3
Diagnosing Overweight and Obesity
Î ES recommends using body mass index (BMI) and the Centers for
Disease Control and Prevention (CDC) normative BMI percentiles to
diagnose overweight or obesity in children and adolescents ≥2 years of
age. (1|⊕⊕⊕
)
Î ES recommends diagnosing a child or adolescent >2 years of age as
overweight if the BMI is ≥85th percentile but <95th percentile for age
and sex, as obese if the BMI is ≥95th percentile, and as extremely
obese if the BMI is ≥120% of the 95th percentile or ≥35 kg/m
2
(1|⊕⊕
). ES suggests that clinicians take into account that variations
in BMI correlate differently to comorbidities according to race/
ethnicity and that increased muscle mass increases BMI. (2|⊕
)
Î ES suggests calculating, plotting, and reviewing a child's or
adolescent's BMI percentile at least annually during well-child and/or
sick-child visits. (U)
Î ES suggests that a child <2 years of age be diagnosed as obese if the
sex-specific weight for recumbent length is ≥97.7th percentile on the
World Health Organization (WHO) charts, since US and international
pediatric groups accept this method as valid. (2|⊕
)
Î ES recommends against routine laboratory evaluations for endocrine
etiologies of pediatric obesity unless the patient's stature and/or
height velocity are attenuated (assessed in relationship to genetic/
familial potential and pubertal stage). (1|⊕⊕⊕
)
Î ES recommends that children or adolescents with a BMI of ≥85th
percentile be evaluated for potential comorbidities (see Table 2 and
Fig. 1). (1|⊕⊕⊕
)
Î ES recommends against measuring insulin concentrations when
evaluating children or adolescents for obesity. (1|⊕⊕⊕
)
Genetic Obesity Syndromes
Î ES suggests genetic testing in patients with extreme early onset
obesity (before 5 years of age) and that have clinical features of
genetic obesity syndromes (in particular extreme hyperphagia) and/or
a family history of extreme obesity (2|⊕⊕
)
Diagnosis
