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82 Chapter 3 For fecal incontinence (with or without FC), overweight and obesity were both significantly more prevalent in the patient group (25% and 25%, respectively) compared with both healthy control groups (overweight control group 1: 13%; overweight control group 2: 15%; obesity control group 1: 8%; obesity control group 2: 11%; comparisons are further specified in Table 3). Wagner et al . 29 recently published a prospective case-control study describing 43 children who presentedwith fecal and/or urinary incontinence problems, including 17 children (40%) with fecal incontinence. Of these 17 children with fecal incontinence, 14 (82%) were found to have FC based on the Rome III criteria. The authors compared children with incontinence (both urinary incontinence and fecal incontinence) to 44 matched healthy controls. There was no statistically significant difference in FC prevalence between BMI groups. In children with fecal incontinence (both FNRFI and FC-associated fecal incontinence), the rate of obesity was high (24%) compared with controls (0% obese, 14% overweight; no statistical analysis reported). Group 3: Prevalence of overweight, obesity, and FDDs in pediatric population-based studies In a survey study among 450 healthy children in the United States, Phatak et al. 9 found that FC was significantly more prevalent in overweight and obese children (44/191, 23%) than in normal-weight children (36/259, 14%). 9 The odds ratio for having FC in the combined overweight and obese population was 1.83 ( P = .01). An important feature of this study was that a logistic regression analysis was performed after including factors such as age, gender, ethnicity, and recruitment site. Costa et al. 30 performed a study in 1,077 adolescents (10–18 years) in Brazil. They defined constipation according to a combination of pediatric and adult Rome III criteria (Table 4). Overweight was defined as a BMI >85th percentile, and this study did not differentiate further between obesity and overweight. They found no association between overweight and constipation in adolescents. However, in a subanalysis in constipated adolescents, an association between overweight and fecal incontinence was confirmed; fecal incontinence occurred in 8/28 (29%) of overweight patients versus 14/168 (8%) in nonoverweight patients. In the most recent study on this topic, our research group investigated 2,820 Colombian school children by using a Spanish translation of the Questionnaire on Pediatric Gastrointestinal Symptoms-Rome III Version and anthropometric measurements. 21 In this sample, FC was not significantly more prevalent in children who were obese (28/188, 15%) or overweight (71/542, 13%) compared with children with normal weight (269/2,090, 13%).