Childhood obesity is one of the most serious global public-health challenges of the twenty-first century. Over the past four decades, the number of children and adolescents with obesity has risen more than tenfold. Worldwide, an increasing number of youth are facing greater exposure to obesity throughout their lives, and this increase will contribute to the early development of type 2 diabetes, fatty liver and cardiovascular complications. Herein, we provide a brief overview of trends in the global shifts in, and environmental and genetic determinants of, childhood obesity. We then discuss recent progress in the elucidation of the central role of insulin resistance, the key element linking obesity and cardiovascular-risk-factor clustering, and the potential mechanisms through which ectopic lipid accumulation leads to insulin resistance and its associated cardiometabolic complications in obese adolescents. In the absence of effective prevention and intervention programs, childhood obesity will have severe public-health consequences for decades to come.

儿童肥胖是二十一世纪最严重的全球公共卫生挑战之一。在过去的四年里，患有肥胖症的儿童和青少年人数增加了十倍以上。在世界范围内，越来越多的年轻人在他们的一生中面临着更多的肥胖风险，而这种增加将导致 2 型糖尿病、脂肪肝和心血管并发症的早期发展。在此，我们简要概述了儿童肥胖的全球变化趋势，以及儿童肥胖的环境和遗传决定因素。然后，我们讨论了在阐明胰岛素抵抗的核心作用方面的最新进展，这是连接肥胖和心血管危险因素聚集的关键因素，以及异位脂质积累导致肥胖青少年胰岛素抵抗及其相关心脏代谢并发症的潜在机制。在缺乏有效的预防和干预计划的情况下，儿童肥胖症将在未来几十年对公共卫生造成严重后果。