Childhood obesity results when energy intake (calories) exceeds energy expenditure over time. There has been a steady rise in children becoming overweight and obese globally.
Contributing factors include:
- Easy access to hyperpalatable, high-calorie, highly processed, and inexpensive foods
- Reduced physical activity and increased sedentary behaviours (e.g., screen time)
- Family dietary patterns and genetic predisposition
Obese children are often tall for their age and have overweight families. Short stature and obesity should prompt further assessment for pathological causes (e.g., hypothyroidism or growth hormone deficiency). Pathological causes are rare.
Criteria
The UK-WHO growth charts for age 2-18 years contain a BMI centile chart. The weight centile (y-axis) can be plotted against the height centile (x-axis) to give the BMI centile. The results are classified as:
- Above the 91st centile: overweight
- Above the 98th centile: very overweight (obese)
The NICE guidelines on obesity (January 2025) recommend also measuring the waist-to-height ratio:
- 0.4 – 0.49: healthy
- 0.5 – 0.59: increased central adiposity
- 0.6 and above: high central adiposity
Management
Achieving and maintaining a healthy weight requires improved nutrition and physical activity levels through sustainable lifestyle changes. Results are heavily influenced by patient and family engagement and their education, beliefs, ideas, environments and habits. Individualised, realistic and sustainable changes are more likely to succeed than more drastic or restrictive changes.
Preventing and reversing obesity is challenging but essential for avoiding the long-term adverse health consequences.
Consequences
Short-term, childhood obesity can lead to bullying, poor self-esteem and limitations on activities (e.g., sports).
Long-term adverse effects include:
- Impaired glucose tolerance and type 2 diabetes
- Hypertension and cardiovascular disease
- Orthopaedic problems (e.g. slipped upper femoral epiphysis and joint pain)
- Fatty liver disease and metabolic syndrome
- Increased risk of certain cancers in adulthood
Last updated October 2025
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