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Obesity is the most common chronic childhood disease, affecting 14,400,000 children and adolescents worldwide. According to data from the World Health Organization, in Europe 29% of school-age children are overweight or obese, while in our country the percentages range from 21% in preschool to 41% in school and adolescence, unfortunately higher than in European countries.

The classification of a child or adolescent as normal weight, overweight or obese is based on a body mass index (BMI) greater than the 95th percentile for age and gender. A BMI greater than the 95th percentile for age and gender characterizes the individual as obese, while a BMI between the 85th and 95th percentile is considered overweight.

In addition to an individual’s genetic background, a multitude of other factors, socioeconomic, environmental and psychological, have led to a rapid increase in obesity.

Children and adolescents who are overweight or obese are at increased risk of weight-related complications, an increased likelihood of obesity in adulthood and ultimately a reduced life expectancy. This probability ranges from 8% for children aged 1-2 years whose parents are not obese to 79% for children/adolescents aged 10-14 years with at least one obese parent. After the age of 6, the probability of being obese in adulthood exceeds 50%, compared to approximately 10% for non-obese children. Parental obesity more than doubles the risk of obesity in adulthood in all children under 10 years of age.

The main complications of obesity, which appear from a young age, but their frequency clearly increases in adolescence, are:

Dyslipidemia and metabolic syndrome lead to early fatty infiltration of the liver in 1/3 of children as well as atherosclerosis with thickening of the carotid media and to a similar extent of the coronary vessels, drastically increasing cardiovascular risk, while also posing serious risks of respiratory failure for e.g. pneumonia, as occurred in the recent COVID-19 pandemic, as well as obstructive sleep apnea with a risk of even sudden death.

Early insulin resistance will lead more quickly to prediabetes type 2 or even type 2 diabetes, especially in cases where there is a positive family history, while in adolescents it will contribute to the appearance of polycystic ovary syndrome, a main cause of infertility in modern times. There is no shortage of orthopedic complications, with the main one being slipped capital femoral epiphysis, while of course the effects on the self-esteem and psyche of children are incalculable with an increased likelihood of behavioral disorders, social isolation, poor school performance, depression and bullying (either as a victim or as a perpetrator).

In addition to prevention and treatment with coordinated “life style modification”, pediatric endocrinology, as a basic specialization in the treatment of obesity, now also has powerful pharmaceutical weapons, so that with timely and personalized intervention, both the treatment of obesity as a chronic disease and the prevention of its complications can be achieved, while it can also differentiate these rare but very serious forms that are due to pathological causes and even directly threaten the child’s life (e.g. hypothalamic tumors, Cushing’s, syndromic forms, etc.).