Time for a new framework that treats obesity in children as an adiposity-based chronic disease

The recent publication ‘A new framework for the diagnosis, staging and management of obesity in adults’ by authors from the European Association for the Study of Obesity¹ illustrates a practical context for the diagnosis and treatment of obesity in adults. The document paves the way for more tailored assessment and treatment of obesity in adults. Although the authors deliberately focused on obesity in adults in this work, the framework they propose fits well with what is observed in the pediatric population and provides a basis for some considerations.

As described in that article¹, body mass index does not reflect the severity of fat accumulation and dysfunction in adults. In children, it does so even less even if it is normalized for age and sex^2,3. In the pediatric setting, the concept of age- and sex-specific references for visceral fat measured as abdominal circumference, waist-to-height ratio and other indices is firmly grounded in the need to reflect continuous body growth. Few of these indices are well referenced to reflect visceral fat in children. This is a critical oversight, as without a doubt, obesity is an adiposity-based chronic disease in children⁴. Accurate quantification of excess adiposity and how it affects the health and function of the child or adolescent is crucial.