SynopsisCodesLook ForDiagnostic PearlsDifferential Diagnosis & PitfallsBest TestsManagement PearlsTherapyDrug Reaction DataReferences

View all Images (3)

Obesity in Child
Other Resources UpToDate PubMed

Obesity in Child

Contributors: Vivian Wong MD, PhD, Michael W. Winter MD, Paritosh Prasad MD, Susan Burgin MD
Other Resources UpToDate PubMed


In children, obesity is defined as a body mass index (BMI) greater than the 95th percentile for age and sex. Severe obesity is defined as a BMI in the 99th percentile, or over 120% of the 95th percentile value, or a BMI greater than 35 (weight in kilograms divided by height in meters squared). BMI reference standards for children ages 2-20 are published by the US Centers for Disease Control and Prevention (CDC) and the US National Center for Health Statistics (NCHS).

Pediatric obesity increases in prevalence with age. In the United States, approximately 14% of preschool children and 21% of adolescents are obese. Severe obesity also increases in prevalence with age. Approximately 2% of preschool children and 7%-10% of adolescents are severely obese. Risk factors include ethnicity (Native American, African American, and Mexican American patients are at increased risk), low socioeconomic class, low education level, and living in a rural community. In the United States, childhood obesity rates have been rising for the last several decades. Obesity tends to persist into adulthood.

The majority of obese children are obese due to a net-positive energy balance resulting from high caloric intake and insufficient physical activity.

There are many risk factors for the development of pediatric obesity. In rare instances, a specific genetic, hypothalamic, or endocrine disorder will predispose a patient to obesity. Specific mutations in GNAS and their effects on G protein-coupled receptor (GPCR) signaling have been identified. Rare cases of early-onset obesity are associated with variants in leptin. More often, environmental factors such as high consumption of sugar-rich beverages, physical inactivity, and excess screen time all contribute to a net-positive caloric balance that leads to obesity. The role of epigenetics in obesity is an emerging field of research for which specific causality has yet to be defined.

The following common skin conditions are seen more frequently in obese pediatric patients: hyperhidrosis and bromhidrosis, bacterial and candidal skin infections, onychomycosis, acne vulgaris, hirsutism, hidradenitis suppurativa, psoriasis, and rosacea.

Additionally, obese pediatric patients have an increased risk of psychosocial conditions such as depression and eating disorders; cardiovascular conditions such as hypertension, dyslipidemia, and coagulopathy; gastrointestinal conditions such as gallstones and nonalcoholic fatty liver disease; endocrine conditions such as diabetes mellitus type 2, precocious puberty, polycystic ovary syndrome, and male hypogonadism; pulmonary conditions such as asthma and sleep apnea; and renal conditions such as glomerulopathy. Childhood obesity has been shown to increase risk for adult cardiovascular events, including death, before the age of 60.


E66.9 – Obesity, unspecified

414916001 – Obesity

Look For

Subscription Required

Diagnostic Pearls

Subscription Required

Differential Diagnosis & Pitfalls

Early-onset obesity, dysmorphic physical features, and intellectual disability should raise suspicion for an underlying genetic syndrome that results in obesity (eg, Prader-Willi syndrome, Beckwith-Wiedemann syndrome).

Endocrine and hypothalamic disorders should also be considered:
  • Cushing syndrome, including exogenous corticosteroid exposure
  • Hypothyroidism
  • Growth hormone deficiency
  • Pseudohypoparathyroidism type 1A
  • Panhypopituitarism (post-craniopharyngioma resection)
  • ROHHADNET syndrome: rapid onset obesity, hypothalamic dysfunction, hypoventilation, autonomic dysregulation, and neuroendocrine tumors

Best Tests

Subscription Required

Management Pearls

Subscription Required


Subscription Required

Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

Subscription Required


Subscription Required

Last Reviewed:12/15/2019
Last Updated:07/26/2023
Copyright © 2024 VisualDx®. All rights reserved.
Obesity in Child
A medical illustration showing key findings of Obesity
Copyright © 2024 VisualDx®. All rights reserved.