributes to weight gain.
• Liquid calories. People can drink many calories without feeling full, especially calories from alcohol. Other high-calorie beverages, such as sugared soft drinks, can contribute to weight gain.
• Inactivity. If you have an inactive lifestyle, you can easily take in more calories every day than you burn through exercise and routine daily activities. Looking at computer, tablet and phone screens is inactivity. The number of hours spent in front of a screen is highly associated with weight gain.

Certain diseases and medications

In some people, obesity can be traced to a medical cause, such as hypothyroidism, Cushing syndrome, Prader-Willi syndrome and other conditions. Medical problems, such as arthritis, also can lead to decreased activity, which may result in weight gain.

Some medicines can lead to weight gain if you don't compensate through diet or activity. These medicines include steroids, some antidepressants, anti-seizure medicines, diabetes medicines, antipsychotic medicines and certain beta blockers.

Social and economic issues

Social and economic factors are linked to obesity. It's hard to avoid obesity if you don't have safe areas to walk or exercise. You may not have learned healthy ways of cooking. Or you may not have access to healthier foods. Also, the people you spend time with may influence your weight. You're more likely to develop obesity if you have friends or relatives with obesity.

Obesity can occur at any age, even in young children. But as you age, hormonal changes and a less active lifestyle increase your risk of obesity. The amount of muscle in your body also tends to decrease with age. Lower muscle mass often leads to a decrease in metabolism. These changes also reduce calorie needs and can make it harder to keep off excess weight. If you don't consciously control what you eat and become more physically active as you age, you'll likely gain weight.

Other factors

• Pregnancy. Weight gain is common during pregnancy. Some women find this weight difficult to lose after the baby is born. This weight gain may contribute to the development of obesity in women.
• Quitting smoking. Quitting smoking is often associated with weight gain. And for some, it can lead to enough weight gain to qualify as obesity. Often, this happens as people use food to cope with smoking withdrawal. But overall, quitting smoking is still a greater benefit to your health than is continuing to smoke. Your health care team can help you prevent weight gain after quitting smoking.
• Lack of sleep. Not getting enough sleep can cause changes in hormones that increase appetite. So can getting too much sleep. You also may crave foods high in calories and carbohydrates, which can contribute to weight gain.
• Stress. Many external factors that affect mood and well-being may contribute to obesity. People often seek more high-calorie food during stressful situations.
• Microbiome. The make-up of your gut bacteria is affected by what you eat and may contribute to weight gain or trouble losing weight.

Even if you have one or more of these risk factors, it doesn't mean that you're destined to develop obesity. You can counteract most risk factors through diet, physical activity and exercise. Behavior changes, medicines and procedures for obesity also can help.

Complications

People with obesity are more likely to develop a number of potentially serious health problems, including:

• Heart disease and strokes. Obesity makes you more likely to have high blood pressure and unhealthy cholesterol levels, which are risk factors for heart disease and strokes.
• Type 2 diabetes. Obesity can affect the way the body uses insulin to control blood sugar levels. This raises the risk of insulin resistance and diabetes.
• Certain cancers. Obesity may increase the risk of cancer of the uterus, cervix, endometrium, ovary, breast, colon, rectum, esophagus, liver, gallbladder, pancreas, kidney and prostate.
• Digestive problems. Obesity increases the likelihood of developing heartburn, gallbladder disease and liver problems.
• Sleep apnea. People with obesity are more likely to have sleep apnea, a potentially serious disorder in which breathing repeatedly stops and starts during sleep.
• Osteoarthritis. Obesity increases the stress placed on weight-bearing joints. It also promotes inflammation, which includes swelling, pain and a feeling of heat within the body. These factors may lead to complications such as osteoarthritis.
• Fatty liver disease. Obesity increases the risk of fatty liver disease, a condition that happens due to excessive fat deposit in the liver. In some cases, this can lead to serious liver damage, known as liver cirrhosis.
• Severe COVID-19 symptoms. Obesity increases the risk of developing severe symptoms if you become infected with the virus that causes coronavirus disease 2019, known as COVID-19. People who have severe cases of COVID-19 may need treatment in intensive care units or even mechanical assistance to breathe.

Related information

• Link between extra pounds, severe COVID-19 illness grows stronger - Related information Link between extra pounds, severe COVID-19 illness grows stronger

Quality of life

Obesity can diminish the overall quality of life. You may not be able to do physical activities that you used to enjoy. You may avoid public places. People with obesity may even encounter discrimination.

Other weight-related issues that may affect your quality of life include:

• Depression.
• Disability.
• Shame and guilt.
• Social isolation.
• Lower work achievement.
• Overweight and obesity. National Heart, Lung, and Blood Institute. https://www.nhlbi.nih.gov/health-topics/overweight-and-obesity. Accessed Dec. 21, 2022.
• Goldman L, et al., eds. Obesity. In: Goldman-Cecil Medicine. 26th ed. Elsevier; 2020. https://www.clinicalkey.com. Accessed Dec. 21. 2022.
• Kellerman RD, et al. Obesity in adults. In: Conn's Current Therapy 2023. Elsevier; 2023. https://www.clinicalkey.com. Accessed Dec. 21, 2022.
• Feldman M, et al., eds. Obesity. In: Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, Management. 11th ed. Elsevier; 2021. https://www.clinicalkey.com. Accessed Dec. 21, 2022.
• Perrault L. Obesity in adults: Prevalence, screening and evaluation. https://www.uptodate.com/contents/search. Accessed Dec. 21, 2022.
• Melmed S, et al. Obesity. In: Williams Textbook of Endocrinology. 14th ed. Elsevier; 2020. https://www.clinicalkey.com. Accessed Dec. 21, 2022.
• COVID-19: People with certain medical conditions. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html. Accessed Dec. 21, 2022.
• Perrault L. Obesity in adults: Overview of management. https://www.uptodate.com/contents/search. Accessed Dec. 21, 2022.
• Healthy weight, nutrition and physical activity. Centers for Disease Control and Prevention. https://www.cdc.gov/healthyweight/index.html. Accessed Dec. 21, 2022.
• Ferri FF. Obesity. In: Ferri's Clinical Advisor 2023. Elsevier; 2023. https://www.clinicalkey.com. Accessed Jan. 20, 2023.
• Feldman M, et al., eds. Surgical and Endoscopic Treatment of Obesity. In: Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, Management. 11th ed. Elsevier; 2021. https://www.clinicalkey.com. Accessed Dec. 21, 2022.
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