Severe Obesity in Children and Adolescents

Overweight mother and child exercising. Ariel Skelley/Getty Images

Not long ago, parents were often worried about baby fat on their child. Some still are. But with the childhood obesity epidemic in full swing, the pendulum of worries has swung to the other end of the spectrum for many parents, as severe obesity has become a, well, larger concern. Severe obesity, often defined as being in the 99th percentile for body mass index (BMI) for a child’s age and gender, afflicts between 4 and 6 percent of kids in the U.S. It’s a condition that has both immediate and long-term consequences on a young person’s health and life.

It’s no secret that obesity is on the rise among children in the U.S. but what’s especially alarming is the upswing in the more severe forms of obesity. A recent study from Kaiser Permanente Northern California found that severe obesity is even evident in the preschool set—in kids as young as 3 to 5 years old! In another recent study, researchers examined the prevalence of obesity among nearly 27,000 children, ages 2 to 19, over a 14-year period and found that those with a BMI that is 20 to 39 percent higher than their peers (what’s often called “class 2 obesity”) is on the rise: nearly 6 percent of kids now meet that criteria. Meanwhile, another 2 percent have “class 3 obesity”, defined as a BMI that’s at least 40 percent higher than their peers.

Kids whose BMI puts them in the severely obese category have a higher risk of developing the immediate risks that accompany childhood obesity (including bone and joint problems, sleep apnea, depression).

They also have a higher risk of developing serious, persistent health problems such as cholesterol abnormalities, high blood pressure, type 2 diabetes, heart disease, stroke, even premature death. In a recent study involving 117,618 children between the ages of 6 and 17 at the Kaiser Permanente Northern California healthcare system, researchers found that kids with severe obesity had nearly a three-fold higher risk of developing hypertension than kids with moderate obesity.

That’s a big difference! There’s also a strong suggestion that kids who are severely obese have a greater likelihood of continuing to be obese (perhaps severely so) as adults, which brings another set of health risks.

If your child is severely obese, it’s time to have a heart-to-heart conversation with his doctor, in order to decide upon the best course of action. There isn’t a single treatment for obesity that works for all children. So it’s important to consider all the options: behavior modification measures (improving eating habits and increasing physical activity, for example), a commercial weight-loss program, a physician-supervised weight-loss regimen, an inpatient treatment program, medications, or even bariatric surgery.

Treating severe obesity in a child often involves an aggressive approach but it’s important to find one that will work for your child’s personality and health issues and your family’s lifestyle. One way or another, severe obesity needs to be taken seriously in children because it’s more likely to lead to life-threatening chronic diseases, shorten the years in a child’s life, and compromise the quality of the years he has.

That’s a triple-whammy no child should suffer.


Kelly AS, Barlow SE, Rao G, Inge TH, Hayman LL, Steinberger J, Urbina EM, Ewing LJ, Daniels SR. Severe Obesity in Children and Adolescents: Identification, Associated Health Risks, and Treatment Approaches: A Scientific Statement From the American Heart Association. Circulation, 2013 [Accessed online September 6, 2014]; 128: 1689-1712.
Lo JC, Chandra M, Sinaiko A, Daniels SR, Prineas RJ, Maring B, Parker ED, Sherwood NE, Daley MF, Kharbanda EO, Adams KF, Magid DJ, O’Connor PF, Greenspan LC. Severe obesity in children: prevalence, persistence and relation to hypertension. 
International Journal of Pediatric Endocrinology, 2014 [Accessed online September 6, 2014]; 3.
Lo JC, Maring B, Chandra M, Daniels SR, Sinaiko A, Daley MF, Sherwood NE, Kharbanda EO, Parker ED, Adams KF, Prineas RJ, Magid DJ, O’Connor PJ, Greenspan LC. Prevalence of obesity and extreme obesity in children aged 3-5 years. Pediatric Obesity, June 2014 [Accessed online September 6, 2014]; 9(3): 167-75. 
Skinner AC, Skelton JA. Prevalence and trends in obesity and severe obesity among children in the United States, 1999-2012. JAMA Pediatrics, June 2014 [Accessed online September 6, 2014]; 168(6): 561-6.

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