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Just as a combination of medications offer greater effect with fewer adverse effects than monotherapy, we can expect that various combinations of diet, behavior modification, medical therapy, and minimally invasive procedures will likely be needed. Furthermore, the effectiveness of a given intervention or combination of interventions will vary among individuals, and understanding the best match at a genetic or metabolic level could improve efficacy.

Treatment will need to be broad-based and target not only adiposity but also the risk factors associated with it. Increased research funding will be needed from the National Institutes of Health, other funding agencies, and industry. Stakeholders at all levels will need to work together to engage the growing problem of severe pediatric obesity.

The task ahead will be arduous and complicated, but the high prevalence and serious consequences of severe obesity require us to commit time, intellectual capital, and financial resources to address it. Writing Group Disclosures. This table represents the relationships of writing group members that may be perceived as actual or reasonably perceived conflicts of interest as reported on the Disclosure Questionnaire, which all members of the writing group are required to complete and submit.

Reviewer Disclosures. This table represents the relationships of reviewers that may be perceived as actual or reasonably perceived conflicts of interest as reported on the Disclosure Questionnaire, which all reviewers are required to complete and submit. The American Heart Association makes every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel.

Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest. To purchase additional reprints, call or e-mail kelle. Severe obesity in children and adolescents: identification, associated health risks, and treatment approaches: a scientific statement from the American Heart Association. Home Circulation Vol. View PDF. Tools Add to favorites Download citations Track citations Permissions.

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Daniels Stephen R. Daniels Search for more papers by this author. You are viewing the most recent version of this article. Previous versions: January 1, Previous Version 1. Download figure Download PowerPoint. Endorsed by The Obesity Society The American Heart Association makes every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel. References 1.

Prevalence of high body mass index in US children and adolescents, Crossref Medline Google Scholar 2. Prevalence of obesity and trends in body mass index among US children and adolescents, Crossref Medline Google Scholar 3. Prevalence and trends of severe obesity among US children and adolescents.

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Int J Pediatr Obes ; 6 — Crossref Google Scholar 5. Characterizing extreme values of body mass index-for-age by using the Centers for Disease Control and Prevention growth charts. Am J Clin Nutr. Crossref Medline Google Scholar 6.

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Cardiovascular risk factors and excess adiposity among overweight children and adolescents: the Bogalusa Heart Study. J Pediatr. Crossref Medline Google Scholar 7. Prevalence of extreme obesity in a multiethnic cohort of children and adolescents. Crossref Medline Google Scholar 8. Prevalence of metabolic syndrome MS in children and adolescents with varying degrees of obesity.

Clin Endocrinol Oxf. Crossref Medline Google Scholar 9. Crossref Medline Google Scholar Int J Pediatr Obes. A proinflammatory state is detectable in obese children and is accompanied by functional and morphological vascular changes. Arterioscler Thromb Vasc Biol. Link Google Scholar Circulating activated endothelial cells in pediatric obesity. Hyperleptinemia and hypoadiponectinemia in extreme pediatric obesity.


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Metab Syndr Relat Disord. Inter- and intra-ethnic group comparison of metabolic syndrome components among morbidly obese adolescents. J Clin Hypertens Greenwich. Circulating oxidized LDL and inflammation in extreme pediatric obesity. Obesity Silver Spring. Microvascular function is impaired in children with morbid obesity. Vasc Med. Presence of increased stiffness of the common carotid artery and endothelial dysfunction in severely obese children: a prospective study.