Diagnosis

Diagnosis involves the steps that a healthcare professional takes to find out if your child has obesity. A healthcare professional calculates your child's BMI and figures out where it falls on a standard growth chart.

Your child's healthcare professional uses the growth chart to find out how your child's weight compares with that of other children of the same sex and age. This is called your child's BMI percentile. For example, a child in the 80th percentile has a higher BMI than 80% of other children of the same sex and age.

Cutoff points on these growth charts mean the following:

  • Underweight — BMI 5th percentile or below.
  • Healthy weight — BMI between 5th and 84th percentiles.
  • Overweight — BMI between 85th and 94th percentiles.
  • Obese — BMI 95th percentile or above.
  • Severely obese — BMI greater than or equal to 120% of the 95th percentile.

BMI doesn't take into account factors such as being muscular or having a larger than average body frame. What's more, growth patterns vary greatly among children. So, the healthcare professional also factors in your child's growth and development to help find out whether your child's weight is a health concern.

Along with BMI and charting weight on the growth charts, the healthcare professional looks at:

  • Your family's history of obesity and weight-related health conditions, such as diabetes.
  • Your child's eating habits. This can include what your child eats and how often, and how big the portion sizes are.
  • Your child's activity level and amount of screen time.
  • Your child's blood pressure.
  • Other health conditions your child has or medicines your child takes.
  • Mental health history, including bouts of depression, sleep troubles, and whether your child feels isolated, alone or bullied.

Blood tests

Your child's healthcare professional also might do blood tests. These may include:

  • A cholesterol test.
  • A blood sugar test.
  • A liver test.
  • Other blood tests to check certain hormone levels or to look for other conditions linked with obesity.

Ask if your child needs to stop eating or drinking for a certain number of hours before a blood test. This is called fasting.

Treatment

Treatment for childhood obesity is based on factors such as your child's age and whether your child has other health conditions. Treatment usually includes changes in your child's eating habits and physical activity level. The key is to make these healthy changes over time and help your child follow them long term. Sometimes, treatment also includes medicines or weight-loss surgery.

Experts recommend that treatment include a mix of the following:

  • A healthcare team's guidance on nutrition and physical activity.
  • Skills for building habits as a family to form a healthy lifestyle over time. These habits need to work for the family long term.

In some areas, these treatments are offered in the form of classes that children and parents attend together. Or parents might go to such classes and apply what they've learned at home. When these classes aren't available, your child's healthcare professional may need to work with you to arrange key parts of the treatment plan. These parts include visits with a dietitian and more-regular healthcare visits that are focused on supporting healthy habits and goals.

Your child's healthcare professional likely will set healthy eating and physical activity goals for your family and your child. Any goal for your child's weight is tailored to:

  • Your child's age.
  • The severity of the obesity.
  • Whether your child has obesity-related health conditions.

Remember, success with treatment partly depends on how committed you are to helping your child make long-term healthy changes. Understand that your child is still growing. And be aware that healthy-lifestyle changes can benefit your child and family in ways that the scale may not or cannot show.

Healthy eating

Parents are the ones who buy groceries, cook meals and decide where the food is eaten. Even small changes can make a big difference in your child's health.

  • Sit down together for family meals. Make it an event — a time to share news and tell stories. Try not to eat in front of a TV, computer or video game screen. That can lead to fast eating and less awareness of the amount eaten.
  • Serve fruits and vegetables. Try to have your child eat at least five fruits and vegetables a day. For instance, aim for two pieces of fruit and three vegetables.
  • Cut back on convenience foods. These include cookies, crackers, fast food and prepared meals. They're often high in sugar, fat, sodium and calories.
  • Limit sweetened drinks. This includes fruit juice. Sugar-sweetened drinks have little nutrition and lots of calories. They also can make your child feel too full to eat healthier foods.
  • Serve appropriate portion sizes. Children don't need as much food as adults do. Start with a small portion. After your child finishes, have your child wait 10 minutes before taking another portion. Let your child eat only until full, even if that means leaving food on the plate. Older children and teens may eat less food when they serve themselves. Also, keep in mind that when you eat out, restaurant portion sizes often are way too large.
  • Keep a daily food journal. Write down what your child eats and how much. Show your child this journal. The journal can help your child learn to be more mindful about food choices. You also can teach your child to track physical activity.

Physical activity

A key part of reaching and staying at a healthy weight is physical activity. It burns calories, and strengthens bones and muscles. It also helps children sleep well at night and stay alert during the day. Good habits during childhood help teens stay at healthy weights. Plus, active children are more likely to become fit adults.

To help your child become more active:

  • Limit TV time. Children older than age 2 should have no more than two hours a day of leisure screen time. That includes sitting in front of a TV, computer, tablet or smartphone for fun. Children younger than 2 should have no screen time.
  • Encourage activity. Children should get at least an hour of physical activity a day. Your child's activity doesn't have to be a structured exercise program. The goal is to get your child moving. Free-play activities such as hide-and-seek, tag and jump rope can be great ways to burn calories and boost fitness. So can dancing, swimming, brisk walking and biking.
  • Find activities your child likes. For instance, if your child likes to make art, go on a nature hike to collect leaves and rocks. Your child can use them to make a collage. If your child likes to climb, go to the neighborhood jungle gym or climbing wall. If your child likes to read, then walk or bike to the neighborhood library for a book.
  • Encourage more movement and less sitting. You could suggest the following ideas to your child: Stand or walk in place while watching TV. Take the stairs instead of elevators. If school is within a safe walking distance from home, walk or bike instead of riding the bus or in a car. You also could ask if your child would like a wearable device that keeps track steps taken. The device may help your child set fitness goals.

Medications

Your child's healthcare professional may prescribe medicine to help with weight loss if diet and exercise alone aren't enough. Medicines that can help manage childhood obesity need to be used along with healthy eating and more movement. The type of medicine that might be right for your child depends on factors such as your child's age and cause of obesity. Medicines that may boost weight loss include:

  • Semaglutide (Wegovy).
  • Liraglutide (Saxenda).
  • Phentermine and topiramate (Qsymia).
  • Phentermine.
  • Lisdexamfetamine.

Ask about the side effects of any medicine that your child's healthcare professional recommends.

Surgery or other procedures

Weight-loss surgery might be an option for some teens with severe obesity. Your teen's healthcare professional may recommend the surgery if diet changes and physical activity alone don't help enough. As with any type of surgery, there are risks and possible long-term complications. Talk with your teen's healthcare professional about the pros and cons of weight-loss surgery.

The healthcare professional may recommend surgery if your teen's weight poses a greater health threat than do the risks of surgery. Before weight-loss surgery, it's important to meet with a team of specialists, including:

  • An obesity medicine expert.
  • A psychologist.
  • A registered dietitian.

Surgery may be a treatment option that you support, but your teen needs to decide whether or not to get it. If your teen chooses to get weight-loss surgery, encourage the rest of your family to support the choice.

Weight-loss surgery isn't a miracle cure. It doesn't guarantee that a teen will lose extra weight or be able to keep it off long term. And surgery doesn't replace the need for a healthy diet and regular physical activity.

Coping and support

Parents play a key role in helping children feel loved and in control of their weight. So try to build your child's self-esteem as often as you can. Don't be afraid to bring up the topic of health and fitness. Also, be direct and open when you talk with your child. Try not to judge or be critical.

You can use the following tips:

  • Stay upbeat and practical when talking about weight. Harmful comments about your own weight, someone else's weight or your child's weight can hurt your child. That's true even if you mean well with your comments. Harmful talk about weight can lead to poor body image. Instead, focus your talks on healthy eating and positive body image. Make sure that other family members talk with your child in an upbeat way too.
  • Tell your child not to skip meals or follow fad diets. Instead, encourage and support healthy eating. Help your child work up to at least an hour of physical activity a day too.
  • Find reasons to praise your child's efforts. Celebrate small changes in eating and physical activity. But don't reward your child with food. Choose other ways to mark your child's successes, such as going to the bowling alley or a local park.
  • Talk about your child's feelings. Listen to any concerns that your child shares with you about weight or body image. Show that you love your child and that you care about your child's feelings.
  • Help your child focus on healthy goals. For example, point out when your child can bike or jog longer than your child used to. Or say how proud you are when your child can run the required number of laps in gym class.
  • Be patient. Realize that an intense focus on your child's eating habits and weight can backfire. It can lead a child to overeat even more. It also can raise the risk of an eating disorder. So don't ever shame, blame or shout at your child about weight.
  • Put a stop to bullying. If another child bullies your child about weight, take charge of the situation as soon as possible. Talk with the other child's parents. If the bullying happens at school, talk with your child's teachers or principal.

Preparing for your appointment

Your child's healthcare professional likely will be first to tell you whether your child's BMI is in the obese range. If your child has complications of obesity, you might be referred to other specialists to help manage these health concerns.

Here's some information to help you get ready for your appointment.

What you can do

When you make the appointment, ask if there's anything your child needs to do ahead of time. For instance, your child may have to stop eating or drinking for a certain number of hours before a test. Before the healthcare checkup, make a list of:

  • Your child's symptoms, if any, and when they began.
  • Key personal information, including a family medical history and history of obesity.
  • All medicines, vitamins or other supplements your child takes, including doses.
  • What your child typically eats in a week, and how active your child is.

  • Questions to ask your child's healthcare professional.

    Bring a family member or friend along if you can. This person can help you remember all the information you're given.

For childhood obesity, some basic questions to ask your child's healthcare professional include:

  • What other health conditions might my child develop?
  • What are the treatment choices?
  • Are there medicines that might help manage my child's weight and other health conditions?
  • How long will treatment take?
  • What can I do to help my child lose weight?
  • Are there brochures or other printed material I can have? What websites do you recommend?

Feel free to ask other questions.

What to expect from your doctor

Your child's healthcare professional is likely to ask you questions about your child's eating and activity, including:

  • What does your child eat in a typical day?
  • How much activity does your child get in a typical day?
  • What factors do you believe affect your child's weight?
  • What diets or treatments, if any, have you tried to help your child lose weight?
  • Are you ready to make changes in your family's lifestyle to help your child lose weight?
  • What might prevent your child from losing weight?
  • How often does the family eat together? Does the child help prepare the food?
  • Does your child, or family, eat while watching TV, texting or using a computer?

What you can do in the meantime

If you have days or weeks before your child's appointment, keep a record of what your child eats and how active your child is.

By Mayo Clinic Staff