India Specific Consensus Guidelines for the Management of Differences of Sexual Development.

Childhood obesity has become one of the most pressing global public health challenges, with its prevalence rising rapidly in both developed and developing countries. The World Health Organization (WHO) reports that the number of children and adolescents aged 5-19 years living with obesity globally surged from 11 million in 1975 to 340 million in 2023. In China, the 2020 National Nutrition and Chronic Disease Survey showed that the combined prevalence of overweight and obesity was 10.4% in children under 6 and 19% in those aged 6-17 years. It is estimated that Chinese children aged 0-19 are expected to bear substantial losses in disability-adjusted life years, with an estimated economic burden of $31.6 trillion and an average societal cost of $350 000 per affected child. Clinically, childhood obesity is associated with insulin resistance, hypertension, and psychosocial impairments. It is increasingly regarded as a pathological condition rather than merely a consequence of unhealthy lifestyles, and represents a key modifiable risk factor for numerous comorbidities, especially respiratory tract infections (RTIs). RTIs are among the most prevalent pediatric disorders, characterized by high incidence, diverse etiologies, recurrent episodes, and prolonged recovery periods, and they severely compromise children’s physical and mental health and constitute a major health background for children at enhanced obesity risk. Notably, the latest Global Burden of Disease (GBD) study identified lower RTIs as the leading cause of death in children under 5. An 80-year follow-up cohort study revealed that over 20% of premature respiratory-related deaths in adults were directly attributable to lower RTIs during early childhood. Epidemiological evidence suggests that children and adolescents with a history of RTIs may be more susceptible to obesity. Potential underlying mechanisms include RTI-induced disruptions in metabolic homeostasis, alterations in dietary and physical activity patterns during recovery, or induction of chronic low-grade inflammation, all of which may contribution to weight gain. Conversely, obesity can impair respiratory function and increase RTI susceptibility, forming a bidirectional relationship that exacerbates health risks. However, the specific factors influencing obesity development in children and adolescents with prior RTIs remain poorly understood, representing a big gap in pediatric research. It is widely recognized that obesity impacts respiratory health in children. In a study of 143 hospitalized children aged 1-5 years with acute RTIs, those with obesity had longer hospital stays, greater requirements of oxygen therapy, and higher rates of mechanical ventilation than their normal-weight counterparts. Other studies have demonstrated an inverse association between pulmonary oxygen uptake capacity and body mass index (BMI), with children with obesity exhibiting poorer baseline respiratory function and enhanced RTI susceptibility.