Children with varying degrees of body fat.
|Classification and external resources|
|Patient UK||Childhood obesity|
Childhood obesity is a condition where excess body fat negatively affects a child's health or well-being. As methods to determine body fat directly are difficult, the diagnosis of obesity is often based on BMI. Due to the rising prevalence of obesity in children and its many adverse health effects it is being recognized as a serious public health concern. The term overweight rather than obese is often used in children as it is less stigmatizing.
- 1 Classification
- 2 Statistics
- 3 Causes
- 4 Effects on health
- 5 Prevention
- 6 Management
- 7 Epidemiology
- 8 Research
- 9 See also
- 10 References
- 11 External links
The normal range for BMI in children vary with age and sex. While a BMI above the 85th percentile is defined as overweight, a BMI greater than or equal to the 95th percentile is defined as obesity by Centers for Disease Control and Prevention. It has published tables for determining this in children.
The US Preventive Service Task Force reported that not all children with a high BMI need to lose weight though. High BMI can identify a possible weight problem, but doesn’t differentiate between fat or lean tissue.
With more than 42 million overweight children around the world, childhood obesity is increasing worldwide. Since 1980, the number of obese children has doubled in all three North American countries, Mexico, the United States, and Canada. Although the rate of childhood obesity in the United States has stopped increasing, the current rate remains high. In 2010, 32.6 percent of 6- to 11-year-olds were overweight, and 18 percent of 6- to 9-year-olds were obese.
Childhood obesity can be brought on by a range of factors which often act in combination. “Obesogenic environment” is the medical term set aside for this mixture of elements. The greatest risk factor for child obesity is the obesity of both parents. This may be reflected by the family's environment and genetics. Other reasons may also be due to psychological factors and the child's body type.
A 2010 review stated that childhood obesity likely is the result of the interaction of natural selection favouring those with more parsimonious energy metabolism and today's consumerist society with easy access to energy dense cheap foods and less energy requirements in daily life.
Childhood obesity is often the result of an interplay between many genetic and environmental factors. Polymorphisms in various genes controlling appetite and metabolism predispose individuals to obesity when sufficient calories are present. Over 200 genes affect weight by determining activity level, food preferences, body type, and metabolism. Having two copies of the allele called FTO increases the likelihood of both obesity and diabetes.
As such, obesity is a major feature of a number of rare genetic conditions that often present in childhood:
- Prader-Willi syndrome with an incidence between 1 in 12,000 and 1 in 15,000 live births is characterized by hyperphagia and food preoccupations which leads to rapid weight gain in those affected.
- Bardet-Biedl syndrome
- MOMO syndrome
- Leptin receptor mutations
- Congenital leptin deficiency
- Melanocortin receptor mutations
In children with early-onset severe obesity (defined by an onset before ten years of age and body mass index over three standard deviations above normal), 7% harbor a single locus mutation. One study found that 80% of the offspring of two obese parents were obese in contrast to less than 10% of the offspring of two parents who were of normal weight. The percentage of obesity that can be attributed to genetics varies from 6% to 85% depending on the population examined.
In the recent decades, family practices have significantly changed, and several of these practices greatly contribute to childhood obesity:
- With a decreasing number of mothers who breast-feed, more infants become obese children as they grow up.
- Less children go outside and engage in active play as technologies, such as the television and video games, keep children indoors.
- Rather than walking or biking to a bus-stop or directly to school, more school-age children are driven to school by their parents, reducing physical activity.
- As family sizes decrease, the children's pester power, their ability to force adults to do what the want, increases. This ability enables them to have easier access to calorie-packed foods, such as candy and soda drinks.
Social Practices and Policies
Different communities and nations have adopted varying social practices and policies that are either beneficial or detrimental to children's physical health. These social factors include:
- the quality of school lunches
- the emphasis of schools on physical activity
- access to vending machines and fast-food restaurants
- prevalence of and access to parks, bike paths, and sidewalks
- government subsidies for corn oil and sugar
- advertising of fast-food restaurants and candy
- prices of healthy and unhealthy foods
Advertising of unhealthy foods correlates with childhood obesity rates. In some nations, advertising of candy, cereal, and fast-food restaurants is illegal or limited on children's television channels. The media defends itself by blaming the parents for yielding to their children's demands for unhealthy foods.
It is much more common for young people who come from a racial or ethnic minority, or for those who have a lower socioeconomic status, to be overweight and to engage in less healthy behaviors and sedentary activities.
Effects on health
The first problems to occur in obese children are usually emotional or psychological. Childhood obesity however can also lead to life-threatening conditions including diabetes, high blood pressure, heart disease, sleep problems, cancer, and other disorders. Some of the other disorders would include liver disease, early puberty or menarche, eating disorders such as anorexia and bulimia, skin infections, and asthma and other respiratory problems. Asthma severity is not affected by obesity however.
Obese children often suffer from teasing by their peers. Some are harassed or discriminated against by their own family. Stereotypes abound and may lead to low self-esteem and depression.
Long term health effects
Children who are obese are likely to be obese as adults. Thus, they are more at risk for adult health problems such as heart disease, type 2 diabetes, stroke, several types of cancer, and osteoarthritis. One study showed that children who became obese as early as age 2 were more likely to be obese as adults. According to an article in the New York Times all of these health effects are contributing to a shorter lifespan of five years for these obese children. It is the first time in two centuries that the current generation of children in America may have a shorter life span than their parents.
Schools play a large role in preventing childhood obesity by providing a safe and supporting environment with policies and practices that support healthy behaviors. At home, parents can help prevent their children from becoming overweight by changing the way the family eats and exercises together. The best way children learn is by example, so parents need to lead by example by living a healthy lifestyle.
The effects of eating habits on childhood obesity are difficult to determine. A three-year randomized controlled study of 1,704 3rd grade children which provided two healthy meals a day in combination with an exercise program and dietary counsellings failed to show a significant reduction in percentage body fat when compared to a control group. This was partly due to the fact that even though the children believed they were eating less their actual calorie consumption did not decrease with the intervention. At the same time observed energy expenditure remained similar between the groups. This occurred even though dietary fat intake decreased from 34% to 27%. A second study of 5,106 children showed similar results. Even though the children ate an improved diet there was no effect found on BMI. Why these studies did not bring about the desired effect of curbing childhood obesity has been attributed to the interventions not being sufficient enough. Changes were made primarily in the school environment while it is felt that they must occur in the home, the community, and the school simultaneously to have a significant effect.
Calorie-rich drinks and foods are readily available to children. Consumption of sugar-laden soft drinks may contribute to childhood obesity. In a study of 548 children over a 19 month period the likelihood of obesity increased 1.6 times for every additional soft drink consumed per day.
Calorie-dense, prepared snacks are available in many locations frequented by children. As childhood obesity has become more prevalent, snack vending machines in school settings have been reduced by law in a small number of localities. Some research suggests that the increase in availability of junk foods in schools can account for about one-fifth of the increase in average BMI among adolescents over the last decade. Eating at fast food restaurants is very common among young people with 75% of 7th to 12th grade students consuming fast food in a given week. The fast food industry is also at fault for the rise in childhood obesity. This industry spends about $4.2 billion on advertisements aimed at young children. McDonald's alone has thirteen websites that are viewed by 365,000 children and 294,000 teenagers each month. In addition, fast food restaurants give out toys in children's meals, which helps to entice children to buy the fast food. Forty percent of children ask their parents to take them to fast food restaurants on a daily basis. To make matters worse, out of 3000 combinations created from popular items on children's menus at fast food restaurants, only 13 meet the recommended nutritional guidelines for young children. Some literature has found a relationship between fast food consumption and obesity. Including a study which found that fast food restaurants near schools increases the risk of obesity among the student population.
Whole milk consumption verses 2% milk consumption in children of one to two years of age had no effect on weight, height, or body fat percentage. Therefore, whole milk continues to be recommended for this age group. However the trend of substituting sweetened drink for milk has been found to lead to excess weight gain.
Some jurisdictions attempt to use laws and regulations to steer kids and parents towards making healthier food choices. Two examples are calorie count laws and banning soft drinks from sale at vending machines in schools.
Physical inactivity of children has also shown to be a serious cause, and children who fail to engage in regular physical activity are at greater risk of obesity. Researchers studied the physical activity of 133 children over a three-week period using an accelerometer to measure each child's level of physical activity. They discovered the obese children were 35% less active on school days and 65% less active on weekends compared to non-obese children.
Physical inactivity as a child could result in physical inactivity as an adult. In a fitness survey of 6,000 adults, researchers discovered that 25% of those who were considered active at ages 14 to 19 were also active adults, compared to 2% of those who were inactive at ages 14 to 19, who were now said to be active adults. Staying physically inactive leaves unused energy in the body, most of which is stored as fat. Researchers studied 16 men over a 14 day period and fed them 50% more of their energy required every day through fats and carbohydrates. They discovered that carbohydrate overfeeding produced 75–85% excess energy being stored as body fat and fat overfeeding produced 90–95% storage of excess energy as body fat.
Many children fail to exercise because they are spending time doing immobile activities such as computer usage, playing video games or watching television. Technology has a large factor on the children's activeness. Researchers provided a technology questionnaire to 4,561 children, ages 14, 16, and 18. They discovered children were 21.5% more likely to be overweight when watching 4+ hours of TV per day, 4.5% more likely to be overweight when using a computer one or more hours per day, and unaffected by potential weight gain from playing video games. A randomized trial showed that reducing TV viewing and computer use can decrease age-adjusted BMI; reduced calorie intake was thought to be the greatest contributor to the BMI decrease.
Technological activities are not the only household influences of childhood obesity. Low-income households can affect a child's tendency to gain weight. Over a three-week period researchers studied the relationship of socioeconomic status (SES) to body composition in 194 children, ages 11–12. They measured weight, waist girth, stretch stature, skinfolds, physical activity, TV viewing, and SES; researchers discovered clear SES inclines to upper class children compared to the lower class children.
Childhood inactivity is linked to obesity in the United States with more children being overweight at younger ages. In a 2009 preschool study 89% of a preschoolers' day was found to be sedentary while the same study also found that even when outside, 56 percent of activities were still sedentary. One factor believed to contribute to the lack of activity found was little teacher motivation, but when toys, such as balls were made available, the children were more likely to play.
Children's food choices are also influenced by family meals. Researchers provided a household eating questionnaire to 18,177 children, ranging in ages 11–21, and discovered that four out of five parents let their children make their own food decisions. They also discovered that compared to adolescents who ate three or fewer meals per week, those who ate four to five family meals per week were 19% less likely to report poor consumption of vegetables, 22% less likely to report poor consumption of fruits, and 19% less likely to report poor consumption of dairy foods. Adolescents who ate six to seven family meals per week, compared to those who ate three or fewer family meals per week, were 38% less likely to report poor consumption of vegetables, 31% less likely to report poor consumption of fruits, and 27% less likely to report poor consumption of dairy foods. The results of a survey in the UK published in 2010 imply that children raised by their grandparents are more likely to be obese as adults than those raised by their parents. An American study released in 2011 found the more mothers work the more children are more likely to be overweight or obese.
Various developmental factors may affect rates of obesity. Breast-feeding for example may protect against obesity in later life with the duration of breast-feeding inversely associated with the risk of being overweight later on. A child's body growth pattern may influence the tendency to gain weight. Researchers measured the standard deviation (SD [weight and length]) scores in a cohort study of 848 babies. They found that infants who had an SD score above 0.67 had catch up growth (they were less likely to be overweight) compared to infants who had less than a 0.67 SD score (they were more likely to gain weight).
A child's weight may be influenced when he/she is only an infant. Researchers also did a cohort study on 19,397 babies, from their birth until age seven and discovered that fat babies at four months were 1.38 times more likely to be overweight at seven years old compared to normal weight babies. Fat babies at the age of one were 1.17 times more likely to be overweight at age seven compared to normal weight babies.
Cushing's syndrome (a condition in which the body contains excess amounts of cortisol) may also influence childhood obesity. Researchers analyzed two isoforms (proteins that have the same purpose as other proteins, but are programmed by different genes) in the cells of 16 adults undergoing abdominal surgery. They discovered that one type of isoform created oxo-reductase activity (the alteration of cortisone to cortisol) and this activity increased 127.5 pmol mg sup when the other type of isoform was treated with cortisol and insulin. The activity of the cortisol and insulin can possibly activate Cushing's syndrome.
Hypothyroidism is a hormonal cause of obesity, but it does not significantly affect obese people who have it more than obese people who do not have it. In a comparison of 108 obese patients with hypothyroidism to 131 obese patients without hypothyroidism, researchers discovered that those with hypothyroidism had only 0.077 points more on the caloric intake scale than did those without hypothyroidism.
Researchers surveyed 1,520 children, ages 9–10, with a four-year follow up and discovered a positive correlation between obesity and low self-esteem in the four-year follow up. They also discovered that decreased self-esteem led to 19% of obese children feeling sad, 48% of them feeling bored, and 21% of them feeling nervous. In comparison, 8% of normal weight children felt sad, 42% of them felt bored, and 12% of them felt nervous.
Stress can influence a child's eating habits. Researchers tested the stress inventory of 28 college females and discovered that those who were binge eating had a mean of 29.65 points on the perceived stress scale, compared to the control group who had a mean of 15.19 points. This evidence may demonstrate a link between eating and stress.
Feelings of depression can cause a child to overeat. Researchers provided an in-home interview to 9,374 adolescents, in grades seven through 12 and discovered that there was not a direct correlation with children eating in response to depression. Of all the obese adolescents, 8.2% had said to be depressed, compared to 8.9% of the non-obese adolescents who said they were depressed. Antidepressants, however, seem to have very little influence on childhood obesity. Researchers provided a depression questionnaire to 487 overweight/obese subjects and found that 7% of those with low depression symptoms were using antidepressants and had an average BMI score of 44.3, 27% of those with moderate depression symptoms were using antidepressants and had an average BMI score of 44.7, and 31% of those with major depression symptoms were using antidepressants and had an average BMI score of 44.2.
The escalation of obese children is due to the upsurge of technology, increase in snacks and portion size of meals, and the decrease in the physical activity of children. If children were more mobile and less sedentary, the rate of obesity would decrease. Children have to put down the electronic devices and spend more time outside playing or exploring other options of physical acitvity. A study found kids that use electronic devices 3 or more hours a day had between a 17- 44% increased risk of being overweight, or a 10- 61% increased risk of obese (Cespedes 2011).[full citation needed] Parents have to recognize the signs and encourage their children to be more physically active. There are many programs designed to encourage activities such as Letsmove.gov, a program launched by the first lady, Michelle Obama to help combat problems with this epidemic of obesity.
Exclusive breast-feeding is recommended in all newborn infants for its nutritional and other beneficial effects. Parents changing the diet and lifestyle of their offspring by offering appropriate food portions, increasing physical activity, and keeping sedentary behaviors at a minimum may also decrease the obesity levels in children.
There are no medications currently approved for the treatment of obesity in children. Orlistat and sibutramine may however be helpful in managing moderate obesity in adolescence. Sibutramine is approved for adolescents older than 16. It works by altering the brain's chemistry and decreasing appetite. Orlistat is approved for adolescents older than 12. It works by preventing the absorption of fat in the intestines. Metformin is minimally useful.
From 1980 to 2013, the prevalence of overweight and obesity in children increased by nearly 50%. Currently 10% of children worldwide are either overweight or obese. In 2014, the World Health Organization established a high-level commission to end childhood obesity.
The rate of overweight and obesity among Canadian children has increased dramatically in recent years. In boys, the rate increased from 11% in 1980s to 30% in 1990s.
The rate of overweight and obesity in Brazilian children increased from 4% in the 1980s to 14% in the 1990s. In 2007 the prevalence of children overweight and childhood obesity was 11.1% and 2.7% in girls, 8.2% and 1.5% in boys, respectively.
The rate of obesity among children and adolescents in the United States has nearly tripled between the early 1980s and 2000. It has however not changed significantly between 2000 and 2006 with the most recent statistics showing a level just over 17 percent. In 2008, the rate of overweight and obese children in the United States was 32%, and had stopped climbing. In 2011, a national cohort study of infants and toddlers found that nearly one-third of US children were overweight or obese at 9 months and 2 years old.  In a follow-up study, infant weight status (healthy and obese) was strongly associated with preschool weight status.
Since the onset of the 21st Century, Australia has found that childhood obesity has followed trend with the United States. Information garnered has concluded that the increase has occurred in the lower socioeconomic areas where poor nutritional education has been blamed.
A study of 1800 children aged 2 to 12 in Colac, Australia tested a program of restricted diet (no carbonated drinks or sweets) and increased exercise. Interim results included a 68% increase in after school activity programs, 21% reduction in television viewing, and an average of 1 kg weight reduction compared to a control group.
A survey carried out by the American Obesity Association into parental attitudes towards their children's weight showed the majority of parents think that recess should not be reduced or replaced. Almost 30% said that they were concerned with their child's weight. 35% of parents thought that their child's school was not teaching them enough about childhood obesity, and over 5% thought that childhood obesity was the greatest risk to their child's long term health.
A Northwestern University study indicates that inadequate sleep has a negative impact on a child's performance in school, their emotional and social welfare, and increases their risk of being overweight. This study was the first nationally represented, longitudinal investigation of the correlation between sleep, Body Mass Index (BMI) and overweight status in children between the ages of 3 and 18. The study found that an extra hour of sleep lowered the children's risk of being overweight from 36% to 30%, while it lessened older children's risk from 34% to 30%.
Obese children and adolescents are more likely to become obese as adults. For example, one study found that approximately 80% of children who were overweight at aged 10–15 years were obese adults at age 25 years. Another study found that 25% of obese adults were overweight as children. The latter study also found that if overweight begins before 8 years of age, obesity in adulthood is likely to be more severe.
A study has also found that tackling childhood obesity will not necessarily lead to eating disorders later in life.
A review of secular trends in the number of overweight or obese children have come to the conclusion that prevalence had increased during the past two decades in the most industrialised countries, apart from Russia and Poland, and in several low-income countries, especially in urban areas. Prevalence doubled or tripled between the early 1970s and late 1990s in Australia, Brazil, Canada, Chile, Finland, France, Germany, Greece, Japan, the UK, and the USA. By 2010, more than 40% of children in the North American and eastern Mediterranean WHO regions, 38% in Europe, 27% in the western Pacific, and 22% in southeast Asia were predicted to be overweight or obese. However, that 2006 review pre-dates recent data, which, although still too soon to be certain, suggest that the increase in childhood obesity in the USA, the UK, and Sweden might be abating.3–5 
- International Journal of Pediatric Obesity
- Task Force on Childhood Obesity
- Classification of childhood obesity
- Obesity and walking
- Social stigma of obesity
- EPODE International Network, the world's largest obesity-prevention network
- World Fit A program of the United States Olympic Committee (USOC), and the United States Olympians and Paralympians Association (USOP)
- Kopelman, Peter G (2005). Clinical obesity in adults and children: In Adults and Children. Blackwell Publishing. p. 493. ISBN 978-1-4051-1672-5.
- Bessesen DH (June 2008). "Update on obesity". J. Clin. Endocrinol. Metab. 93 (6): 2027–34. doi:10.1210/jc.2008-0520. PMID 18539769.
- Deurenberg P, Weststrate JA, Seidell JC (March 1991). "Body mass index as a measure of body fatness: age- and sex-specific prediction formulas". Br. J. Nutr. 65 (2): 105–14. doi:10.1079/BJN19910073. PMID 2043597.
- Berger, Kathleen Stassen (2014). Invitation to the Life Span, Second Edition. New York: Worth Publishers. p. 247. ISBN 1464172056.
- "Healthy Weight: Assessing Your Weight: BMI: About BMI for Children and Teens". CDC.
- "Experts Available to Discuss Childhood Obesity, Role of BMI". Business Wire ExpertSource Group. 2005. Retrieved 15 December 2013.
- Ogden, Cynthia L.; Carroll, Margaret D.; Dommarco, Juan A. Rivera; Carroll, Margaret; Shields, Margot; Flegal, Katherine (2012). "Prevalence of obesity and trends in body mass index among US children and adolescents, 1999-2010". Journal of American Medical Association.
- Ebbeling CB, Pawlak DB, Ludwig DS (2002). "Childhood obesity: public-health crisis, common sense cure". Lancet 360 (9331): 473–82. doi:10.1016/S0140-6736(02)09678-2. PMID 12241736.
- Dietz WH (1998). "Health consequences of obesity in youth: childhood predictors of adult disease". Pediatrics 101 (3 Pt 2): 518–25. PMID 12224658.
- Speiser PW, Rudolf MC, Anhalt H, et al. (2005). "Childhood obesity". J. Clin. Endocrinol. Metab. 90 (3): 1871–87. doi:10.1210/jc.2004-1389. PMID 15598688.
- Kimm SY, Obarzanek E (2002). "Childhood obesity: a new pandemic of the new millennium". Pediatrics 110 (5): 1003–7. doi:10.1542/peds.110.5.1003. PMID 12415042.
- Miller J, Rosenbloom A, Silverstein J (2004). "Childhood obesity". J. Clin. Endocrinol. Metab. 89 (9): 4211–8. doi:10.1210/jc.2004-0284. PMID 15356008.
- McBride, D. (2010). Childhood obesity. Practice Nurse, 39(11), 40-45
- Cole T.J. (2006). Early Causes of Childhood Obesity and Implications for Prevention. Retrieved December 1, 2011, from http://discovery.ucl.ac.uk/14548/1/14548.pdf
- Han J, Lawlor D, Kimm (2010). "Childhood obesity". Lancet 375 (9727): 1737–1748. doi:10.1016/S0140-6736(10)60171-7. PMC 3073855. PMID 20451244.
- Gluckman, Peter; Hanson, Mark A. (2006). "Developmental origins of health and disease". Cambridge University Press.
- Frayling, Timothy M. (May 11, 2007). "A common variant in the FTO gene is associated with body mass index and predisposes to childhood and adult obesity". Science.
- Farooqi S, O'Rahilly S (December 2006). "Genetics of obesity in humans". Endocr. Rev. 27 (7): 710–18. doi:10.1210/er.2006-0040. PMID 17122358.
- Kolata G (2007). Rethinking Thin: The new science of weight loss — and the myths and realities of dieting. Picador. ISBN 978-0-312-42785-6.
- Yang W, Kelly T, He J (2007). "Genetic epidemiology of obesity". Epidemiol Rev 29: 49–61. doi:10.1093/epirev/mxm004. PMID 17566051.
- Lobstein, Tim; Dibb, Sue (2005). "Evidence of a possible link between obesogenic food advertising and child overweight". Obesity Reviews.
- Delva, Ph.D., Jorge, Patrick M. O'Malley, Ph.D., and Lloyd D. Johnston Ph.D. "Racial/Ethnic and Socioeconomic Status Differences in Overweight and Health-Related Behaviors among American Students: National Trends 1986-2003." Journal of Adolescent Health 39 (2006):536-45. Web. 25 Sept. 2013
- Great Britain Parliament House of Commons Health Committee (May 2004). Obesity - Volume 1 - HCP 23-I, Third Report of session 2003-04. Report, together with formal minutes. London, UK: TSO (The Stationery Office). ISBN 978-0-215-01737-6. Retrieved 2007-12-17.
- Childhood obesity - CNN
- Childhood Obesity
- Childhood obesity: Complications - MayoClinic.com
- Must A, Jacques PF, Dallal GE, Bajema CJ, Dietz WH (November 1992). "Long-term morbidity and mortality of overweight adolescents. A follow-up of the Harvard Growth Study of 1922 to 1935". The New England Journal of Medicine 327 (19): 1350–5. doi:10.1056/NEJM199211053271904. PMID 1406836.
- Janssen I, Craig WM, Boyce WF, Pickett W (2004). "Associations between overweight and obesity with bullying behaviors in school-aged children". Pediatrics 113 (5): 1187–94. doi:10.1542/peds.113.5.1187. PMID 15121928.
- SRTS Guide: Health Risks
- "Obese kids have arteries of 45-year-olds: study". CTV News. Retrieved 2008-11-11.
- Polotsky AJ, Hailpern SM, Skurnick JH, Lo JC, Sternfeld B, Santoro N (April 2010). "Association of adolescent obesity and lifetime nulliparity—the Study of Women's Health Across the Nation (SWAN)". Fertil. Steril. 93 (6): 2004–11. doi:10.1016/j.fertnstert.2008.12.059. PMC 2891509. PMID 19185860.
- Cornette R (2008). "The emotional impact of obesity on children". Worldviews Evid Based Nurs 5 (3): 136–41. doi:10.1111/j.1741-6787.2008.00127.x. PMID 19076912.
- http://www.cdc.gov/healthyyouth/obesity/facts.htm, Adolescent and school health, CDC
- Belluck, Pam (17 March 2005). "Children's Life Expectancy Being Cut Short by Obesity". The New York Times.
- "Adolescent and School Health".
- Which BMI standards to use in practice? (2012). Public Health Nutrition, 15(8), 1541-2. doi:10.1017/s136898001200167x
- Caballero B, Clay T, Davis SM, et al. (November 2003). "Pathways: a school-based, randomized controlled trial for the prevention of obesity in American Indian schoolchildren". Am. J. Clin. Nutr. 78 (5): 1030–8. PMID 14594792.
- Nader PR, Stone EJ, Lytle LA, et al. (July 1999). "Three-year maintenance of improved diet and physical activity: the CATCH cohort. Child and Adolescent Trial for Cardiovascular Health". Arch Pediatr Adolesc Med 153 (7): 695–704. doi:10.1001/archpedi.153.7.695. PMID 10401802.
- James J, Kerr D (2005). "Prevention of childhood obesity by reducing soft drinks". Int J Obes (Lond) 29 (Suppl 2): S54–7. doi:10.1038/sj.ijo.0803062. PMID 16385753.
- Federal Reserve Bank of Chicago, Reading, Writing, and Raisinets: Are School Finances Contributing to Children's Obesity?, October 2004
- French SA, Story M, Neumark-Sztainer D, Fulkerson JA, Hannan P (2001). "Fast food restaurant use among adolescents: associations with nutrient intake, food choices and behavioral and psychosocial variables". Int. J. Obes. Relat. Metab. Disord. 25 (12): 1823–33. doi:10.1038/sj.ijo.0801820. PMID 11781764.
- Tracy, Ben. "Fast Food Restaurants Not Fighting Child Obesity - CBS Evening News - CBS News." Breaking News Headlines: Business, Entertainment & World News - CBS News. CBS Evening News, 8 Nov. 2010. Web. 22 Nov. 2010. <http://www.cbsnews.com/stories/2010/11/08/eveningnews/main7035550.shtml>.
- Thompson OM, Ballew C, Resnicow K, et al. (2004). "Food purchased away from home as a predictor of change in BMI z-score among girls". Int. J. Obes. Relat. Metab. Disord. 28 (2): 282–9. doi:10.1038/sj.ijo.0802538. PMID 14647177.
- Davis B, Carpenter C (December 2008). "Proximity of Fast-Food Restaurants to Schools and Adolescent Obesity". Am J Public Health 99 (3): 505–10. doi:10.2105/AJPH.2008.137638. PMC 2661452. PMID 19106421.
- Allen RE, Myers AL (November 2006). "Nutrition in toddlers". American Family Physician 74 (9): 1527–32. PMID 17111891.
- Reinehr T, Wabitsch M (2011). "Childhood Obesity". Current Opinion in Lipidology 22 (1): 21–25. doi:10.1097/MOL.0b013e32833f9c37. PMID 20871401.
- Ortega FB, Ruiz JR, Castillo MJ, Sjöström M (2007). "Physical fitness in childhood and adolescence: a powerful marker of health". Int J Obes (Lond) 23 (1): 1–11. doi:10.1038/sj.ijo.0803774. PMID 18043605.
- Horton TJ, Drougas H, Brachey A, Reed GW, Peters JC, Hill JO (1995). "Fat and carbohydrate overfeeding in humans: different effects on energy storage". Am. J. Clin. Nutr. 62 (1): 19–29. PMID 7598063.
- Epstein LH, Roemmich JN, Robinson JL, et al. (March 2008). "A randomized trial of the effects of reducing television viewing and computer use on body mass index in young children". Arch Pediatr Adolesc Med 162 (3): 239–45. doi:10.1001/archpediatrics.2007.45. PMC 2291289. PMID 18316661.
- Lluch A, Herbeth B, Méjean L, Siest G (2000). "Dietary intakes, eating style and overweight in the Stanislas Family Study". Int. J. Obes. Relat. Metab. Disord. 24 (11): 1493–9. doi:10.1038/sj.ijo.0801425. PMID 11126347.
- "The Inactivity Of Preschoolers Amid Rising Childhood Obesity" (Summarized from Child Development, Vol. 80, Issue 1, Social and Environmental Factors Associated with Preschoolers' Non-sedentary Physical Activity by Brown, WH (University of South Carolina), Pfeiffer, KA (Michigan State University), McIver, KL (East Carolina University), Dowda, M, Addy, CL, and Pate, RR (University of South Carolina).). Medical News Today. February 2009. Retrieved September 25, 2010.
- Videon TM, Manning CK (2003). "Influences on adolescent eating patterns: the importance of family meals". J Adolesc Health 32 (5): 365–73. doi:10.1016/S1054-139X(02)00711-5. PMID 12729986.
- Wilkinson, Emma (2010-02-15). "Grandparents 'boost obesity risk'". BBC News. Retrieved 2010-04-28.
- "Childhood obesity risk tied to amount of work mother does lineup announced". Sydney Morning Herald. 8 February 2011. Retrieved 8 February 2011.
- "North American Society for Pediatric Gastroenterology, Hepatology and Nutrition" (PDF).
- Ong KK, Ahmed ML, Emmett PM, et al. (2000). "Association between postnatal catch-up growth and obesity in childhood: prospective cohort study". BMJ 320 (7240): 967–71. doi:10.1136/bmj.320.7240.967. PMC 27335. PMID 10753147.
- Stettler N, Zemel BS, Kumanyika S, Stallings VA (2002). "Infant weight gain and childhood overweight status in a multicenter, cohort study". Pediatrics 109 (2): 194–9. doi:10.1542/peds.109.2.194. PMID 11826195.
- Bujalska IJ, Kumar S, Stewart PM (1997). "Does central obesity reflect "Cushing's disease of the omentum"?". Lancet 349 (9060): 1210–3. doi:10.1016/S0140-6736(96)11222-8. PMID 9130942.
- Tagliaferri M, Berselli ME, Calò G, et al. (2001). "Subclinical hypothyroidism in obese patients: relation to resting energy expenditure, serum leptin, body composition, and lipid profile". Obes. Res. 9 (3): 196–201. doi:10.1038/oby.2001.21. PMID 11323445.
- Strauss RS (2000). "Childhood obesity and self-esteem". Pediatrics 105 (1): e15. doi:10.1542/peds.105.1.e15. PMID 10617752.
- Ogg EC, Millar HR, Pusztai EE, Thom AS (1997). "General practice consultation patterns preceding diagnosis of eating disorders". Int J Eat Disord 22 (1): 89–93. doi:10.1002/(SICI)1098-108X(199707)22:1<89::AID-EAT12>3.0.CO;2-D. PMID 9140741.
- Goodman E, Whitaker RC (2002). "A prospective study of the role of depression in the development and persistence of adolescent obesity". Pediatrics 110 (3): 497–504. doi:10.1542/peds.110.3.497. PMID 12205250.
- Dixon JB, Dixon ME, O'Brien PE (2003). "Depression in association with severe obesity: changes with weight loss". Arch. Intern. Med. 163 (17): 2058–65. doi:10.1001/archinte.163.17.2058. PMID 14504119.
- Han JC, Lawlor DA, Kimm SY (May 2010). "Childhood obesity". Lancet 375 (9727): 1737–48. doi:10.1016/S0140-6736(10)60171-7. PMC 3073855. PMID 20451244.
- Childhood obesity: Treatments and drugs - MayoClinic.com
- McDonagh, MS; Selph, S; Ozpinar, A; Foley, C (Feb 2014). "Systematic review of the benefits and risks of metformin in treating obesity in children aged 18 years and younger.". JAMA pediatrics 168 (2): 178–84. doi:10.1001/jamapediatrics.2013.4200. PMID 24343296.
- "Global, regional, and national prevalence of overweight and obesity in children and adults during 1980—2013: a systematic analysis for the Global Burden of Disease Study 2013". The Lancet 384 (9945). May 29, 2014.
- Cheng, Maria (May 29, 2014). "UW study: 30 percent of world is now fat, no country immune". Seattle Times. Associated Press. Retrieved 13 November 2014.
- Flynn MA, McNeil DA, Maloff B, et al. (February 2006). "Reducing obesity and related chronic disease risk in children and youth: a synthesis of evidence with 'best practice' recommendations". Obes Rev 7 (Suppl 1): 7–66. doi:10.1111/j.1467-789X.2006.00242.x. PMID 16371076.
- Guedes DP, Rocha GD, Silva AJ, Carvalhal IM, Coelho EM,"Effects of social and environmental determinants on overweight and obesity among Brazilian schoolchildren from a developing region.", Rev Panam Salud Publica., October 30, 2011
- Ogden CL, Carroll MD, Flegal KM (May 2008). "High body mass index for age among US children and adolescents, 2003–2006". JAMA 299 (20): 2401–5. doi:10.1001/jama.299.20.2401. PMID 18505949.
- U.S. Childhood Obesity Rates Level Off
- Moss, B.G. & Yeaton, W.H. (Jan 2011). "Young children’s weight trajectories and associated risk factors: Results from the ECLS-B.". American Journal of Health Promotion 23 (3): 190–198. doi:10.4278/ajhp.090123-QUAN-29.
- Moss, B.G. & Yeaton, W.H. (Jan 2012). "U.S. children’s preschool weight status trajectories: Patterns from 9 month, 2 year, and 4 year ECLS-B data.". American Journal of Health Promotion 26 (3): 172–175. doi:10.4278/ajhp.100304-ARB-73.
- "Obesity study bears fruit", Jamie Oliver, 24 August 2006.
- Survey on parents' perceptions of their children's weight, American Obesity Association. August, 2000. Retrieved 2006-11-21.
- Snell E, Adam EK, Duncan GJ (January–February 2007). "Sleep and the Body Mass Index and Overweight Status of Children and Adolescents". Child Development (Society for Research in Child Development's) 78 (1): 309–23. doi:10.1111/j.1467-8624.2007.00999.x. PMID 17328707.
- Childhood Overweight and Obesity, The Centers for Disease Control and Prevention. March, 2011. Retrieved 4/18/2011.
- "How To Deal With Overweight/Obese Children". Sydney Morning Herald. 19 October 2010. Retrieved 20 October 2010.
- Han, Joan; Debbie Lawor; Sue YS Kimm (6 May 2010). "Child Obesity" 375. p. 1737.
- Childhood Obesity, The Institute for Good Medicine at the Pennsylvania Medical Society
- Dubois L, Girard M, Potvin Kent M (June 2006). "Breakfast eating and overweight in a pre-school population: is there a link?". Public Health Nutr 9 (4): 436–42. doi:10.1079/phn2005867. PMID 16870015.
- Mindless eating Cornell University Food and Brand Lab
- Mayo clinic article on preventing childhood obesity
- March, Peter. "Fattened statistics". Social Issues Research Center. Retrieved 2007-04-21.
- Summerfield, Liane M. "Childhood Obesity". Education Resources Information Center Clearinghouse on Teacher Education, Washington, DC. Retrieved 2007-08-04.
- Hereditary Obesity
- Lewis LA, Page IH (July 1956). "Hereditary obesity: relation to serum lipoproteins and protein concentrations in swine" (PDF). Circulation 14 (1): 55–9. doi:10.1161/01.cir.14.1.55. PMID 13356457.
- Obesity gene
- Leadership for Healthy Communities - Robert Wood Johnson Foundation
- Farooqi IS (September 2005). "Genetic and hereditary aspects of childhood obesity". Best Pract. Res. Clin. Endocrinol. Metab. 19 (3): 359–74. doi:10.1016/j.beem.2005.04.004. PMID 16150380.
- Hopson, Krista. "Obesity No. 1 health concern for kids in 2008". The University Record, University of Michigan, Ann Arbor, Michigan.
- "North American Society for Pediatric Gastroenterology, Hepatology and Nutrition" (PDF).