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Increasing concerns focus on the effects ofobesity on morbidity and health-related quality of lifeissues, particularly in cases of paediatric onset ofobesity. However, the economic burden and long-termhealth consequences of extreme childhood obesity arelargely unknown and ill-defined because there havebeen no large prospective epidemiological studies thatincluded enough extremely obese children to deliverstable estimates of the health consequences.To address current gaps in the knowledge aboutthe health consequences of extreme childhood obes-ity, we created a contemporary cohort study of chil-dren and adolescents 2–19 years of age in southernCalifornia who are actively enrolled in a large, pre-paid, integrated managed healthcare system. TheKaiser Permanente Southern California (KPSC)Children’s Health Study is an ongoing cohort studythat currently includes 4920000 children and adoles-cents and continues to enrol new patients joiningthe health plan. The study is currently supported bya grant from the National Institute of Diabetes andDigestive and Kidney Disorders (R21DK085395;Principal Investigator: Koebnick) and by KaiserPermanente Direct Community Benefit Funds.Since 2007, new screening guidelines for paediatricweight management have been implemented at KPSCoffering a unique opportunity to fill current know-ledge gaps regarding the disease burden associatedwith childhood obesity. These guidelines include regu-lar screening of blood lipids, liver enzymes and mark-ers of glucose metabolism recommended for childrenat or above the 95th percentile of BMI-for-age accord-ing to the 2000 sex-specific Centers for DiseaseControl and Prevention (CDC) growth charts

Cohort Profile: The KPSC Children's Health Study, a population-based study of 920 000 children and adolescents in southern California