Obesity in Children and Adolescents

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.