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 CDC Classification for childhood obesity Previous terminology such as extreme or morbid obesity has been replaced by the current classification of obesity into Class 1, Class 2 and Class 3.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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The actuality of the problem Obesity is defined as a chronic complex disease characterized by abnormal accumulation of body fat that poses a risk to health. From 1990 to 2022 the prevalence of overweight including obesity of children and adolescents aged 5-19 years increased dramatically from 8% to 20% and living with obesity increased by 2% to 8%. Over the past five decades, the prevalence of childhood obesity has grown globally Childhood obesity is a global pandemic with significant health consequence. Childhood obesity is no longer just an individual health issue but has become a serious global public health issue with far-reaching medical, psychological, social and economic consequences. Childhood obesity is a chronic, relapsing, and multifactorial disease that occurs because of a complex interaction of genetic predisposition, environmental influences, dietary patterns, physical inactivity, metabolic alterations, and psychosocial factors. The problem was exacerbated by the COVID-19 pandemic, which threw children’s routines into disarray with lockdowns and school closures, leading to less physical activity, more sedentary behaviour, unhealthy eating habits and a higher risk of excessive weight gain, all of which could add to the longer-term burden of childhood obesity. The consequences of childhood obesity on health are far more than just extra body weight. Obesity in children is associated with a substantially increased risk of developing insulin resistance, type 2 diabetes mellitus, dyslipidemia, arterial hypertension, non-alcoholic fatty liver disease, obstructive sleep apnoea, orthopaedic disorders, and psychosocial problems such as anxiety, depression, low self-esteem, and social stigmatization. Moreover, childhood obesity often carries into adulthood and is linked with an increased lifetime risk of cardiovascular disease, chronic kidney disease, some cancers, disability and premature death. Accurate evaluation of obesity in children is thus a critical component of modern paediatric practice. Current international guidelines emphasize that diagnosis should not be based solely on body weight but should also include standardized anthropometric assessment, growth monitoring, comprehensive clinical evaluation, and the identification of obesity-related comorbidities. The primary screening method is body mass index (BMI)-for-age; however, additional measures such as BMI percentiles, BMI-for-age Z-scores, growth charts, waist circumference, waist-to-height ratio, and the Tri-Ponderal Mass Index (TMI) improve adiposity and cardiometabolic risk assessment. Given the growing prevalence of childhood obesity, an in-depth understanding of current evaluation methods is crucial for improving early detection, making evidence-based clinical decision making, and alleviating the burden of obesity-related complications in children. PURPOSE AND OBJECTIVES OF THE RESEARCH Purpose of the Research Review the diagnostic approach to obesity in children including its definition, etiologic factors, clinical evaluation, associated comorbidities and evidence-based assessment strategies for early identification and risk stratification. Objectives of the Research • To define childhood obesity and describe the current diagnostic criteria used in paediatric clinical practice. • To review the epidemiology and global trends of childhood obesity. • To describe the principal anthropometric methods used in the evaluation of obesity • To review current international clinical guidelines for the evaluation and monitoring of children with obesity. Practical Importance of Work The practical importance of the thesis is that it generalises and analyses the up-to-date evidence on the assessment of childhood obesity and describes the standardised diagnostic approaches recommended by leading international organisations. This review summarises validated anthropometric and clinical assessment techniques that can help in early detection of obesity and obesity-related health risks in children. Can you give precise bibliography for this within last 10 years