Obesity pp 295-322 | Cite as

Obesity in Children and Adolescents

  • Claudia K. FoxEmail author
  • Justin R. Ryder
  • Amy C. Gross
  • Aaron S. Kelly
Reference work entry
Part of the Endocrinology book series (ENDOCR)


This chapter reviews the definitions, prevalence, etiology, comorbidities, prevention, and treatment of childhood obesity. Obesity in childhood and adolescents is highly prevalent with the rates of severe obesity, in particular, increasing considerably. Biological contributors, principally in the form of genetic risk which is susceptible to expression in the context of an obesogenic environment, account for the primary etiology of childhood obesity. Critical periods in child development, including gestation and early infancy, early childhood, and adolescence, are especially vulnerable to various factors that may increase the likelihood of later obesity. Comorbidities associated with childhood obesity are similar to those seen in adults: hypertension, dyslipidemia, insulin resistance, nonalcoholic fatty liver disease, obstructive sleep apnea, and psychosocial distress. Treatment to date relies mostly on lifestyle modification therapy despite the fact that outcomes in the real-world clinical setting remain dismal, particularly for adolescents with severe obesity. As the field of pediatric obesity management continues to mature, pharmacotherapy may prove to be a helpful adjunctive treatment and access to bariatric surgery for eligible adolescents may increase as evidence of its safety and effectiveness continues to accumulate.


Childhood obesity Adolescent obesity Definitions Prevalence Etiology Comorbidities Treatment Prevention 


  1. Agostoni C, Braegger C, Decsi T, Kolacek S, Koletzko B, Mihatsch W, Moreno LA, Puntis J, Shamir R, Szajewska H, Turck D, Van Goudoever J. Role of dietary factors and food habits in the development of childhood obesity: a commentary by the ESPGHAN Committee On Nutrition. J Pediatr Gastroenterol Nutr. 2011;52:662–9.PubMedCrossRefGoogle Scholar
  2. Anzman-Frasca S, Stifter CA, Birch LL. Temperament and childhood obesity risk: a review of the literature. J Dev Behav Pediatr. 2012;33:732–45.PubMedCrossRefGoogle Scholar
  3. Arnold M, Jiang L, Stefanick ML, Johnson KC, Lane DS, Leblanc ES, Prentice R, Rohan TE, Snively BM, Vitolins M, Zaslavsky O, Soerjomataram I, Anton-Culver H. Duration of adulthood overweight, obesity, and cancer risk in the women’s health initiative: a longitudinal study from the United States. PLoS Med. 2016;13:e1002081.PubMedPubMedCentralCrossRefGoogle Scholar
  4. Barlow SE. Expert committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: summary report. Pediatrics. 2007;120(Suppl 4):S164–92.PubMedPubMedCentralCrossRefGoogle Scholar
  5. Bleich SN, Ku R, Wang YC. Relative contribution of energy intake and energy expenditure to childhood obesity: a review of the literature and directions for future research. Int J Obes. 2011;35:1–15.CrossRefGoogle Scholar
  6. Borys JM, Le Bodo Y, Jebb SA, Seidell JC, Summerbell C, Richard D, De Henauw S, Moreno LA, Romon M, Visscher TL, Raffin S, Swinburn B. EPODE approach for childhood obesity prevention: methods, progress and international development. Obes Rev. 2012;13:299–315.PubMedPubMedCentralCrossRefGoogle Scholar
  7. Bretault M, Boillot A, Muzard L, Poitou C, Oppert JM, Barsamian C, Gatta B, Muller H, Weismann D, Rottembourg D, Inge T, Veyrie N, Carette C, Czernichow S. Clinical review: bariatric surgery following treatment for craniopharyngioma: a systematic review and individual-level data meta-analysis. J Clin Endocrinol Metab. 2013;98:2239–46.PubMedCrossRefGoogle Scholar
  8. Campbell MK. Biological, environmental, and social influences on childhood obesity. Pediatr Res. 2016;79:205–11.PubMedCrossRefGoogle Scholar
  9. Cassidy SB, Schwartz S, Miller JL, Driscoll DJ. Prader-Willi syndrome. Genet Med. 2012;14:10–26.PubMedCrossRefGoogle Scholar
  10. Cole TJ, Bellizzi MC, Flegal KM, Dietz WH. Establishing a standard definition for child overweight and obesity worldwide: international survey. BMJ. 2000;320:1240–1243.PubMedPubMedCentralCrossRefGoogle Scholar
  11. Cortese S, Angriman M, Maffeis C, Isnard P, Konofal E, Lecendreux M, Purper-Ouakil D, Vincenzi B, Bernardina BD, Mouren MC. Attention-deficit/hyperactivity disorder (ADHD) and obesity: a systematic review of the literature. Crit Rev Food Sci Nutr. 2008;48:524–37.PubMedCrossRefGoogle Scholar
  12. Dohil R, Meyer L, Schmeltzer S, Cabrera BL, Lavine JE, Phillips SA. The effect of cysteamine bitartrate on adiponectin multimerization in non-alcoholic fatty liver disease and healthy subjects. J Pediatr. 2012;161:639–45.e1.CrossRefGoogle Scholar
  13. Doyle J, Colville S, Brown P, Christie D. ‘For the cases we’ve had…I don’t think anybody has had enormous confidence’ – exploring ‘uncertainty’ in adolescent bariatric teams: an interpretative phenomenological analysis. Clin Obes. 2014;4:45–52.PubMedCrossRefGoogle Scholar
  14. Farooqi S, O’Rahilly S. Genetics of obesity in humans. Endocr Rev. 2006;27:710–8.PubMedCrossRefGoogle Scholar
  15. Farooqi IS, O’Rahilly S. Mutations in ligands and receptors of the leptin-melanocortin pathway that lead to obesity. Nat Clin Pract Endocrinol Metab. 2008;4:569–77.PubMedCrossRefGoogle Scholar
  16. Feldstein AE, Charatcharoenwitthaya P, Treeprasertsuk S, Benson JT, Enders FB, Angulo P. The natural history of non-alcoholic fatty liver disease in children: a follow-up study for up to 20 years. Gut. 2009;58:1538–44.PubMedPubMedCentralCrossRefGoogle Scholar
  17. Franks PW, Hanson RL, Knowler WC, Sievers ML, Bennett PH, Looker HC. Childhood obesity, other cardiovascular risk factors, and premature death. N Engl J Med. 2010;362:485–93.PubMedPubMedCentralCrossRefGoogle Scholar
  18. Germano G, Allavena P, Mantovani A. Cytokines as a key component of cancer-related inflammation. Cytokine. 2008;43:374–9.PubMedCrossRefGoogle Scholar
  19. Gulati AK, Kaplan DW, Daniels SR. Clinical tracking of severely obese children: a new growth chart. Pediatrics. 2012;130:1136–40.PubMedPubMedCentralCrossRefGoogle Scholar
  20. Guo DF, Rahmouni K. Molecular basis of the obesity associated with Bardet-Biedl syndrome. Trends Endocrinol Metab. 2011;22:286–93.PubMedPubMedCentralGoogle Scholar
  21. Jansen E, Mulkens S, Jansen A. Tackling childhood overweight: treating parents exclusively is effective. Int J Obes. 2011;35:501–9.CrossRefGoogle Scholar
  22. Katzmarzyk PT, Barlow S, Bouchard C, Catalano PM, Hsia DS, Inge TH, Lovelady C, Raynor H, Redman LM, Staiano AE, Spruijt-Metz D, Symonds ME, Vickers M, Wilfley D, Yanovski JA. An evolving scientific basis for the prevention and treatment of pediatric obesity. Int J Obes. 2014;38:887–905.CrossRefGoogle Scholar
  23. Kelly KP, Kirschenbaum DS. Immersion treatment of childhood and adolescent obesity: the first review of a promising intervention. Obes Rev. 2011;12:37–49.PubMedCrossRefGoogle Scholar
  24. Khan MJ, Gerasimidis K, Edwards CA, Shaikh MG. Mechanisms of obesity in Prader-Willi syndrome. Pediatr Obes. 2016.Nov 10. [Epub ahead of print]PubMedCrossRefGoogle Scholar
  25. Kim JH, Choi JH. Pathophysiology and clinical characteristics of hypothalamic obesity in children and adolescents. Ann Pediatr Endocrinol Metab. 2013;18:161–7.PubMedPubMedCentralCrossRefGoogle Scholar
  26. Kit BK, Kuklina E, Carroll MD, Ostchega Y, Freedman DS, Ogden CL. Prevalence of and trends in dyslipidemia and blood pressure among US children and adolescents, 1999–2012. JAMA Pediatr. 2015;169:272–9.PubMedCrossRefGoogle Scholar
  27. Koot BG, Van Der Baan-Slootweg OH, Vinke S, Bohte AE, Tamminga-Smeulders CL, Jansen PL, Stoker J, Benninga MA. Intensive lifestyle treatment for non-alcoholic fatty liver disease in children with severe obesity: inpatient versus ambulatory treatment. Int J Obes. 2016;40:51–7.CrossRefGoogle Scholar
  28. Ladikou EE, Kassi E. The emerging role of estrogen in B cell malignancies. Leuk Lymphoma. 2017;58(3):528–539.CrossRefGoogle Scholar
  29. Latzer Y, Stein D. A review of the psychological and familial perspectives of childhood obesity. J Eat Disord. 2013;1:7.PubMedPubMedCentralCrossRefGoogle Scholar
  30. Lauby-Secretan B, Scoccianti C, Loomis D, Grosse Y, Bianchini F, Straif K. Body fatness and cancer – viewpoint of the IARC Working Group. N Engl J Med. 2016;375:794–8.PubMedCrossRefGoogle Scholar
  31. Lavine JE, Schwimmer JB, Van Natta ML, Molleston JP, Murray KF, Rosenthal P, Abrams SH, Scheimann AO, Sanyal AJ, Chalasani N, Tonascia J, Unalp A, Clark JM, Brunt EM, Kleiner DE, Hoofnagle JH, Robuck PR. Effect of vitamin E or metformin for treatment of nonalcoholic fatty liver disease in children and adolescents: the TONIC randomized controlled trial. JAMA. 2011;305:1659–68.PubMedPubMedCentralCrossRefGoogle Scholar
  32. Lee JM, Pilli S, Gebremariam A, Keirns CC, Davis MM, Vijan S, Freed GL, Herman WH, Gurney JG. Getting heavier, younger: trajectories of obesity over the life course. Int J Obes. 2010;34:614–23.CrossRefGoogle Scholar
  33. Lobstein T, Jackson-Leach R. Planning for the worst: estimates of obesity and comorbidities in school-age children in 2025. Pediatr Obes. 2016;11:321–5.PubMedCrossRefGoogle Scholar
  34. Lohmann AE, Goodwin PJ, Chlebowski RT, Pan K, Stambolic V, Dowling RJ. Association of obesity-related metabolic disruptions with cancer risk and outcome. J Clin Oncol. 2016;34:4249–55.PubMedCrossRefGoogle Scholar
  35. Maes HH, Neale MC, Eaves LJ. Genetic and environmental factors in relative body weight and human adiposity. Behav Genet. 1997;27:325–51.PubMedCrossRefGoogle Scholar
  36. Manco M, Dallapiccola B. Genetics of pediatric obesity. Pediatrics. 2012;130:123–33.PubMedCrossRefGoogle Scholar
  37. Manco M, Mosca A, De Peppo F, Caccamo R, Cutrera R, Giordano U, De Stefanis C, Alisi A, Baumann U, Silecchia G, Nobili V. The benefit of sleeve gastrectomy in obese adolescents on nonalcoholic steatohepatitis and hepatic fibrosis. J Pediatr. 2017;180:31–37.e2.PubMedCrossRefGoogle Scholar
  38. Mead E, Atkinson G, Richter B, Metzendorf MI, Baur L, Finer N, Corpeleijn E, O’Malley C, Ells LJ. Drug interventions for the treatment of obesity in children and adolescents. Cochrane Database Syst Rev. 2016;11:Cd012436.PubMedGoogle Scholar
  39. Miller AL, Lumeng JC, Lebourgeois MK. Sleep patterns and obesity in childhood. Curr Opin Endocrinol Diabetes Obes. 2015;22:41–7.PubMedPubMedCentralCrossRefGoogle Scholar
  40. Mummadi RR, Kasturi KS, Chennareddygari S, Sood GK. Effect of bariatric surgery on nonalcoholic fatty liver disease: systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2008;6:1396–402.PubMedCrossRefGoogle Scholar
  41. Nobili V, Manco M, Ciampalini P, Alisi A, Devito R, Bugianesi E, Marcellini M, Marchesini G. Metformin use in children with nonalcoholic fatty liver disease: an open-label, 24-month, observational pilot study. Clin Ther. 2008;30:1168–76.PubMedCrossRefGoogle Scholar
  42. Nobili V, Alkhouri N, Alisi A, Della Corte C, Fitzpatrick E, Raponi M, Dhawan A. Nonalcoholic fatty liver disease: a challenge for pediatricians. JAMA Pediatr. 2015;169:170–6.PubMedCrossRefGoogle Scholar
  43. Ogden CL, Kuczmarski RJ, Flegal KM, Mei Z, Guo S, Wei R, Grummer-Strawn LM, Curtin LR, Roche AF, Johnson CL. Centers for Disease Control and Prevention 2000 growth charts for the United States: improvements to the 1977 National Center for Health Statistics version. Pediatrics. 2002;109:45–60.PubMedCrossRefGoogle Scholar
  44. Orgel E, Tucci J, Alhushki W, Malvar J, Sposto R, Fu CH, Freyer DR, Abdel-Azim H, Mittelman SD. Obesity is associated with residual leukemia following induction therapy for childhood B-precursor acute lymphoblastic leukemia. Blood. 2014;124:3932–8.PubMedCrossRefGoogle Scholar
  45. Park MH, Kinra S, Ward KJ, White B, Viner RM. Metformin for obesity in children and adolescents: a systematic review. Diabetes Care. 2009;32:1743–5.PubMedPubMedCentralCrossRefGoogle Scholar
  46. Puhl RM, King KM. Weight discrimination and bullying. Best Pract Res Clin Endocrinol Metab. 2013;27:117–27.PubMedCrossRefGoogle Scholar
  47. Rankin J, Matthews L, Cobley S, Han A, Sanders R, Wiltshire HD, Baker JS. Psychological consequences of childhood obesity: psychiatric comorbidity and prevention. Adolesc Health Med Ther. 2016;7:125–46.PubMedPubMedCentralCrossRefGoogle Scholar
  48. Renehan AG, Tyson M, Egger M, Heller RF, Zwahlen M. Body-mass index and incidence of cancer: a systematic review and meta-analysis of prospective observational studies. Lancet. 2008;371:569–78.PubMedCrossRefGoogle Scholar
  49. Ryder JR, Kaizer AM, Rudser KD, Daniels SR, Kelly AS. Utility of body mass index in identifying excess adiposity in youth across the obesity Spectrum. J Pediatr. 2016;177:255–61.e2.PubMedPubMedCentralCrossRefGoogle Scholar
  50. Santoro N, Zhang CK, Zhao H, Pakstis AJ, Kim G, Kursawe R, Dykas DJ, Bale AE, Giannini C, Pierpont B, Shaw MM, Groop L, Caprio S. Variant in the glucokinase regulatory protein (GCKR) gene is associated with fatty liver in obese children and adolescents. Hepatology. 2012;55:781–9.PubMedCrossRefGoogle Scholar
  51. Sato A, Jelalian E, Hart C, Lloyd-Richardson E, Mehlenbeck R, Neill M, Wing R. Associations between parent behavior and adolescent weight control. J Pediatr Psychol. 2011;36:451–60.PubMedCrossRefGoogle Scholar
  52. Schmidt ME, Haines J, O’Brien A, Mcdonald J, Price S, Sherry B, Taveras EM. Systematic review of effective strategies for reducing screen time among young children. Obesity (Silver Spring). 2012;20:1338–54.CrossRefGoogle Scholar
  53. Schwimmer JB. Cysteamine bitartrate delayed-release (DR) for the treatment of nonalcoholic fatty liver disease (NAFLD) in children (CyNCh) trial. Hepatology. 2015;62:1398A–9A.CrossRefGoogle Scholar
  54. Schwimmer JB. Clinical advances in pediatric nonalcoholic fatty liver disease. Hepatology. 2016;63:1718–25.PubMedPubMedCentralCrossRefGoogle Scholar
  55. Schwimmer JB, Burwinkle TM, Varni JW. Health-related quality of life of severely obese children and adolescents. JAMA. 2003;289:1813–9.PubMedCrossRefGoogle Scholar
  56. Schwimmer JB, Deutsch R, Kahen T, Lavine JE, Stanley C, Behling C. Prevalence of fatty liver in children and adolescents. Pediatrics. 2006;118:1388–93.PubMedCrossRefGoogle Scholar
  57. Schwimmer JB, Middleton MS, Behling C, Newton KP, Awai HI, Paiz MN, Lam J, Hooker JC, Hamilton G, Fontanesi J, Sirlin CB. Magnetic resonance imaging and liver histology as biomarkers of hepatic steatosis in children with nonalcoholic fatty liver disease. Hepatology. 2015;61:1887–1895.PubMedPubMedCentralCrossRefGoogle Scholar
  58. Sica A, Allavena P, Mantovani A. Cancer related inflammation: the macrophage connection. Cancer Lett. 2008;267:204–15.PubMedCrossRefGoogle Scholar
  59. Silva ACF, Bortolini GA, Jaime PC. Brazil’s national programs targeting childhood obesity prevention. Int J Obes Supp. 2013;3:S9–S11.CrossRefGoogle Scholar
  60. Singh RK, Kumar P, Mahalingam K. Molecular genetics of human obesity: a comprehensive review. C R Biol. 2017;340(2):87–108.PubMedCrossRefGoogle Scholar
  61. Skinner AC, Perrin EM, Skelton JA. Prevalence of obesity and severe obesity in US children, 1999–2014. Obesity. 2016;24:1116–23.PubMedCrossRefGoogle Scholar
  62. Small L, Aplasca A. Child obesity and mental health: a complex interaction. Child Adolesc Psychiatr Clin N Am. 2016;25:269–82.PubMedCrossRefGoogle Scholar
  63. Swinburn BA, Sacks G, Hall KD, Mcpherson K, Finegood DT, Moodie ML, Gortmaker SL. The global obesity pandemic: shaped by global drivers and local environments. Lancet. 2011;378:804–14.CrossRefGoogle Scholar
  64. Tevie J, Shaya FT. Association between mental health and comorbid obesity and hypertension among children and adolescents in the US. Eur Child Adolesc Psychiatry. 2015;24:497–502.PubMedCrossRefGoogle Scholar
  65. Twig G, Tirosh A, Leiba A, Levine H, Ben-Ami Shor D, Derazne E, Haklai Z, Goldberger N, Kasher-Meron M, Yifrach D, Gerstein HC, Kark JD. BMI at age 17 years and diabetes mortality in midlife: a Nationwide cohort of 2.3 million adolescents. Diabetes Care. 2016a;39:1996–2003.CrossRefGoogle Scholar
  66. Twig G, Yaniv G, Levine H, Leiba A, Goldberger N, Derazne E, Ben-Ami Shor D, Tzur D, Afek A, Shamiss A, Haklai Z, Kark JD. Body-mass index in 2.3 million adolescents and cardiovascular death in adulthood. N Engl J Med. 2016b;374:2430–40.CrossRefGoogle Scholar
  67. Wang Y, Cai L, Wu Y, Wilson RF, Weston C, Fawole O, Bleich SN, Cheskin LJ, Showell NN, Lau BD, Chiu DT, Zhang A, Segal J. What childhood obesity prevention programmes work? A systematic review and meta-analysis. Obes Rev. 2015;16:547–65.PubMedPubMedCentralCrossRefGoogle Scholar
  68. Waterhouse EG, Xu B. The skinny on brain-derived neurotrophic factor: evidence from animal models to GWAS. J Mol Med (Berl). 2013;91:1241–7.CrossRefGoogle Scholar
  69. Weismann D, Pelka T, Bender G, Jurowich C, Fassnacht M, Thalheimer A, Allolio B. Bariatric surgery for morbid obesity in craniopharyngioma. Clin Endocrinol. 2013;78:385–90.CrossRefGoogle Scholar
  70. Xanthakos SA, Schwimmer JB. On a knife-edge – weight-loss surgery for NAFLD in adolescents. Nat Rev Gastroenterol Hepatol. 2015;12:316–8.PubMedPubMedCentralCrossRefGoogle Scholar
  71. Xanthakos S, Miles L, Bucuvalas J, Daniels S, Garcia V, Inge T. Histologic spectrum of nonalcoholic fatty liver disease in morbidly obese adolescents. Clin Gastroenterol Hepatol. 2006;4:226–32.PubMedCrossRefGoogle Scholar
  72. Xanthakos SA, Jenkins TM, Kleiner DE, Boyce TW, Mourya R, Karns R, Brandt ML, Harmon CM, Helmrath MA, Michalsky MP, Courcoulas AP, Zeller MH, Inge TH. High prevalence of nonalcoholic fatty liver disease in adolescents undergoing bariatric surgery. Gastroenterology. 2015;149:623–34.e8.CrossRefGoogle Scholar
  73. Xi B, Zhang T, Zhang M, Liu F, Zong X, Zhao M, Wang Y. Trends in elevated blood pressure among US children and adolescents: 1999–2012. Am J Hypertens. 2016;29:217–25.PubMedCrossRefGoogle Scholar
  74. Yang Q, Zhong Y, Merritt R, Cogswell ME. Trends in high blood pressure among United States adolescents across body weight category between 1988 and 2012. J Pediatr. 2016;169:166–73.e3.Google Scholar
  75. Zegers D, Beckers S, Hendrickx R, Van Camp JK, De Craemer V, Verrijken A, Van Hoorenbeeck K, Verhulst SL, Rooman RP, Desager KN, Massa G, Van Gaal LF, Van Hul W. Mutation screen of the SIM1 gene in pediatric patients with early-onset obesity. Int J Obes. 2014;38:1000–4.CrossRefGoogle Scholar

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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Claudia K. Fox
    • 1
    Email author
  • Justin R. Ryder
    • 1
  • Amy C. Gross
    • 1
  • Aaron S. Kelly
    • 1
  1. 1.Department of PediatricsUniversity of MinnesotaMinneapolisUSA

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