Children's Hospital Colorado

Severe Obesity

What is severe obesity?

Obesity is diagnosed based on how a child's body mass index (BMI) relates to the normal range for their age and gender. BMI is calculated using your child’s weight and height. To be diagnosed with severe obesity, a child's BMI must be at or above the 99th percentile for their age and gender.

To compare, overweight children have a BMI in the 85th to 95th percentile, and obese children have a BMI in the 95th to 98.9th percentiles.

You can determine your child's BMI using the CDC BMI calculator.

What causes severe obesity?

Severe obesity results from lack of energy balance. This means that the calories your child takes in through food and drinks are greater than the calories they burn at rest and during exercise.

Most patients with severe obesity do not have a known medical cause for their obesity. However, there are medical conditions that can make children more likely to gain weight. These include very rare genetic conditions and conditions that affect a part of the brain called the hypothalamus.

Who is at risk for severe obesity?

Severe obesity can affect children of all ages, races and ethnicities, and it affects boys and girls equally. It is more common among minorities, children with a family history of obesity and children born to mothers who are obese during pregnancy. Some minorities at risk of severe obesity include African Americans and Hispanics.

Helpful resources

  • The Lifestyle Medicine Program at Children's Hospital Colorado is a weight management program that provides multidisciplinary treatment options for obese or overweight infants, toddlers, school-age children and adolescents.
  • The National Heart, Lung and Blood Institute's We Can education program offers diet and exercise tips for children and families dealing with childhood obesity.
  • The American Academy of Pediatrics offers tips for obesity prevention and weight reduction.
  • The Centers for Disease Control provides helpful information on childhood obesity.
  • The American Heart Association has many resources to better understand and help address childhood obesity.

What are the signs and symptoms of severe obesity?

Often, there are no signs or symptoms of severe obesity. Carrying excess weight can cause joint pain, especially in the lower back, hips, knees and ankles. Some children with severe obesity have sleep problems. Signs of sleep problems include snoring, pauses in breathing at night, daytime sleepiness and changes in school behavior.

Why do we care about helping children with severe obesity?

Children with severe obesity are at very high risk for developing health problems related to their weight. These health problems can affect all systems of the body, ranging from joint pain to mental health problems.

What other health problems can severe obesity cause?

  • High cholesterol
  • High blood pressure
  • Obstructive sleep apnea
  • Asthma that is difficult to control
  • Liver problems
  • Type 2 diabetes
  • Joint pain and some joint disorders
  • Polycystic ovary syndrome
  • Irregular periods
  • Bladder problems, like leaking urine with coughing or sneezing
  • Idiopathic intracranial hypertension (also called pseudotumor cerebri)
  • Low levels of vitamin D
  • Poor self-esteem, depression or anxiety

What tests are used to diagnose severe obesity?

Severe obesity is diagnosed by measuring height and weight to calculate BMI. BMI is plotted on a normal range curve for your child's age and gender. This is something that should be done every year at your child's annual pediatric visit.

How is severe obesity treated?

Severe obesity is treated by changing energy balance to make the calories that go out (calories burned through physical activity) greater than calories that go in (calories from food and drinks). This is done by addressing behaviors that affect nutrition, physical activity, screen time and sleep. The specific treatment approach is different for every child and family. Sometimes, specialized meal programs, weight loss medicines or weight loss surgery are needed to make it easier to change energy balance. Children who have medical conditions, such as high blood pressure or high cholesterol, may need to change specific foods they are eating, or may need medicines to treat these conditions.

Why choose Children's Colorado for treatment of your child's severe obesity?

The Children's Lifestyle Medicine Program is unique because the program includes multiple types of medical specialists, such as nutrition specialists, cardiologists, endocrinologists, liver doctors and sleep specialists all in one program. Our program also includes one of the top pediatric weight loss (bariatric) surgeons in the world, as well as specialists who have the expertise to prescribe weight loss medications. In addition to medical providers, our program includes dietitians, behavior specialists and exercise specialists.

Our Lifestyle Medicine Program offers orientation sessions, individual appointments, a variety of group classes, and a free exercise program to help families. In the Lifestyle Medicine program, every child is treated as a unique individual and the medical provider will help your family decide what the best pathway is to treat your child's severe obesity.

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