Childhood Obesity

Childhood obesity is a growing public health concern in the United States, with obesity rates continuing to rise. Obesity is defined by a body mass index (BMI) at or above the 95th percentile for a child’s age and sex. Children with obesity face increased risks for serious health conditions, including high blood pressure, Type 2 diabetes, and heart disease. Beyond physical health, obesity in children can also affect mental well-being, increasing the likelihood of anxiety, depression, and social isolation.

Over the past three decades, the number of children and adolescents affected by obesity has surged worldwide. In 1990, only 8% of children aged 5 to 19 had obesity, but by 2022, that number had grown to 20%, affecting more than 159 million children. The United States ranks among the top five countries for childhood obesity, and if current trends continue, millions more children are projected to be affected by 2050.

At Children’s Hospital Los Angeles, we recognize that obesity is a complex, chronic disease—not a matter of willpower or lifestyle choices alone. Genetics, metabolism, medical conditions, and environmental factors all play a role. For some children, a staged approach focusing on a healthy diet and regular physical activity may be effective, but for others, medical interventions—including surgery—may be the most appropriate first step. At CHLA, we are committed to breaking the stigma around obesity and providing compassionate, science-based care to support children and families on their journey to better health.

Causes and Risk Factors of Childhood Obesity

Childhood obesity is influenced by a combination of genetic predisposition, environmental factors, medical conditions, and metabolism—not simply diet and exercise. It’s important to recognize that obesity is not the fault of the child or their parents—it is the result of multiple interconnected factors.

Genetics and Metabolism: Children with a family history of obesity are more likely to develop the condition. Additionally, metabolism varies from person to person, meaning some children may gain weight more easily than others.
Medical Conditions and Medications: Conditions, such as hypothyroidism and hormonal imbalances, can contribute to obesity. Certain medications—including steroids and antidepressants—can also affect weight.
Environmental Factors: Limited access to fresh foods, the prevalence of processed and sugary foods, and reduced opportunities for physical activity all contribute to excess weight.
Sleep and Stress: Obesity can affect sleep patterns, and poor sleep—especially conditions like sleep apnea—can further disrupt metabolism, increasing the risk of weight gain.

At CHLA, we take a compassionate, personalized approach that focuses on addressing the root causes of obesity rather than placing blame. Our team provides families with the education, tools, and medical support needed to help children achieve their healthiest future.

Signs, Symptoms, and Complications of Childhood Obesity

Childhood obesity affects both physical and mental health, leading to a range of signs, symptoms, and complications:

Physical Symptoms:

Shortness of breath and fatigue
Difficulty with physical activity
Sleep disturbances, including sleep apnea
Skin-related changes, such as acanthosis nigricans (darkened patches of skin in areas like the neck or armpits)

Psychological Effects:

Increased risk of anxiety, depression, and social isolation
Low self-esteem due to societal stigma and bullying
Emotional struggles that can impact school performance and friendships

Long-Term Health Risks:

Type 2 diabetes and insulin resistance
Heart disease, high cholesterol, and high blood pressure
Joint pain and orthopedic issues
Liver disease and nonalcoholic fatty liver disease (NAFLD)

At CHLA, we understand that obesity is not just about weight—it’s about health. That’s why our expert team takes a comprehensive, whole-child approach to both physical and emotional well-being, ensuring children receive the care, respect, and support they deserve.

Diabetes

Type 2 diabetes, once rare in children, has become increasingly common due to rising rates of childhood obesity. This condition occurs when the body becomes resistant to insulin, leading to high blood sugar levels. Today, approximately 45% of children diagnosed with diabetes have Type 2, with obesity being a major contributing factor.

For some children, lifestyle changes, such as healthy eating habits and regular physical activity, alone are not enough, and medical interventions—including weight-loss surgery—may be necessary to manage the disease. Early intervention is key to preventing long-term complications, such as heart disease, kidney problems, and vision loss.

Heart Disease

Children with obesity are at a higher risk for heart disease, even at a young age. Elevated cholesterol levels, high blood pressure, and insulin resistance—common in children with obesity—can damage blood vessels and lead to serious cardiovascular issues later in life. Without intervention, children with obesity are more likely to develop heart attacks, strokes, and vascular diseases as they grow.

Asthma

Asthma is a chronic condition that causes inflammation in the airways, making it difficult to breathe. Children with obesity are at an increased risk of developing asthma, with studies showing that obesity increases the likelihood of an asthma diagnosis by 52%. Excess weight can worsen asthma symptoms by placing additional pressure on the chest and lungs, making it harder to breathe. Treating obesity can help reduce asthma severity and improve overall respiratory health.

Sleep Disorders

Obesity in childhood is strongly linked to sleep disorders, particularly sleep apnea. Children with obesity often experience short or disrupted sleep, which can affect hormone levels—specifically leptin and ghrelin, the hormones that regulate appetite and energy balance. This hormonal imbalance can increase hunger, leading to further weight gain and creating a cycle of poor sleep and obesity.

For children with severe obesity and sleep-related complications, bariatric surgery may be considered. Procedures such as gastric banding, gastric bypass, and gastric sleeve surgery can assist with weight loss, potentially improving sleep quality and reducing the severity of sleep apnea. However, a comprehensive approach that includes lifestyle changes, medical management, and mental health support is essential for long-term success.

Joint Pain

Excess weight can place additional strain on growing bones and joints, leading to chronic pain, stiffness, and limited mobility. Over time, this added stress can increase the risk of orthopedic conditions, such as osteoarthritis and soft-tissue injuries.

For children with obesity, joint pain is not just uncomfortable, it can significantly impact their ability to move, play, and enjoy everyday activities. Limited mobility can also create a cycle where pain makes physical activity difficult, leading to further weight gain and worsening symptoms. Weight loss has been shown to reduce joint pain, improve mobility, and enhance overall comfort. For some children, losing even a small amount of weight can reduce joint pain. In cases of severe obesity, bariatric surgery may be considered as a way to relieve stress in the joints and restore mobility.

Diagnosis and Tests for Childhood Obesity

Diagnosing childhood obesity begins with measuring Body Mass Index (BMI), which is adjusted for age and sex to account for natural variations in body composition during growth. While BMI is a useful screening tool, it does not provide a complete picture of a child’s health.

To gain a more comprehensive assessment, health care providers may evaluate waist circumference, visceral fat (deep belly fat surrounding internal organs), and the Body Adiposity Index (BAI), which estimates body fat using hip size instead of height. Additionally, understanding a child’s family history is crucial, as genetic factors can increase the risk for chronic diseases, such as Type 2 diabetes, high blood pressure, and heart disease.

By analyzing these factors, health care providers can identify the underlying causes of obesity and develop a personalized treatment plan that addresses the child’s unique needs, supporting long-term health and well-being.

Treatment for Childhood Obesity

The treatment of childhood obesity requires a comprehensive, multidisciplinary approach focused on long-term health and well-being. At CHLA, we believe that treatment should be tailored to each child’s needs, not a one-size-fits-all approach.

For many children, structured support in nutrition, physical activity, and emotional well-being is the first step. In more severe cases, medical interventions, such as weight-loss medications or bariatric surgery may be considered. Our expert team, which includes specialists in nutrition, endocrinology, psychology, and bariatric surgery, work collaboratively to develop personalized treatment plans and provide families with the resources and support they need to achieve lasting health improvements and the best possible outcomes.

Lifestyle Changes

Adopting healthy eating habits and promoting regular physical activity are essential components of childhood obesity treatment. Parents play a critical role in influencing their children's food choices and activity levels. Encouraging children to eat a balanced diet with plenty of fresh fruits and vegetables, limiting sugary drinks, and engaging in at least 60 minutes of physical activity daily can help them achieve and maintain a healthy weight. These foundational habits are key to promoting long-term health and preventing obesity-related complications. Families can access additional support through CHLA’s Healthy Weight Clinic, which offers a comprehensive approach to treating children with severe obesity.

Medications

As the prevalence of obesity among children continues to rise, weight-loss medications have become an important option for children who are unable to achieve a healthy weight through lifestyle changes alone. In line with the American Academy of Pediatrics (AAP) 2023 guidelines, prescription medications may be recommended for children ages 12 and older, and in certain cases, for children as young as 8.

At CHLA, we take a personalized approach to obesity treatment, considering each child's medical history and the severity of their condition before prescribing weight-loss medications. Some of the FDA-approved medications for pediatric obesity include:

Orlistat, which reduces fat absorption
Liraglutide and Semaglutide, which help regulate appetite and improve insulin sensitivity
Phentermine and Topiramate, which can suppress appetite and promote weight loss
Metformin, which is used to improve insulin resistance

These medications are most effective when combined with healthy eating, regular physical activity, and behavioral support. Our expert team closely monitors each child’s progress to ensure the treatment is safe, effective, and sustainable for long-term health.

Weight-loss Surgery

For adolescents with severe obesity and obesity-related health risks, weight-loss surgery may be the most effective and medically necessary option. At CHLA, we offer gastric sleeve surgery as part of a comprehensive, multidisciplinary treatment plan.

Weight-loss surgery is not a last resort—it’s a proven medical treatment for a complex disease. While some children can achieve weight loss with lifestyle changes, others may require surgery first to prevent life-threatening complications. At CHLA, we ensure families have all the information, support, and resources needed to make the best decision for their child.