Obesity in Children and Adolescents

Abstract

1. Marcie B. Schneider, MD* 2. Susan R. Brill, MD† 1. *Director, Adolescent Program, Greenwich Hospital, Greenwich, Conn., and Assistant Clinical Professor of Pediatrics, Yale University School of Medicine, New Haven, Conn 2. †Director, Girl Street: A Young Women’s Health Program, Children’s Medical Center, Adolescent/Young Adult Center for Health, Overlook Hospital, Summit, NJ, and Assistant Professor of Clinical Pediatrics, University of Medicine & Dentistry of New Jersey, Newark, NJ After completing this article, readers should be able to: 1. Describe the appropriate use of the body mass index. 2. Delineate the relationship between sedentary activities such as television/video viewing and overweight. 3. Explain when clinicians should screen for impaired glucose tolerance in overweight children and adolescents. 4. Explain the expected results of thyroid studies in tall-for-age obese children. 5. List the psychiatric disorders for which obese children and adolescents should be screened. 6. Describe the management approach to obesity in overweight children and adolescents. Obesity has grown to epidemic proportions in children and adults. The medical consequences of obesity, including heart disease, hypertension, and diabetes, also have increased. Hospital costs from obesity-related diseases in youth have increased from $35 million (0.43% of total hospital costs) during 1979 to 1981 to $127 million (1.79% of total costs) during 1997 to 1999. Thus, it has become increasingly important to identify the risk factors predisposing to obesity and to identify youth who are overweight and at risk for becoming overweight. To prevent both the medical and psychological complications of obesity, treatment should be started as early as possible Although there are several methods of describing overweight, body mass index (BMI), defined as weight in kilograms divided by height in meters squared (kg/m2), has become the acceptable format for children, adolescents, and adults. The correlation of BMI with measures of adiposity is excellent in adults, but slightly less reliable for children, whose BMI changes with age during childhood and adolescence. Adiposity is influenced by several factors, including age, sex, pubertal stages, waist-to-hip ratio, and race. Boys have less body fat than do girls at the same BMI. Maturational level is more important than age, with those who are further along in puberty having more body fat. Those who have a higher waist-to-hip ratio at the same BMI have …