ESPE Yearbook of Paediatric Endocrinology

To read the full abstract: Journal of Pediatrics 2018;192:105-114

Rising degree of obesity has been shown to predict increased metabolic risk in obese children and adolescents (1). Nonetheless, it is unclear if BMI categories can be successfully applied to populations of obese children and adolescents for a risk-adapted stratification of therapeutic approaches, and here especially for the indication of pharmacologic and bariatric interventions. Here, Zabarsky et al. demonstrate the limitations of a simple, BMI-based categorization of the degree of obesity in the pediatric age range. As has been shown before, clustering of cardiovascular risk factors rises significantly with increasing degree of obesity and also with increasing weight gain during follow-up. But importantly, the “dose-response” relationship between obesity and metabolic risk seems to plateau above the threshold for class III obesity (BMI 140-160% of the 95^th percentile), which – according to the authors – roughly corresponds to an adult BMI >40 kg/m² in their population. Therefore, the challenge of developing an accurate and easy-to-use clinical classification system for metabolic risk specifically in severely obese children and adolescents remains unsolved for now.

1. Skinner AC, EM Perrin, LA Moss, JA Skelton. Cardiometabolic Risks and Severity of Obesity in Children and Young Adults. N Engl J Med 2015; 373:1307-1317.