Defining Pediatric Overweight and Obesity

What is pediatric obesity? The Expert Committee on the Evaluation and Treatment of Childhood Obesity has defined pediatric obesity as "excess body weight (adipose tissue)

associated with adverse health or psychological outcomes" (11). BMI is used to assess the presence or risk of overweight. Children among whom the BMI exceeds the 95th percentile for age and gender are considered overweight. Those whose BMI falls between the 85th and 94th percentile for age and gender are considered "at risk" for overweight. In this chapter, the term "obesity" will be used in reference to the clinical condition as defined above, whereas the term "overweight" will be used in reference to patients, individually or as a group. Although BMI is not an ideal measure of body fatness, it represents a clear advance over reliance on skinfold thickness or other indirect measures of fatness in the clinical environment. Difficulties with reliability make skinfold measurement prone to error, especially as body fatness increases, and the BMI can be assessed quickly with each well-child visit (12). For more precise estimation of body fatness, investigators are turning to dual-energy X-ray absorptiometry (DEXA), which is gaining acceptance in the research literature (13). Use of densitometry and bioelectric impedance have not become widely accepted in studies of children and adolescents owing to practical limitations and variations in hydration and fat-free mass in this age group (14). Another method for estimation of body fatness, air-displacement plethys-mography, shows promise as a method for monitoring change in body fatness over time and is now becoming commercially available outside the research environment (15).

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