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Perioperative paediatric obesity

Paediatric obesity is a worldwide epidemic with estimations of the prevalence of overweight and obese as high as 23.8% and 22.6% in paediatric and adolescent males and females, respectively. In the United States, significant increases in the prevalence of obesity in children were noted in the 1980s and 1990s but have since levelled off in 2010 at 16.9% overall. Moreover, about 12% of infants 6–23 months of age in the United States are considered overweight. The World Health Organization and the United States Centers for Disease Control have slightly different definitions of paediatric obesity based on body mass index, which leads to somewhat varied estimations of prevalence. Despite this, recent trends suggest the number of overweight and obese children presenting for elective and emergent procedures is increasing. A serious public health concern, paediatric obesity can accompany congenital or genetic comorbidities or be the cause of accelerated comorbidities such as cardiovascular disease, diabetes, and cancers that are typically associated with adult morbidity and mortality. This chapter describes the comorbidities that are typically associated with paediatric obesity as they become relevant in the perioperative period, summarizes surgical procedures in which paediatric obesity is common, and discusses peri-anaesthetic implications of the obese child or adolescent.