Obesity in Children Aged 2 to 12 Years

Importance Obesity affects 15% of children aged 2 to 5 years and 22% of children aged 6 to 11 years in the US. Obesity in children is associated with dyslipidemia, hypertension, metabolic dysfunction–associated steatotic liver disease, and obstructive sleep apnea. Compared with normal-weight peers, children with obesity have lower quality of life and are 5 times more likely to have obesity in adulthood. Observations Body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) is used to identify children at risk for excess adiposity, and guidelines recommend that clinicians screen for obesity using BMI starting at age 2 years. Among children, obesity is defined using standardized age- and sex-specific growth charts, with obesity defined as BMI in the 95th or higher percentile and severe obesity as BMI of 120% or greater of the 95th percentile. Obesity treatment in children includes intensive health behavior and lifestyle treatment, consisting of at least 26 contact hours of face-to-face group or family-based activities that incorporate nutrition, physical activity, and behavior change education delivered to the child and caregivers over a 3- to 12-month period. Intensive health behavior and lifestyle treatment reduces BMI by 0.7 compared with children who do not participate in intensive health behavior and lifestyle treatment. The only obesity pharmacotherapy currently approved by the US Food and Drug Administration (FDA) for children younger than 12 years is setmelanotide, a melanocortin-4 receptor agonist, which is indicated for 3 forms of rare monogenic obesity ( LEPR , POMC , and PCSK1 genetic variants), Bardet-Biedl syndrome, and acquired hypothalamic obesity. Liraglutide is currently only FDA approved for youth aged 12 years or older; however, a randomized clinical trial among children aged 6 to younger than 12 years demonstrated that, compared with placebo, liraglutide reduced BMI by 7.4%. Metabolic and bariatric surgery is rarely used in children younger than age 12 years and evidence supporting its use in children is limited. Early identification and treatment of obesity during childhood may reduce risk of type 2 diabetes, dyslipidemia, hypertension, and mortality in adulthood. Conclusions and Relevance Obesity in children is associated with chronic disease, such as hypertension, and with poor quality of life. Evidence-based treatment for obesity in children includes intensive health behavior and lifestyle treatment, and pharmacotherapy may provide additional benefit, although short- and long-term safety and efficacy data are limited. Early identification and treatment of obesity during childhood may reduce risk of type 2 diabetes, dyslipidemia, hypertension, and mortality in adulthood.