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Obesity is an increasingly common condition in childhood and adolescence, and has emerged as one of the most serious public health concerns in the 21st century. With the growing prevalence of childhood obesity has come an increase in the incidence of obesity-related comorbid disease prior to adulthood. The profound personal and economic impacts of childhood obesity should compel us to understand this complex topic in the hope that successful efforts can be made at prevention and early intervention.

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Definitions of Overweight and Obesity in Children

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Any discussion of this topic must begin with a consensus as to how overweight and obesity are to be defined in the pediatric population. Multiple different indices and techniques can be used to estimate the degree of adiposity. The most commonly used measure is body mass index (BMI), defined as kilograms (kg) of body weight per height in square meters (m2). Adults are defined as overweight if their BMI is 25.0 to 29.9 kg/m2 and obese if more than 30.0 kg/m2. This index of adiposity, however, is less accurate in children that have not yet achieved full adult height. The number of children defined as obese using the adult criteria would be greatly underestimated. Therefore, the BMI percentile (%ile) is a more accurate index of body mass in the pediatric age group. BMI percentile curves have been generated using data from the National Health and Nutrition Examination Survey (NHANES) and take into account both age and gender (Figure 9-1). The Centers for Disease Control define children as overweight if the BMI is more than 95th %ile and, at risk for overweight, if the BMI is between the 85th to 95th %ile. The BMI percentile graphs only include children older than 2 years of age. For children less than 2 years of age, standard weight-for-length curves can be used to assess body mass.

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Figure 9-1
Graphic Jump LocationGraphic Jump Location

BMI percentile curves. Age- and gender-specific curves generated using data from the National Health and Nutrition Examination Survey (NHANES). (Source: National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.) A = boys and B = girls. (http://www.cdc.gov/growthcharts)

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Prevalence of Overweight and Obesity in Children

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Multiple national surveys indicate a significant increase in the frequency of overweight children over the past 30 years. With current prevalences of overweight and obese children ranging from 12% to 30% in developed nations and from 2% to 12% in the developing world, this has become one of the most common health problems in childhood.1 The most recent NHANES data indicate that 33.6% of American children and adolescents aged 2 to 19 year have a BMI more than 85th %ile, with ...

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