Obesity has become one of the most important public health problems in the United States (figure 1) [1-3]. As the prevalence of obesity increases so does the prevalence of the comorbidities associated with obesity . For this reason it is imperative that health care providers identify overweight and obese children so that counseling and treatment can be provided.
The comorbidities of obesity in childhood and adolescence include abnormalities in the endocrine, cardiovascular, gastrointestinal, pulmonary, orthopedic, neurologic, dermatologic, and psychosocial systems . Certain comorbidities, such as type 2 diabetes mellitus and steatohepatitis, that used to be considered "adult diseases" are now regularly seen in obese children. Moreover, obesity during adolescence increases the risk for disease and premature death during adulthood, independent of obesity during adulthood [6-9]. As an example, in a longitudinal study, females who had been overweight during childhood had an increased risk of death from breast cancer and from all causes in adulthood . Males who had been overweight during childhood had an increased risk of death from ischemic heart disease.
The comorbidities of obesity in children and adolescents will be discussed here. The definition, epidemiology, etiology, clinical evaluation of obesity in children and adolescents and the health hazards of obesity in adults are discussed separately. (See "Definition; epidemiology; and etiology of obesity in children and adolescents" and "Clinical evaluation of the obese child and adolescent" and "Health hazards associated with obesity in adults" and "Management of childhood obesity in the primary care setting".)
In the discussion that follows, the term "obesity" refers to children with body mass index (BMI) ≥95th percentile for age and sex and the term "overweight" refers to children with BMI between the 85th and 95th percentile for age and sex, unless otherwise noted. Calculation of body mass index and definitions of obesity are discussed in detail separately. (See "Definition; epidemiology; and etiology of obesity in children and adolescents", section on 'Definitions'.)
Endocrine comorbidities of obesity in children and adolescents include impaired glucose tolerance, diabetes mellitus, hyperandrogenism in females, and abnormalities in growth and puberty.