Evaluating obesity and cardiovascular risk factors in children and adolescents.

Obesity continues to be a growing public health problem. According to the 2003-2004 National Health and Nutrition Examination Survey, 17 percent of persons two to 19 years of age are overweight. The number of obese children and adolescents has tripled in the past 20 years. Obesity in adults is associated with cardiovascular risk factors including hypertension, dyslipidemia, and diabetes. The growing prevalence of overweight in children and adolescents is paralleled by the growth of its associated complications in that population: hypertension, diabetes, hyperlipidemia, and metabolic syndrome. A modification of the metabolic syndrome criteria designed for children and adolescents shows that as many as 50 percent of those who are severely overweight have the syndrome. The U.S. Preventive Services Task Force has not found sufficient evidence to support screening children for obesity or other cardiovascular risk factors. The American Academy of Pediatrics and the American Heart Association have adopted a more aggressive stance, based largely on consensus opinion. Current suggestions include focusing on children whose body mass indexes exceed the 85th percentile; who are rapidly gaining weight; who have a family history of type 2 diabetes or hypercholesterolemia; or who have hypertension or signs of insulin resistance. Physician advocacy for healthy communities and institutions that foster physical activity, good eating habits, and healthy lifestyles is also encouraged.