Treating Childhood Obesity

Early detection and treatment of metabolic syndrome is key to reducing morbidity and mortality in adulthood


By Hidekazu Hosono, MD


Today, approximately 30 percent of children are considered either overweight or obese in California, an increase in prevalence since 2003.  This growing epidemic points to two of the most serious public health concerns: unhealthy diets and increasingly sedentary lifestyle among children.


Obesity is complex and costly to cure, and previously obese people experience difficult challenges to maintain a healthy weight.  Approximately one-third of overweight children and half of overweight adolescents remain obese as adults.


Obesity in early life is particularly concerning due to its associated health consequences.

Hidekazu Hosono, MD


Each of these children is at increased risk of developing type 2 diabetes, cardiovascular disease and many other complications, including hypertension, dyslipidemia, some types of cancer (endometrial, breast, and colon), liver/gallbladder disease and sleep apnea/respiratory problems, in later life.  Therefore, early identification of children at risk and preventive actions are essential.


The term metabolic syndrome (or insulin resistance syndrome) has been used to identify who are at higher risk of health complications and to distinguish them from those with low-risk obesity.  Adults with metabolic syndrome are two to three times as likely to have a heart attack or stroke and five times as likely to develop type 2 diabetes compared with adults without the syndrome.


Metabolic syndrome in children and adolescents

In 2007, the International Diabetes Federation (IDF) defined the diagnosis of metabolic syndrome in children and adolescents. Early identification and diagnosis of metabolic syndrome allow preventive measures to be taken before the child or adolescent develops type 2 diabetes or cardiovascular disease:

  • For adolescents 16 years or older, existing IDF criteria for adults are used to diagnose metabolic syndrome.
  • For children between 10 and 16 years, metabolic syndrome can be diagnosed with abdominal obesity (waist circumference 90th percentile* or adult cut-off if lower) and the presence of two or more other clinical features: triglycerides ≥ 150 mg/dL, HDL-cholesterol < 40 mg/dL, blood pressure systolic ≥ 130 or diastolic ≥ 85 mm hg, and impaired fasting blood glucose (fasting blood glucose ≥100 mg/dL). 
  • For children between 6 and 10 years, metabolic syndrome should not be diagnosed, but further measurements should be made for children with abdominal obesity if there is a family history of metabolic syndrome and/or obesity-related diseases.
  • Children younger than 6 years were excluded from the definition because of insufficient data from this age-group.

Again, early detection and treatment are key to reducing morbidity and mortality in adulthood.  IDF recommends a healthy lifestyle – moderate calorie restriction, moderate increase in physical activity and change in dietary composition – for prevention and primary management of metabolic syndrome.


The term “healthy lifestyle” can be vague for our patients and families.  In our clinic, we advocate a simple 5-2-1-0 Rule:  5 or more servings of fruits and vegetables; 2 hours or less recreational screen time per day; 1 hour or more of moderate physical activity a day; zero sugary drinks, more water.  The rule is simple to memorize and follow.


*90th percentile waist circumference for 10-year-old boys, 78 cm; for 10-year-old girls, 76.6 cm; for 15-year-old boys, 95 cm; for 15-year-old girls, 91.9 cm.



 << Return to Spring 2014 CCH Magazine