The pediatric sports physician faces an epidemic of obesity. A preliminary triage of individual patients can be based on the body mass index (BMI). The 80th and 95th percentiles of age-specific BMI suggest overweight and obesity, respectively; the diagnosis is confirmed by measurements of triceps and subscapular skinfolds. Over the last twenty years, the proportions of overweight and obese children have increased in both indigenous populations and most developed societies. The increase in body fat content seems to be associated with a decline in daily energy expenditure. Immediate health consequences include an increased prevalence of atherosclerotic plaques, hypertension, and an adverse lipid profile; in addition, the resulting poor self-image limits sport participation. Many obese children become obese adults, facing increased risks of cardiovascular and all-cause deaths. A combination of increased lifestyle activities, behavioral modification techniques to reduce sedentary behavior, and an appropriate diet seems to be the most effective approach to both prevention and treatment of obesity. Such initiatives should be supported by quality daily physical education and changes in the urban environment that encourage an active lifestyle.
The author is with the Faculty of Physical and Health Education and Dept. of Public Health Sciences, Faculty of Medicine, University of Toronto, Toronto, ON.