{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T15:47:59Z","timestamp":1792597679094,"version":"4.5.0"},"reference-count":57,"publisher":"American Medical Association (AMA)","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA"],"abstract":"\n Importance<\/jats:title>\n Obesity affects 15% of children aged 2 to 5 years and 22% of children aged 6 to 11 years in the US. Obesity in children is associated with dyslipidemia, hypertension, metabolic dysfunction\u2013associated steatotic liver disease, and obstructive sleep apnea. Compared with normal-weight peers, children with obesity have lower quality of life and are 5 times more likely to have obesity in adulthood.<\/jats:p>\n <\/jats:sec>\n \n Observations<\/jats:title>\n \n Body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) is used to identify children at risk for excess adiposity, and guidelines recommend that clinicians screen for obesity using BMI starting at age 2 years. Among children, obesity is defined using standardized age- and sex-specific growth charts, with obesity defined as BMI in the 95th or higher percentile and severe obesity as BMI of 120% or greater of the 95th percentile. Obesity treatment in children includes intensive health behavior and lifestyle treatment, consisting of at least 26 contact hours of face-to-face group or family-based activities that incorporate nutrition, physical activity, and behavior change education delivered to the child and caregivers over a 3- to 12-month period. Intensive health behavior and lifestyle treatment reduces BMI by 0.7 compared with children who do not participate in intensive health behavior and lifestyle treatment. The only obesity pharmacotherapy currently approved by the US Food and Drug Administration (FDA) for children younger than 12 years is setmelanotide, a melanocortin-4 receptor agonist, which is indicated for 3 forms of rare monogenic obesity (\n LEPR<\/jats:italic>\n ,\n POMC<\/jats:italic>\n , and\n PCSK1<\/jats:italic>\n genetic variants), Bardet-Biedl syndrome, and acquired hypothalamic obesity. Liraglutide is currently only FDA approved for youth aged 12 years or older; however, a randomized clinical trial among children aged 6 to younger than 12 years demonstrated that, compared with placebo, liraglutide reduced BMI by 7.4%. Metabolic and bariatric surgery is rarely used in children younger than age 12 years and evidence supporting its use in children is limited. Early identification and treatment of obesity during childhood may reduce risk of type 2 diabetes, dyslipidemia, hypertension, and mortality in adulthood.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n Obesity in children is associated with chronic disease, such as hypertension, and with poor quality of life. Evidence-based treatment for obesity in children includes intensive health behavior and lifestyle treatment, and pharmacotherapy may provide additional benefit, although short- and long-term safety and efficacy data are limited. Early identification and treatment of obesity during childhood may reduce risk of type 2 diabetes, dyslipidemia, hypertension, and mortality in adulthood.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jama.2026.18806","type":"journal-article","created":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T15:00:30Z","timestamp":1792594830000},"source":"Crossref","is-referenced-by-count":0,"title":["Obesity in Children Aged 2 to 12 Years"],"prefix":"10.1001","author":[{"given":"Claudia K.","family":"Fox","sequence":"first","affiliation":[{"name":"Department of Pediatrics and Center for Pediatric Obesity Medicine, University of Minnesota Medical School, Minneapolis"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah C.","family":"Armstrong","sequence":"additional","affiliation":[{"name":"Departments of Pediatrics and Population Health Sciences, Duke University, Duke Clinical Research Institute, Duke Center for Childhood Obesity Research, Durham, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aaron S.","family":"Kelly","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and Center for Pediatric Obesity Medicine, University of Minnesota Medical School, Minneapolis"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2026,10,21]]},"reference":[{"issue":"2","key":"jrv260023r2","doi-asserted-by":"publisher","first-page":"95","DOI":"10.1111\/obr.12334","article-title":"Predicting adult obesity from childhood obesity: a systematic review and meta-analysis.","volume":"17","author":"Simmonds","year":"2016","journal-title":"Obes Rev"},{"issue":"23","key":"jrv260023r3","doi-asserted-by":"publisher","first-page":"2329","DOI":"10.1056\/NEJMoa072515","article-title":"Childhood body-mass index and the risk of coronary heart disease in adulthood.","volume":"357","author":"Baker","year":"2007","journal-title":"N Engl J Med"},{"issue":"14","key":"jrv260023r4","doi-asserted-by":"publisher","first-page":"1302","DOI":"10.1056\/NEJMoa1713231","article-title":"Change in overweight from childhood to early adulthood and risk of type 2 diabetes.","volume":"378","author":"Bjerregaard","year":"2018","journal-title":"N Engl J Med"},{"issue":"3","key":"jrv260023r5","doi-asserted-by":"publisher","first-page":"226","DOI":"10.1001\/jama.2024.11146","article-title":"Interventions for high body mass index in children and adolescents: US Preventive Services Task Force recommendation statement.","volume":"332","author":"Nicholson","year":"2024","journal-title":"JAMA"},{"issue":"2","key":"jrv260023r6","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2022-060640","article-title":"Clinical practice guideline for the evaluation and treatment of children and adolescents with obesity.","volume":"151","author":"Hampl","year":"2023","journal-title":"Pediatrics"},{"issue":"14","key":"jrv260023r7","doi-asserted-by":"publisher","first-page":"E372","DOI":"10.1503\/cmaj.241456","article-title":"Managing obesity in children: a clinical practice guideline.","volume":"197","author":"Ball","year":"2025","journal-title":"CMAJ"},{"issue":"2","key":"jrv260023r8","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2022-060643","article-title":"Appraisal of clinical care practices for child obesity treatment\u2014part II: comorbidities.","volume":"151","author":"Skinner","year":"2023","journal-title":"Pediatrics"},{"issue":"2","key":"jrv260023r9","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2022-060642","article-title":"Appraisal of clinical care practices for child obesity treatment\u2014part I: interventions.","volume":"151","author":"Skinner","year":"2023","journal-title":"Pediatrics"},{"issue":"3","key":"jrv260023r10","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2017-3459","article-title":"Prevalence of obesity and severe obesity in US children, 1999-2016.","volume":"141","author":"Skinner","year":"2018","journal-title":"Pediatrics"},{"issue":"4","key":"jrv260023r12","doi-asserted-by":"publisher","first-page":"739","DOI":"10.1002\/oby.21782","article-title":"BMI z-scores are a poor indicator of adiposity among 2- to 19-year-olds with very high BMIs, NHANES 1999-2000 to 2013-2014.","volume":"25","author":"Freedman","year":"2017","journal-title":"Obesity (Silver Spring)"},{"issue":"12","key":"jrv260023r13","doi-asserted-by":"publisher","first-page":"1082","DOI":"10.1001\/jama.2024.27676","article-title":"Trends in obesity-related measures among US children, adolescents, and adults.","volume":"333","author":"Emmerich","year":"2025","journal-title":"JAMA"},{"issue":"10","key":"jrv260023r14","doi-asserted-by":"publisher","first-page":"621","DOI":"10.1056\/NEJM199503093321001","article-title":"Changes in energy expenditure resulting from altered body weight.","volume":"332","author":"Leibel","year":"1995","journal-title":"N Engl J Med"},{"issue":"3","key":"jrv260023r15","doi-asserted-by":"publisher","first-page":"R581","DOI":"10.1152\/ajpregu.00755.2010","article-title":"Biology\u2019s response to dieting: the impetus for weight regain.","volume":"301","author":"Maclean","year":"2011","journal-title":"Am J Physiol Regul Integr Comp Physiol"},{"issue":"17","key":"jrv260023r16","doi-asserted-by":"publisher","first-page":"1597","DOI":"10.1056\/NEJMoa1105816","article-title":"Long-term persistence of hormonal adaptations to weight loss.","volume":"365","author":"Sumithran","year":"2011","journal-title":"N Engl J Med"},{"issue":"2","key":"jrv260023r17","doi-asserted-by":"publisher","first-page":"120","DOI":"10.1038\/s41576-021-00414-z","article-title":"The genetics of obesity: from discovery to biology.","volume":"23","author":"Loos","year":"2022","journal-title":"Nat Rev Genet"},{"issue":"2","key":"jrv260023r18","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1002744","article-title":"Maternal body mass index, gestational weight gain, and the risk of overweight and obesity across childhood: an individual participant data meta-analysis.","volume":"16","author":"Voerman","year":"2019","journal-title":"PLoS Med"},{"issue":"10","key":"jrv260023r19","doi-asserted-by":"publisher","first-page":"1005","DOI":"10.1001\/jama.2018.11628","article-title":"Association of gestational diabetes with maternal disorders of glucose metabolism and childhood adiposity.","volume":"320","author":"Lowe","year":"2018","journal-title":"JAMA"},{"issue":"14","key":"jrv260023r20","doi-asserted-by":"publisher","first-page":"1303","DOI":"10.1056\/NEJMoa1803527","article-title":"Acceleration of BMI in early childhood and risk of sustained obesity.","volume":"379","author":"Geserick","year":"2018","journal-title":"N Engl J Med"},{"issue":"3","key":"jrv260023r21","doi-asserted-by":"publisher","first-page":"321","DOI":"10.1111\/obr.12632","article-title":"Rapid weight gain during infancy and subsequent adiposity: a systematic review and meta-analysis of evidence.","volume":"19","author":"Zheng","year":"2018","journal-title":"Obes Rev"},{"issue":"7504","key":"jrv260023r22","doi-asserted-by":"publisher","first-page":"1357","DOI":"10.1136\/bmj.38470.670903.E0","article-title":"Early life risk factors for obesity in childhood: cohort study.","volume":"330","author":"Reilly","year":"2005","journal-title":"BMJ"},{"issue":"3","key":"jrv260023r23","doi-asserted-by":"publisher","first-page":"709","DOI":"10.1210\/jc.2016-2573","article-title":"Pediatric obesity-assessment, treatment, and prevention: an Endocrine Society clinical practice guideline.","volume":"102","author":"Styne","year":"2017","journal-title":"J Clin Endocrinol Metab"},{"issue":"3","key":"jrv260023r24","doi-asserted-by":"publisher","first-page":"305","DOI":"10.1159\/000523943","article-title":"Autism spectrum disorder and obesity in children: a systematic review and meta-analysis.","volume":"15","author":"Sammels","year":"2022","journal-title":"Obes Facts"},{"issue":"1","key":"jrv260023r25","doi-asserted-by":"publisher","first-page":"34","DOI":"10.1176\/appi.ajp.2015.15020266","article-title":"Association between ADHD and obesity: a systematic review and meta-analysis.","volume":"173","author":"Cortese","year":"2016","journal-title":"Am J Psychiatry"},{"issue":"3","key":"jrv260023r26","doi-asserted-by":"publisher","first-page":"281","DOI":"10.1111\/obr.12497","article-title":"Parenting styles and body mass index: a systematic review of prospective studies among children.","volume":"18","author":"Sokol","year":"2017","journal-title":"Obes Rev"},{"issue":"7","key":"jrv260023r27","doi-asserted-by":"publisher","DOI":"10.1111\/obr.13204","article-title":"The association between adverse childhood experiences and childhood obesity: a systematic review.","volume":"22","author":"Schroeder","year":"2021","journal-title":"Obes Rev"},{"issue":"1","key":"jrv260023r28","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2021-055571","article-title":"Food insecurity and childhood obesity: a systematic review.","volume":"150","author":"St Pierre","year":"2022","journal-title":"Pediatrics"},{"issue":"3","key":"jrv260023r29","doi-asserted-by":"publisher","first-page":"274","DOI":"10.1136\/jech-2021-216455","article-title":"Income and neighbourhood deprivation in relation to obesity in urban dwelling children 0-12 years of age: a cross-sectional study from 2013 to 2019.","volume":"76","author":"Anderson","year":"2022","journal-title":"J Epidemiol Community Health"},{"key":"jrv260023r30","doi-asserted-by":"publisher","DOI":"10.1016\/j.metabol.2025.156303","article-title":"Exploring the interplay of genetic variants and environmental factors in childhood obesity: a systematic review and meta-analysis.","volume":"170","author":"Zhu","year":"2025","journal-title":"Metabolism"},{"issue":"6","key":"jrv260023r31","doi-asserted-by":"publisher","first-page":"767","DOI":"10.1016\/j.acap.2019.11.002","article-title":"Use of electronic health record data to study the association of sugary drink consumption with child weight status.","volume":"20","author":"Lewis","year":"2020","journal-title":"Acad Pediatr"},{"issue":"4","key":"jrv260023r32","doi-asserted-by":"publisher","DOI":"10.1093\/sleep\/zsy018","article-title":"Sleep duration and incidence of obesity in infants, children, and adolescents: a systematic review and meta-analysis of prospective studies.","volume":"41","author":"Miller","year":"2018","journal-title":"Sleep"},{"issue":"5","key":"jrv260023r33","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0232990","article-title":"Identifying underlying medical causes of pediatric obesity: results of a systematic diagnostic approach in a pediatric obesity center.","volume":"15","author":"Kleinendorst","year":"2020","journal-title":"PLoS One"},{"issue":"6","key":"jrv260023r34","doi-asserted-by":"publisher","first-page":"603","DOI":"10.1111\/obr.12531","article-title":"A systematic review of genetic syndromes with obesity.","volume":"18","author":"Kaur","year":"2017","journal-title":"Obes Rev"},{"issue":"6 Pt 1","key":"jrv260023r35","doi-asserted-by":"publisher","first-page":"1175","DOI":"10.1542\/peds.103.6.1175","article-title":"The relation of overweight to cardiovascular risk factors among children and adolescents: the Bogalusa Heart Study.","volume":"103","author":"Freedman","year":"1999","journal-title":"Pediatrics"},{"issue":"1","key":"jrv260023r36","doi-asserted-by":"publisher","first-page":"119","DOI":"10.1002\/hep.31018","article-title":"Liver fat and cardiometabolic risk factors among school-age children.","volume":"72","author":"Geurtsen","year":"2020","journal-title":"Hepatology"},{"issue":"10","key":"jrv260023r37","doi-asserted-by":"publisher","first-page":"1266","DOI":"10.3390\/ijerph14101266","article-title":"Association between obesity and puberty timing: a systematic review and meta-analysis.","volume":"14","author":"Li","year":"2017","journal-title":"Int J Environ Res Public Health"},{"issue":"1","key":"jrv260023r38","doi-asserted-by":"publisher","first-page":"70","DOI":"10.1001\/jama.293.1.70","article-title":"Health-related quality of life of overweight and obese children.","volume":"293","author":"Williams","year":"2005","journal-title":"JAMA"},{"issue":"1","key":"jrv260023r39","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2024-065960","article-title":"Screening accuracy of BMI for adiposity among 8- to 19-year-olds.","volume":"154","author":"Freedman","year":"2024","journal-title":"Pediatrics"},{"issue":"2","key":"jrv260023r40","doi-asserted-by":"publisher","DOI":"10.1111\/obr.13375","article-title":"Accuracy of different cutoffs of the waist-to-height ratio as a screening tool for cardiometabolic risk in children and adolescents: a systematic review and meta-analysis of diagnostic test accuracy studies.","volume":"23","author":"Ezzatvar","year":"2022","journal-title":"Obes Rev"},{"issue":"4","key":"jrv260023r41","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2016-0149","article-title":"Brief primary care obesity interventions: a meta-analysis.","volume":"138","author":"Sim","year":"2016","journal-title":"Pediatrics"},{"issue":"23","key":"jrv260023r42","doi-asserted-by":"publisher","first-page":"2417","DOI":"10.1001\/jama.2017.6803","article-title":"Screening for obesity in children and adolescents: US Preventive Services Task Force recommendation statement.","volume":"317","author":"Grossman","year":"2017","journal-title":"JAMA"},{"issue":"8","key":"jrv260023r43","doi-asserted-by":"publisher","first-page":"3171","DOI":"10.1210\/jc.2016-1885","article-title":"Which amount of BMI-SDS reduction is necessary to improve cardiovascular risk factors in overweight children?","volume":"101","author":"Reinehr","year":"2016","journal-title":"J Clin Endocrinol Metab"},{"issue":"2","key":"jrv260023r44","doi-asserted-by":"publisher","first-page":"361","DOI":"10.1542\/peds.2009-2037","article-title":"Screening for obesity in children and adolescents: US Preventive Services Task Force recommendation statement.","volume":"125","author":"Barton","year":"2010","journal-title":"Pediatrics"},{"issue":"12","key":"jrv260023r45","doi-asserted-by":"publisher","first-page":"859","DOI":"10.1016\/S2213-8587(22)00277-7","article-title":"Efficacy and safety of setmelanotide, a melanocortin-4 receptor agonist, in patients with Bardet-Biedl syndrome and Alstr\u00f6m syndrome: a multicentre, randomised, double-blind, placebo-controlled, phase 3 trial with an open-label period.","volume":"10","author":"Haqq","year":"2022","journal-title":"Lancet Diabetes Endocrinol"},{"issue":"12","key":"jrv260023r46","doi-asserted-by":"publisher","first-page":"960","DOI":"10.1016\/S2213-8587(20)30364-8","article-title":"Efficacy and safety of setmelanotide, an MC4R agonist, in individuals with severe obesity due to LEPR or POMC deficiency: single-arm, open-label, multicentre, phase 3 trials.","volume":"8","author":"Cl\u00e9ment","year":"2020","journal-title":"Lancet Diabetes Endocrinol"},{"issue":"6","key":"jrv260023r47","doi-asserted-by":"publisher","first-page":"380","DOI":"10.1016\/S2213-8587(24)00087-1","article-title":"Setmelanotide for the treatment of acquired hypothalamic obesity: a phase 2, open-label, multicentre trial.","volume":"12","author":"Roth","year":"2024","journal-title":"Lancet Diabetes Endocrinol"},{"issue":"5","key":"jrv260023r48","doi-asserted-by":"publisher","DOI":"10.1111\/ijpo.13113","article-title":"Pharmacological interventions for the management of children and adolescents living with obesity\u2014an update of a Cochrane systematic review with meta-analyses.","volume":"19","author":"Torbahn","year":"2024","journal-title":"Pediatr Obes"},{"issue":"2","key":"jrv260023r49","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0314787","article-title":"Pharmacological interventions for addressing pediatric and adolescent obesity: a systematic review and network meta-analysis.","volume":"20","author":"Yang","year":"2025","journal-title":"PLoS One"},{"issue":"6","key":"jrv260023r50","doi-asserted-by":"publisher","first-page":"555","DOI":"10.1056\/NEJMoa2407379","article-title":"Liraglutide for children 6 to <12 years of age with obesity\u2014a randomized trial.","volume":"392","author":"Fox","year":"2025","journal-title":"N Engl J Med"},{"issue":"3","key":"jrv260023r51","doi-asserted-by":"publisher","first-page":"174","DOI":"10.1089\/chi.2019.0040","article-title":"Metformin therapy reduces obesity indices in children and adolescents: a systematic review and meta-analysis of randomized clinical trials.","volume":"16","author":"Sadeghi","year":"2020","journal-title":"Child Obes"},{"issue":"3","key":"jrv260023r52","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2020-1610","article-title":"Efficacy and safety of metformin for obesity: a systematic review.","volume":"147","author":"Masarwa","year":"2021","journal-title":"Pediatrics"},{"issue":"2","key":"jrv260023r53","doi-asserted-by":"publisher","first-page":"477","DOI":"10.2337\/db10-1185","article-title":"Effects of metformin on body weight and body composition in obese insulin-resistant children: a randomized clinical trial.","volume":"60","author":"Yanovski","year":"2011","journal-title":"Diabetes"},{"issue":"6","key":"jrv260023r54","doi-asserted-by":"publisher","first-page":"657","DOI":"10.1016\/j.jamcollsurg.2021.08.678","article-title":"Ten-year outcomes of children and adolescents who underwent sleeve gastrectomy: weight loss, comorbidity resolution, adverse events, and growth velocity.","volume":"233","author":"Alqahtani","year":"2021","journal-title":"J Am Coll Surg"},{"issue":"22","key":"jrv260023r55","doi-asserted-by":"publisher","first-page":"2145","DOI":"10.1056\/NEJMoa1703860","article-title":"Simulation of growth trajectories of childhood obesity into adulthood.","volume":"377","author":"Ward","year":"2017","journal-title":"N Engl J Med"},{"issue":"3","key":"jrv260023r56","doi-asserted-by":"publisher","first-page":"302","DOI":"10.1001\/jamapediatrics.2024.5552","article-title":"Effect of pediatric obesity treatment on long-term health.","volume":"179","author":"Putri","year":"2025","journal-title":"JAMA Pediatr"},{"issue":"19","key":"jrv260023r57","doi-asserted-by":"publisher","first-page":"2519","DOI":"10.1001\/jama.1990.03450190051027","article-title":"Ten-year follow-up of behavioral, family-based treatment for obese children.","volume":"264","author":"Epstein","year":"1990","journal-title":"JAMA"},{"key":"jrv260023r1","unstructured":"National Center for Health Statistics. NCHS data query system: obesity in children, measured by age group, National Health and Nutrition Examination Survey 1999-2000 to 8\/2021-8\/2023. Updated March 6, 2026. Accessed August 4, 2026. https:\/\/www.cdc.gov\/nchs\/fastats\/obesity-overweight.htm"},{"key":"jrv260023r11","unstructured":"World Health Organization. Noncommunicable diseases: childhood overweight and obesity. May 7, 2025. Accessed August 10, 2026. https:\/\/www.who.int\/news-room\/q-a-detail\/noncommunicable-diseases-childhood-overweight-and-obesity"}],"container-title":["JAMA"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jama\/articlepdf\/2855679\/jama_fox_2026_rv_260023_1792517943.12004.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T15:00:31Z","timestamp":1792594831000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jama\/fullarticle\/2855679"}},"subtitle":["A Review"],"short-title":[],"issued":{"date-parts":[[2026,10,21]]},"references-count":57,"URL":"https:\/\/doi.org\/10.1001\/jama.2026.18806","relation":{},"ISSN":["0098-7484"],"issn-type":[{"value":"0098-7484","type":"print"}],"subject":[],"published":{"date-parts":[[2026,10,21]]}}}