Objective To estimate the prevalence of extreme obesity in a large, multiethnic contemporary cohort of children and adolescents. Study design In a cross-sectional study, measured weight and height were extracted from electronic medical records of 710 949 patients aged 2 to 19 years (87.8% of eligible patients) who were enrolled in an integrated prepaid health plan in 2007 and 2008. Prevalence of extreme obesity was defined as body mass index (BMI)-for-age ≥1.2 times 95th percentile or BMI ≥35 kg/m2. Results Extreme obesity was observed in 7.3% of boys and 5.5% of girls. The prevalence peaked at 10 years of age in boys and at 12 years of age with a bimodal distribution in girls (second peak at 18 years; P value for sex × age interaction = .036). The prevalence of extreme obesity varied in ethnic/racial and age groups, with the highest prevalence in Hispanic boys (as high as 11.2%) and African-American girls (as high as 11.9%). Conclusion Extreme obesity in Southern California youth is frequently observed at relatively young ages. The shift toward extreme body weights is likely to cause an enormous burden of adverse health outcomes once these children and adolescents grow older.

Objective To investigate the prevalence of polycystic ovary syndrome (PCOS) in adolescents and its association with obesity. Design Cross-sectional study using electronic medical records. Setting Integrated health care delivery system in Southern California. Patients Adolescents aged 15–19 years (n= 137,502). Interventions None. Main Outcome Measures PCOS diagnosed or defined according to NIH criteria. Results The prevalence of a confirmed diagnosis of PCOS was 0.56%, and increased to 1.14% when undiagnosed cases with documented symptoms qualifying for PCOS according to NIH criteria were included. Compared to normal/underweight girls, the ORs (95% CI) for confirmed PCOS diagnosis were 3.85 (3.04–4.88), 10.25 (8.16–12.84) and 23.10 (18.66–28.61) for overweight, moderately obese, and extremely obese adolescents, respectively (P-trend<0.001) after adjusting for potential confounders. When adolescents with two or more supportive diagnoses were included (diagnosed and undiagnosed PCOS-NIH) the ORs (95% CI) for PCOS-NIH by weight class were significantly attenuated to 2.95 (2.53–3.44), 6.73 (5.78–7.83), and 14.65 (12.73–16.86) for overweight, moderately obese, and extremely obese adolescents, respectively. Conclusions Overweight and obesity were associated with higher odds of PCOS in adolescents. Studies based solely on diagnosis codes may underestimate the prevalence of PCOS and overestimate the magnitude of the association between obesity and PCOS.

Objective-To investigate whether obesity and cardiovascular risk factors are associated with psoriasis in children and adolescents.Study design-For this population-based, cross-sectional study, measured weight and height, laboratory data, and psoriasis diagnoses were extracted from electronic medical records of 710,949 patients 2-19 y enrolled in an integrated health plan. Weight class was assigned based on body mass index-for-age.Results-The OR for psoriasis was 0.68, 1.00, 1.31, 1.39, and 1.78 (95%CI 1.49-2.14) for underweight, normal weight, overweight, moderately obese and extreme obese children, respectively (p for trend<0.001). The OR for psoriasis treated systemic therapy or phototherapy as indicator of severe or widespread psoriasis was 0.00, 1.00, 2.78, 2.93, and 4.19 (95%CI 1.81-9.68) for underweight, normal weight, overweight, moderately obese and extreme obese children, respectively (p for trend<0.003). In adolescents, mean total cholesterol, LDL cholesterol, triglycerides and ALT were significantly higher in children with psoriasis compared with children without psoriasis after adjustment for BMI.Conclusion-Overweight and obesity are associated with higher odds of psoriasis in youths. Independent of body weight, adolescent patients with psoriasis have higher blood lipids. These data suggest that pediatricians and dermatologists should screen youths with psoriasis for cardiovascular disease risk factors. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.The other authors declare no conflicts of interest. [5], and mortality [6]. In children, the rate of obesity has more than tripled in the past 30 years [7] with more and more children becoming extremely obese [8,9]. Like psoriasis, obesity is a condition characterized by chronic low-level inflammation in adults [10] and children [11]. The association between obesity and psoriasis has been well described in adults [12][13][14], including one prospective study suggesting that obesity is a risk factor for adult-onset psoriasis [15]. However, concerns of residualconfounding and lack of causality have been raised by others [16]. NIH Public AccessOne study has examined the association between obesity and psoriasis in children and found obesity to be 1.7 times higher in frequency in children with than without psoriasis [2].Results from that study also suggest that children with psoriasis have a higher prevalence of dyslipidemia and hypertension [2]. However, information on the degree of obesity is lacking in that study and the magnitude of the association cannot be quantified. Given the association of psoriasis ...

Objective To estimate the magnitude of the association between overweight, moderate, and extreme childhood obesity and the risk of idiopathic intracranial hypertension (IIH). Study design Risk estimates were obtained from the Kaiser Permanente Southern California Children’s Health Study (n = 913 178). Weight classes were assigned by body mass index specific for age and sex. A combination of electronic database searches followed by complete medical records review was used to identify all children diagnosed with IIH between 2006 and 2009. Results We identified 78 children with IIH, the majority of whom were girls (n = 66, 84.5%), age 11-19 (n = 66, 84.5%), non-Hispanic Whites (n = 37, 47.4%), and overweight or obese (n = 57, 73.1%). The adjusted ORs and 95% CIs of IIH with increasing weight class were 1.00, 3.56 (1.72-7.39), 6.45 (3.10-13.44), and 16.14 (8.18-31.85) for underweight/normal weight (reference category), overweight, moderately obese and extremely obese 11-19 year olds, respectively (P for trend < .001). Other independent IIH risk factors included White non-Hispanic race/ethnicity for all age groups and female sex, but only in older children. Overweight/obese children also had more IIH symptoms at onset than normal weight children. Conclusions We found that childhood obesity is strongly associated with an increased risk of pediatric IIH in adolescents. Our findings suggest that the childhood obesity epidemic is likely to lead to increased morbidity from IIH particularly among extremely obese, White non-Hispanic teenage girls. Our findings also suggest careful screening of these at risk individuals may lead to earlier detection and opportunity for treatment of IIH.

The aim of this study is to investigate the association between childhood obesity and asthma, and whether this relationship varies by race/ethnicity. For this population-based, cross-sectional study, measured weight and height, and asthma diagnoses were extracted from electronic medical records of 681,122 patients aged 6–19 years who were enrolled in an integrated health plan 2007–2009. Weight class was assigned based on BMI-for-age. Overall, 18.4% of youth had a history of asthma and 10.9% had current asthma. Adjusted odds of current asthma for overweight, moderately obese, and extremely obese youth relative to those of normal weight were 1.22 (95% confidence interval (CI): 1.20, 1.24), 1.37 (95% CI: 1.34, 1.40), and 1.68 (95% CI: 1.64, 1.73), respectively (P trend < 0.001). Black youth are nearly twice as likely (adjusted odds ratio (OR) = 1.93, 95% CI: 1.89, 1.99), and Hispanic youth are 25% less likely (adjusted OR = 0.75, 95% CI: 0.74, 0.77), to have current asthma than to non-Hispanic white youth. However, the relationship between BMI and asthma was strongest in Hispanic and weakest in black youth. Among youth with asthma, increasing body mass was associated with more frequent ambulatory and emergency department visits, as well as increased inhaled and oral corticosteroid use. In conclusion, overweight, moderate, and extreme obesity are associated with higher odds of asthma in children and adolescents, although the association varies widely with race/ethnicity. Increasing BMI among youth with asthma is associated with higher consumption of corticosteroids and emergency department visits.