This report reviews the risks and consequences associated with childhood and adolescent obesity. Although no consensus de®nition of childhood obesity exists, the various measures encountered in the literature are moderately well correlated. The paper is organized in three parts. The ®rst section reviews childhood obesity sequelae that occur during childhood. These short-term risks, for orthopedic, neurological, pulmonary, gasteroenterological, and endocrine conditions, although largely limited to severely overweight children, are becoming more common as the prevalence of severe overweight rises. The social burden of pediatric obesity, especially during middle childhood and adolescence, may have lasting effects on self-esteem, body image and economic mobility. The second section examines the intermediate consequences, such as the development of cardiovascular risk factors and persistence of obesity into adulthood. These mid-range effects of early obesity presage later adult disease and premature mortality. In the ®nal section, the small body of research on the long-term morbidity and mortality associated with childhood obesity is reviewed. These studies suggest that risk of cardiovascular disease and all-cause mortality is elevated among those who were overweight during childhood. The high prevalence and dramatic secular trend toward increasing childhood obesity suggest that without aggressive approaches to prevention and treatment, the attendant health and social consequences will be both substantial and long-lasting.

AIM: To explore the relationship between self-reported weight and height to actual weight and height in a crosssectional nationally representative sample of young adolescents. METHODS: Weights and heights were obtained on 1932 adolescents aged 12 ± 16 y enrolled in the NHANES III study. Self-reported weights and heights were available on 1657 of the adolescents (86%). RESULTS: Correlation between self-reported weight and actual weight ranged between 0.87 and 0.94, depending on gender or race. However, self-reported weights were signi®cantly lower than measured weights among girls, compared to boys (P`0.001). Correlation between self-reported height and actual height ranged from 0.82 ± 0.91. There were no differences in the accuracy of self-reported heights among boys and girls or racial groups. Differences between actual weight and self-reported weight were signi®cantly greater for obese children compared with nonobese children (P`0.001). Nevertheless, the use of self-reported weight and height resulted in the correct classi®ca-tion of weight status in 94% of children. As a result, small differences in self-reported weights and heights had no impact in assessing obesity related morbidities. CONCLUSION: In¯uences of gender and racial biases in reporting of weight and height were relatively small. Selfreported heights and weights were extremely reliable for the predicting obesity related morbidities and behaviours.

OBJECTIVE:To examine long-term safety and efficacy for weight loss of an herbal Ma Huang and Kola nut supplement (90=192 mg=day ephedrine alkaloids=caffeine). DESIGN: Six-month randomized, double-blind placebo controlled trial. SUBJECTS: A total of 167 subjects (body mass index (BMI) 31.8 AE 4.1 kg=m 2 ) randomized to placebo (n ¼ 84) or herbal treatment (n ¼ 83) at two outpatient weight control research units. MEASUREMENTS: Primary outcome measurements were changes in blood pressure, heart function and body weight. Secondary variables included body composition and metabolic changes. RESULTS: By last observation carried forward analysis, herbal vs placebo treatment decreased body weight ( 7 5.3 AE 5.0 vs 7 2.6 AE 3.2 kg, P < 0.001), body fat ( 7 4.3 AE 3.3 vs 7 2.7 AE 2.8 kg, P ¼ 0.020) and LDL-cholesterol ( 7 8 AE 20 vs 0 AE 17 mg=dl, P ¼ 0.013), and increased HDL-cholesterol ( þ 2.7 AE 5.7 vs 7 0.3 AE 6.7 mg=dl, P ¼ 0.004). Herbal treatment produced small changes in blood pressure variables ( þ 3 to 7 5 mmHg, P 0.05), and increased heart rate (4 AE 9 vs 7 3 AE 9 bpm, P < 0.001), but cardiac arrhythmias were not increased (P > 0.05). By self-report, dry mouth (P < 0.01), heartburn (P < 0.05), and insomnia (P < 0.01) were increased and diarrhea decreased (P < 0.05). Irritability, nausea, chest pain and palpitations did not differ, nor did numbers of subjects who withdrew. CONCLUSION: In this 6-month placebo-controlled trial, herbal ephedra=caffeine (90=192 mg=day) promoted body weight and body fat reduction and improved blood lipids without significant adverse events.

AIM: To explore the relationship between smoking and dieting in a cross-sectional nationally representative sample of young adolescents. METHODS: Smoking was assessed by serum cotinine concentrations in 1132 adolescents aged 12 -18 y enrolled in the NHANES III study. Information on adolescents' weight loss attempts were obtained by questionnaire. Normal weight was defined as a body mass index (BMI) less than the 85th percentile for age and gender. Overweight was defined as a BMI equal to or greater than the 85th percentile for age and gender. Nutritional intake was assessed with a 24 h recall and food frequency questionnaire. RESULTS: There was a two-fold increase in smoking among normal-weight adolescent girls who reported trying to lose weight (23.7% vs 12.6%, P < 0.01). In contrast, prevalence of smoking was similar among overweight adolescent girls who tried to lose weight compared to those who did not (15.8% vs 14.1%, P ¼ 0.76). Similar trends were observed in boys. However, overweight boys who were trying to lose weight were less likely to smoke than overweight boys who were not trying to lose weight (9.8% vs 24.5%, P < 0.05). There were no differences in body weight, BMI, caloric intake or fat intake among smokers and non-smokers. However, smokers reported eating less fruit and vegetables compared to non-smokers, and were over five times more likely to drink alcohol compared to non-smokers (odds ratio: ! 1Â=month, 5.28 (3.82 -7.28), ! 4Â=month, 5.29 (3.58 -7.82). CONCLUSION: Tobacco use is common among normal weight adolescents trying to lose weight. Tobacco use is also associated with a cluster of other unhealthy dietary practices in adolescents.

Objective: The objective was to review retrospectively all patients undergoing bariatric surgery at a large university medical center. Methods: Ten adolescents 17 years or younger underwent gastric bypass surgery; 7 of 10 adolescents had severe obesity‐related morbidities. Follow‐up>1 year was present in 9 of 10 adolescents. Results: The average weight before surgery was 148 ± 37 kg. Postoperative recovery was uneventful in all adolescents; 9 of 10 adolescents had weight loss in excess of 30 kg (mean weight loss was 53.6 ± 25.6 kg). Obesity related morbidities resolved in all adolescents. Five adolescents had mild iron deficiency anemia, and 3 adolescents had transient folate deficiency. Late complications requiring operative treatment occurred in 4 of the adolescents. Conclusion: Gastric bypass surgery was an effective method for weight reduction in morbidly obese adolescents. The procedure was well tolerated, with few unanticipated side effects. Gastric bypass remains a last resort option for severely obese adolescents for whom other dietary and behavioral approaches to weight loss have been unsuccessful.