Table 4. Summary and recommendations.

Epidemiology	About 1 in 3 children and adolescents is affected by overweight and obesity
	Obesity is particularly prevalent among Mexican American and African American youth
Etiology	Hormonal factors affect appetite and satiety
	Genetics, perinatal metabolic programming, and the environment (social, media, cultural, and built) contribute to the development of obesity
Clinical considerations	Obesity comorbidities are common and should be screened for by health care professionals (Table 1)
	Functional GI disorders are also common in obesity, including GERD, altered bowel habits, and abdominal pain
	NAFLD/NASH is the most common liver disorder in children; detection is limited by suboptimal noninvasive screening methods and diagnosis requires exclusion of other causes of liver disease; staging of disease requires liver biopsy
	Micronutrient deficiencies are common in obesity and may result from unhealthy dietary habits as well as treatment (particularly surgical)
	Reduced sleep duration is associated with increased risk of obesity
	Care professionals should be aware of weight bias, discrimination, and victimization as they treat the obese child
	Clinicians should ensure adequate facilities for and account for increased perioperative risks and altered pharmacokinetics of medications commonly used for sedation in obese patients requiring GI procedures
Clinical treatment	Overall, multidisciplinary, behavior-based programs should be used when lifestyle modification counseling has not worked and when available; family involvement is necessary to ensure success
	Lifestyle changes and adoption of healthy physical activity and dietary behaviors remain the mainstay of weight management interventions
	Motivational interviewing, a client-centered communication approach, offers promise in effecting such behavioral change
	To date, only Orlistat is FDA approved for weight loss in children and adolescents with modest success
	Bariatric surgery results in significant weight loss and metabolic improvements for the majority of patients and remains the most effective therapy for severe obesity in adults and adolescents with significant BMI declines and improvements in comorbidities in the short term; however, widespread use is limited because of concerns related to surgical risks and psychological maturity to fully understand risks and benefits and provide full assent; long-term safety and efficacy is not known for this age group; postoperative micronutrient deficiencies are common and must be treated
Advocacy	Pediatric gastroenterologists should join community leaders in joint efforts to effect and enact health and environmental policies that permit and encourage healthy behavior choice and lifestyle modification
Patient resources	Patient handouts and information: http://www.gastrokids.org

BMI = body mass index; FDA = Food and Drug Administration; GERD = gastroesophageal reflux disease; GI = gastrointestinal; NAFLD = nonalcoholic fatty liver disease; NASH = nonalcoholic steatohepatitis.