CHAPTER ONE Epidemiology of Childhood Obesity Megan E. Rose, Jinyu Xu, and Ihuoma U. Eneli The foundation of good health is established in childhood and continues to affect adults throughout their lives. Without a strong early foundation, unhealthy lifestyle be­hav­iors are easy to adopt and can lead to chronic health conditions that over time prove increasingly difficult to reverse. One such preventable chronic health condition is childhood obesity. Currently, 18.5 ­ percent of ­children aged 2–19 years in the United States are obese (Hales, Carroll, Fryar, & Ogden, 2017). The prevalence of obesity in ­children across all ages, gender, racial groups, and geographic bound­ aries has increased significantly over the last three de­cades. Paralleling this trend is the rising economic burden of managing the condition and the emergence of serious weight-­related medical complications at younger ages. The significant surge in prevalence has brought visibility to the prob­ lem and has intensified the search for risk ­ factors, causal mechanisms, and treatment modalities. However, an impor­tant first step in tackling the prob­ lem of obesity is to understand the epidemiology of childhood obesity: What ­factors or combination of ­factors makes a child become obese? Precise mea­sure­ment of body fatness is ideal but difficult and costly to obtain, especially in clinical settings or epidemiologic studies. Instead, to estimate body fat, investigators often rely on techniques such as body mass
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