Evaluation of obesity in children and adolescents

Age- and sex-specific body mass index charts are recommended for diagnosing childhood obesity, while waist circumference helps assess cardiometabolic risk. More than 95% of childhood obesity is primary, resulting from excess caloric intake in an obesogenic environment. Secondary obesity should be suspected with early-onset severe obesity, hyperphagia, developmental delay, dysmorphism, short stature, reduced height velocity, delayed puberty, or endocrine features. Primary obesity is usually associated with normal or increased growth velocity, unlike endocrine causes. Evaluation should include detailed history, growth and pubertal assessment, and appropriate investigations. Screening should include glucose, glycosylated hemoglobin, lipid profile, and liver transaminases, especially after 10 years of age or in severe obesity.