*4.2. Influence of BMI on Puberty and Growth*

We have confirmed previous observations pointing to accelerated skeletal maturation in children with obesity, resulting in a standardized height over their target height and directly correlated with the severity of obesity [12,13]. Interestingly, the follow up of a significant number of our patients over an extended period of time, some of them encompassing their entire pubertal development and growth spurt, confirms the lack of impairment of obesity-oriented intervention on growth and the attainment of adult height, which was equal to or slightly above that expected according to parental heights [13,14]. Additionally, we observed that the mean pubertal growth spurt in obesity is lower and inversely correlated with the severity of obesity. At the same time the presence of obesity seems to abolish the differences between sexes in the degree of the growth spurt observed in physiological conditions. This could be related to the acceleration in skeletal maturation and the relative childhood overgrowth observed in these patients [12,13]. In contrast, the mean pubertal duration (3.23 years) and time from Tanner stage II to menarche in girls (1.65 years) were similar to that of the general population, despite the inverse correlation observed between obesity severity and duration of puberty. It is clear that several factors such as sex, severity of obesity or the degree of advancement in skeletal maturation determine

the features of growth during childhood, and particularly during puberty. This should be taken into account when evaluating height, bone age and growth pace in children and adolescents with obesity as previously reported [12,23].
