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Definition; epidemiology; and etiology of obesity in children and adolescents

William J Klish, MD
Section Editors
Kathleen J Motil, MD, PhD
Mitchell Geffner, MD
Deputy Editor
Alison G Hoppin, MD


Obesity has become one of the most important public health problems in the United States and many other resource-rich countries and transitional economies [1,2]. As the prevalence of obesity increased, so did the prevalence of the comorbidities associated with obesity [3]. For this reason, it is imperative that health care providers identify overweight and obese children so that counseling and treatment can be provided.

The definition, epidemiology, and etiology of obesity in children and adolescents will be presented here. Comorbidities of obesity in children and adolescents and the clinical evaluation of the obese child or adolescent are discussed separately. (See "Comorbidities and complications of obesity in children and adolescents" and "Clinical evaluation of the obese child and adolescent".)


The term "obesity" refers to an excess of fat. However, the methods used to directly measure body fat are not available in daily practice. For this reason, obesity usually is assessed by the relationship between weight and height (ie, anthropometrics), which provides an estimate of body fat that is sufficiently accurate for clinical purposes.

The body mass index (BMI) is the accepted standard measure of overweight and obesity for children two years of age and older [4]. BMI provides a guideline for weight in relation to height and is equal to the body weight (in kilograms) divided by the height (in meters) squared (table 1). Other measures of childhood obesity, including weight-for-height (which is particularly useful for the child younger than two years), measures of regional fat distribution (eg, waist circumference and waist-to-hip ratio), and the growth standards developed by the World Health Organization (WHO), are discussed separately. (See "Measurement of body composition in children" and "Measurement of growth in children", section on 'Growth standards'.)

Adults with a BMI between 25 and 30 kg/m2 are considered overweight; those with a BMI ≥30 kg/m2 are considered to be obese. Obesity in adults is subcategorized as class I (BMI ≥30 to 35), class II (BMI ≥35 to 40), and class III (BMI ≥40). Because children grow in height as well as weight, the norms for BMI in children vary with age and sex. In 2000, the National Center for Health Care Statistics and the Centers for Disease Control (CDC) published BMI reference standards for children between the ages of 2 and 20 years (figure 1A-B). BMI percentiles also can be determined using a calculator for boys (calculator 1) and for girls (calculator 2). As children approach adulthood, the 85th and 95th percentiles for BMI are approximately 25 and 30 kg/m2, the thresholds for overweight and obesity in adults, respectively [5].


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