Overview
Clinical Meaning
Pediatric obesity results from chronic energy imbalance, but the pathophysiology extends beyond simple caloric excess.
Pediatric obesity results from chronic energy imbalance, but the pathophysiology extends beyond simple caloric excess. Adipocyte hypertrophy and hyperplasia create a pro-inflammatory state with elevated IL-6, TNF-alpha, and leptin resistance, driving insulin resistance even before frank type 2 diabetes develops. In children, obesity during critical periods of adipocyte development (ages 5-7 and adolescence) programs persistent adiposity through epigenetic mechanisms. Unlike adults, BMI is age- and sex-specific in children: overweight = BMI 85th-94th percentile, obesity = BMI ≥ 95th percentile, severe obesity = BMI ≥ 120% of 95th percentile. Pediatric obesity carries unique complications including slipped capital femoral epiphysis, Blount disease (tibia vara), pseudotumor cerebri, and earlier onset of type 2 diabetes with more aggressive beta-cell decline than adult-onset T2DM.