Etiology and Pathophysiology Factors associated with development of excessive fatness in children and adolescents: a review of prospective studies R. R. Pate 1 , J. R. O’Neill 1 , A. D. Liese 2 , K. F. Janz 3 , E. M. Granberg 4 , N. Colabianchi 5 , D. W. Harsha 6 , M. M. Condrasky 7 , P. M. O’Neil 8 , E. Y. Lau 1 and S. E. Taverno Ross 1 1 Department of Exercise Science, University of South Carolina, Columbia, South Carolina, USA; 2 Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, South Carolina, USA; 3 Department of Health and Human Physiology, University of Iowa, Iowa City, Iowa, USA; 4 Department of Sociology and Anthropology, Clemson University, Clemson, South Carolina, USA; 5 Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA; 6 Chronic Disease Epidemiology and Health Delivery, Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA; 7 Department of Food, Nutrition, and Packaging Science, Clemson University, Clemson, South Carolina, USA; 8 Department of Psychiatry and Behavioral Services, Medical University of South Carolina, Charleston, South Carolina, USA Received 19 December 2012; revised 26 February 2013; accepted 27 February 2013 Address for correspondence: Dr RR Pate, Department of Exercise Science, Arnold School of Public Health, University of South Carolina, 921 Assembly Street Suite 212, Columbia, SC 29208, USA. Email: rpate@mailbox.sc.edu Summary The purpose of this review was to examine the factors that predict the develop- ment of excessive fatness in children and adolescents. Medline, Web of Science and PubMed were searched to identify prospective cohort studies that evaluated the association between several variables (e.g. physical activity, sedentary behav- iour, dietary intake and genetic, physiological, social cognitive, family and peer, school and community factors) and the development of excessive fatness in children and adolescents (5–18 years). Sixty-one studies met the eligibility criteria and were included. There is evidence to support the association between genetic factors and low physical activity with excessive fatness in children and adoles- cents. Current studies yielded mixed evidence for the contribution of sedentary behaviour, dietary intake, physiological biomarkers, family factors and the com- munity physical activity environment. No conclusions could be drawn about social cognitive factors, peer factors, school nutrition and physical activity envi- ronments, and the community nutrition environment. There is a dearth of longi- tudinal evidence that examines specific factors contributing to the development of excessive fatness in childhood and adolescence. Given that childhood obesity is a worldwide public health concern, the field can benefit from large-scale, long-term prospective studies that use state-of-the-art measures in a diverse sample of children and adolescents. Keywords: Childhood obesity, dietary intake, fat mass, physical activity. obesity reviews (2013) 14, 645–658 Introduction Childhood obesity has reached epidemic proportions and has become a critical public health threat. Over the past 30 years, the prevalence of obesity has more than doubled for both preschool children and adolescents, and has more than tripled for elementary school children (1). Currently, 33.2% of children and adolescents (ages 6–19 years) in the United States are overweight or obese (1). The burden of obesity is disproportionately high among minorities; obesity reviews doi: 10.1111/obr.12035 645 © 2013 The Authors obesity reviews © 2013 International Association for the Study of Obesity 14, 645–658, August 2013