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75 Functional defecation disorders and overweight 3 INTRODUCTION Functional defecation disorders (FDDs) are commonly encountered in pediatric health care and comprise functional constipation (FC) and functional nonretentive fecal incontinence (FNRFI). 1,2 FC has a reported prevalence ranging from 0.7% to 29.6%. 3 FNRFI is less prevalent and estimated to occur in <1% of children in the general population. 2 FDDs are diagnosed according to the internationally accepted Rome III criteria (Table 1). 4 These disorders are known to have a significant impact on the quality of life. 5–7 The pathophysiology of FDDs is still incompletely understood, although genetic, biochemical, microbial, behavioral, and psychosocial factors have been suggested to potentially play a role. 1,2,8 More recently, several studies have suggested that there is an association between FDDs and overweight and/or obesity in children. 9–13 TABLE 1. Rome III criteria for functional defecation disorders in children Rome III criteria Children <4 years Children with a developmental age of ≥4 years Functional constipation 1. <3 defecations per week 2. ≥1 episode of fecal incontinence per week after the acquisition of toileting skills 3. History of excessive stool retention 4. History of painful or hard bowel movements 5. Presence of a large fecal mass in the rectum 6. History of large diameter stools which may obstruct the toilet Must fulfill ≥2 criteria for ≥1 month prior to diagnosis. 1. <3 defecations in the toilet per week 2. ≥1 episode of fecal incontinence per week 3. History of retentive posturing or excessive volitional stool retention 4. History of painful or hard bowel movements 5. Presence of a large fecal mass in the rectum 6. History of large diameter stools which may obstruct the toilet Must fulfill ≥2 criteria at least once per week for ≥2 months prior to diagnosis with insufficient criteria for the diagnosis of irritable bowel syndrome. Functional nonretentive fecal incontinence not applicable 1. Defecation into places inappropriate to the social context at least once per month 2. No evidence of an inflammatory, anatomic, metabolic, or neoplastic process that explains the subject's symptoms 3. No evidence of fecal retention Must fulfill all criteria for ≥2 months Pediatric overweight and obesity have emerged as a serious public health concern in the 21 st century. The global prevalence of childhood overweight and obesity has increased dramatically over the past decades; rising by 47% between 1980 and 2013: from 10% to 15%. 14 Obesity is known to cause various comorbidities, such as hypertension, dyslipidemia, and fatty liver disease. 15 Factors that may be involved in the pathophysiology of both FDDs