1.1 Childhood obesity definition and classification Childhood obesity is a complex, multifactorial, ongoing medical condition characterized by an excessive accumulation of body fat that negatively impacts health general and increase the risk of numerous physical, psychological and metabolic impacts over the lifespan [1]. Its fast-rising incidence and relationship with early onset of non-communicable diseases has made it one of the most urgent public health issues worldwide. Unlike adults, childhood obesity cannot be defined using fixed Body Mass Index (BMI) cut-off values, because body composition, including fat mass and lean body mass, changes constantly with growth and varies according to age and sex [2,3]. Therefore, BMI in children is assessed in relation to age and sex specific reference standards, rather than as an absolute BMI score. The Body Mass Index (BMI) is the weight in kilograms divided by the square of height in meters (kg/m²) and remains the most widely accepted and practical screening measurement to assess overweight and obesity in children [2,4]. Although BMI is not a direct measure of body fatness, it has a strong association with adiposity at the population level and is affordable, reliable, and convenient to implement in clinical practice and epidemiological research [2, 6]. For children 2 years of age and older, BMI is expressed as a percentile for age and sex based on standardized growth charts. According to the Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics (AAP), BMI-for-age percentiles are used to classify weight status into underweight, healthy weight, overweight, and three classes of obesity. This classification facilitates early detection of excessive weight gain, enables timely implementation of preventive and therapeutic interventions, and supports consistent monitoring of growth and obesity trends in both clinical practice and public health research (2,3,5) Weight Status BMI- for-Age Percentile Underweight < 5th percentile Healthy weight 5th to < 85th percentile Overweight 85th to < 95th percentile Class 1 Obesity ≥ 95th percentile to <120% of the 95th percentile Class 2 Obesity ≥ 120% to < 140% of the 95th percentile Class 3Obesity ≥ 140% of the 95th percentiles Table 1. CDC Classification for childhood obesity Previous terminology such as extreme or morbid obesity has been replaced by the current classification of obesity into Class 1, Class 2 and Class 3. This new nomenclature reflects a person-first, non-stigmatizing language and provides a clinically meaningful assessment of disease severity and to guide appropriate care methods [3]. BMI is not usually utilized in children under 2 years of age. The World Health Organization (WHO) suggests using weight-for-length growth norms alternatively to assess obesity since no globally agreed definition for obesity based on BMI has been established for this age group [2,3]. BMI is still the standard screening tool for childhood obesity; however, it is considered an indirect marker of adiposity, not a direct measurement of body fat. Recent evidences underscore the need to define obesity as excessive body fat accumulation, not just increased body weight [6]. In 2025 an international global commission recommended a broader framework for diagnosis, in which BMI should be interpreted with at least one other anthropometric measure (e.g., waist circumference) and evidence of obesity-related organ dysfunction or functional impairment. The committee also established the term preclinical obesity, which are children with excess adiposity but without detectable organ impairment, underlining the need for early identification and appropriate management [6]. For this thesis chapter can you give the accurate and precise bibliography with citations

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