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79 Functional defecation disorders and overweight 3 Group 1: Prevalence of FDDs in obese children Fishman et al . 13 administered a self-developed bowel questionnaire to 80 consecutive pediatric patients presenting at an obesity clinic. They found a prevalence of FC of 23%, whichwas higher than the previously reported prevalence of 8.9% in the general population. They also observed that 12 (15%) obese children suffered from fecal incontinence; in 6 of them this was associated with FC. However, in the other 6 children (7.5% of the total obese population), it was not associated with FC and they were diagnosed as having nonretentive soiling, a disorder now referred to as FNRFI. Van der Baan-Slootweg et al . 12 evaluated the bowel habits of 91 morbidly obese children included in an obesity treatment trial, using questionnaires and a 2-week bowel diary. A physical examination was performed in all children, and a rectal examination was performed in 69 (76%) children. Nineteen of 91 (21%) morbidly obese children were found to have FC according to the Rome III criteria. In addition, colonic transit time (CTT) was determined in all study subjects by using a radiopaque marker test using the method described by Bouchoucha et al. 25 A prolonged CTT (>62 hours) was found in two (11%) children with constipation and in 6 (8%) children who did not have FC according the Rome III criteria. FNRFI was found in one patient and, as expected, CTT was normal in this child. Furthermore, food intake was measured by using a 7-day diary record kept by the children after instructions from a dietitian; no difference was found between the diet of children with or without constipation, including regarding fiber and fat intake. Group 2: Prevalence of overweight and obesity in children with FDDs In a prospective case control study, Kavehmanesh et al . 26 compared 124 childrenwith FCwith 135 controls (patients admitted for other diseases). Obesity (18% vs 12%) and overweight (33% vs 23%) were more prevalent in the FC group compared with the controls, but these differences were not statistically significant. The authors mentioned that the prevalence of both overweight and constipation found in this study (both in constipated children and controls) was much higher than found in a nationwide study (4% and 9%, respectively). 27 Teitelbaum et al . 28 performed a prospective case-control study to investigate the association between functional gastrointestinal disorders and overweight. They compared 757 children who presented to their pediatric gastroenterologist for upper and lower functional gastrointestinal disorders with two healthy control groups from a local pediatric practice (control group 1) and a high school (control group 2), comprising 1,691 controls. 28 Out of all children with FC ( n = 196), 37 (19%) were considered to be overweight and 45 (23%) were obese; the obesity rate in the FC group was significantly higher compared with the healthy controls (8% in control group 1 and 11% in control group 2, P < .001 for both comparisons).