Childhood Obesity and Craniofacial Growth: A Cross-Sectional Orthodontic Cephalometric Study

Background and Objectives: Childhood obesity is a major global health concern and is increasingly recognized as a factor influencing skeletal development. Emerging evidence suggests that excess adiposity may alter craniofacial growth patterns, with potential implications for orthodontic diagnosis and treatment planning. However, the extent to which obesity affects craniofacial morphology in growing individuals remains incompletely understood. This study aims to evaluate the association between body mass index (BMI) and craniofacial morphology in children and adolescents using selected sagittal and linear parameters, and to assess the independent effects of age and sex. Materials and Methods: This cross-sectional orthodontic study included 130 subjects aged ≤ 19 years. Anthropometric measurements were recorded, and BMI was used to classify participants as normal weight, overweight, or obese. Standardized lateral cephalometric radiographs were analyzed using skeletal and soft-tissue parameters. Statistical analyses included normality testing, one-way ANOVA with post hoc comparisons, and multivariate modeling. Results: Obesity was significantly associated with increased sagittal skeletal dimensions. Mandibular body length, mandibular unit length, SNB angle, and maxillary unit length demonstrated progressive increases across BMI categories (p < 0.05). In contrast, vertical growth parameters showed no significant differences. Soft-tissue analysis revealed reduced facial convexity and lower facial height ratios in obese subjects. Age was strongly associated with increases in linear jaw dimensions, whereas sex differences were limited primarily to skeletal size rather than morphological relationships. Conclusions: Childhood obesity is associated with enhanced sagittal craniofacial growth, particularly involving mandibular structures, while vertical skeletal patterns remain largely unaffected. These findings highlight the importance of incorporating BMI assessment into orthodontic evaluation and suggest that obesity may influence growth timing, facial morphology, and airway-related risk factors.