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Childhood obesity is the condition of being overweight or severely overweight which causes risks to health between the ages of 2 and 19.
(Illustration by GGS Information Services/Thomson Gale.)
Childhood obesity is of increasing concern as a public health problem in the United States. Overweight and obesity are defined by most healthcare professionals using the Body Mass Index (BMI). BMI is a calculation that compares a person’s weight and height to arrive at a specific number. For details of how to calculate BMI see the body mass index entry.
Children between the ages of 2 and 19 are assigned a percentile based on their BMI number. The percentile tells them how their weight compares to that of other children who are their same age and gender. For example, if a boy is in the 65th percentile for his age group, 65 of every 100 children who are his age weigh less than he does and 35 of every 100 weigh more than he does. Adult BMI is interpreted differently.
The BMI weight categories for children are:
There is some debate about what to call children who are in the at risk for overweight and overweight categories. Some healthcare organizations such as the American Obesity Association use the term overweight for those at or above the 85th percentile and obese for those at or above the 95th percentile. The National Institutes of Health prefers to avoid applying the term obese to children, in part because of the social stigma the word carries. Whatever term is used to describe children in the top 15th percentile, these.
There is no doubt that American children are getting heavier, and although the problem of overweight is growing fastest in the United States, the trend toward heavier children is occurring in most in most developed countries. In the United States, the National Center for Health Statistics has tracked children’s weight for several decades and recorded the following changes in the percent of children who are overweight (above the 85th percentile):
In terms of numbers, this means that 12.5 million children were overweight in 2003-04. During the same time, 32.2% of adults, or 66 million people, were obese. Other surveys have found the total obesity rate among children and adolescents to be between 21% and 24%.
Significant differences exist in the number of children who are overweight in different races and ethnic groups, and these mirror the differences in the adult population. Significantly more Mexican American boys are overweight than non-Hispanic black or white boys. Significantly more Mexican American girls and non-Hispanic black girls are overweight than white girls. Native Americans and Hawaiians also have higher rates of overweight than whites.
At its simplest, overweight is caused by taking in more calories than the body uses. This difference is
called the “energy gap.” A 2006 study done by the Harvard School of Public Health and published in the journal Pediatrics found that, on average, American children consumed between 110 and 165 extra calories than they use up every day. Over a 10-year period, these extra calories would add 10 lbs to their weight. However, already overweight teens took in an average of 700-1,000 extra calories every day, resulting in an average of 58 extra pounds.
There are many reasons why the energy gap exists, these reasons are related to both increased food intake and decreased energy use. Food intake reasons include:
Inadequate energy use reasons include:
Other factors that affect childhood obesity include an inherited tendency toward weight gain, mental illness, binge eating disorder, and eating in response to stress, boredom, and loneliness, poor sleeping habits, and having at least one obese parent.
In rare cases, medical or genetic disorders can cause obesity. For example, Prader-Willi syndrome is a genetic disorder that causes an uncontrollable urge to eat. The only way to prevent a person with Prader-Willi disorder from constant eating is to keep them in an environment where they have no free access to food. Other genetic and hormonal disorders (e.g. hypothyroidism) can cause obesity. Certain medications also can cause weight gain (e.g. cortisone, tri-cyclic antidepressants), but these situations are the exception. Most children are too heavy because they eat to much and/or exercise too little.
The most obvious symptom of obesity is an accumulation of body fat. Other symptoms involve changes in body chemistry. Some of these changes cause disease in children, while others put the child at risk for developing health problems later in life. Children who are overweight are at increased risk of:
Diagnosis is usually made on the basis of the child’s BMI. To better assess the problem, the physician will take a family history and a medical history and do a complete physical examination, including standard blood and urine tests. A thyroid hormone test may be done to rule out hypothyroidism as the cause of obesity. Based on the physician’s findings, other tests may be performed to rule medical causes of obesity.
Overweight children and their parents may be referred to a registered dietician or nutritionist who can help them develop a plan for eliminating empty calories and increasing the amount of nutrient-rich, low-calorie foods in their diets. Nutrition education usually involves the entire family. Children may be asked to keep a food diary to record everything that they eat in order to determine what changes in behavior and diet need to be made. Typically, children are encouraged to increase their level of exercise rather than to drastically reduce calories.
Drug therapy and weight-loss surgery are very rarely used in children, except in the most extreme cases of health-threatening obesity when other methods of weight control have failed. Some teenagers benefit from joining a structured weight-loss program such as Weight Watchers or Jenny Craig. They should check with their physician before joining.
Teaching children how to eat a healthy diet sets a framework for their lifetime eating habits. A nutritionist or dietitian can help families to understand how much and what kinds of food are appropriate for their child’s age, weight, and activity level.
The American Heart Association has adapted the following dietary suggestions from the federal Dietary Guidelines for Americans 2005. These guidelines apply to people over age 2. Separate guidelines exist for infant nutrition.
It is often difficult for parents to understand how much food their child should eat at a particular age. Parents tend to overestimate the amount of food small children need. The daily amounts of some common foods that meet the American Heart Association guidelines for different ages are listed below. These amounts are based on children who are sedentary or physically inactive. Active children will need more calories and slightly larger amounts of food.
Children who are overweight often have psychological and social problems that can be helped with psychotherapy in addition to nutritional counseling.
The younger the child is when weight control strategies begin, the better the chance that the child will be able to maintain a normal weight. When it comes to weight control, one advantage children over adults is that they grow. If a child can maintain his weight without gaining, he may grow into a normal weight as he becomes taller. Parents need to be careful about how they approach weight loss in children. Critical comments about weight from parents or excess zeal in putting their child on a rigorous diet can trigger eating disorders such as anorexia nervosa or bulimia nervosa in some children, especially adolescent girls.
Children who remain overweight have a much greater likelihood of being overweight adults with all the health problems that obesity brings. Studies have found that 26–41%of preschoolers who are obese become obese adults. In school-aged children, 42–63% of children with obesity become obese adults. The greater the degree of overweight, the higher the likelihood that overweight will continue into adulthood.
Parents must take the lead in preventing obesity in children. Some of the ways they can do this are:
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Hassink, Sandra,. ed. A Parent’s Guide to Childhood Obesity: A Road Map to Health. Elk Grove Village, IL: American Academy of Pediatrics, 2006.
Koplan, Jeffrey P., Catharyn T. Liverman, and Vivica I. Kraak, eds. Preventing Childhood Obesity: Health in the Balance. Washington, DC: National Academies Press, 2005.
Okie, Susan. Fed Up!: Winning the War Against Childhood Obesity. Washington, DC: Joseph Henry Press, 2005.
Schumacher, Donald. Overcoming Obesity in Childhood and Adolescence: A Guide For School Leaders. Thousand Oaks, CA: Corwin Press, 2007.
World Health Organization. WHO Child Growth Standards: Length/height-for-age, Weight-for-age, Weight-for-length, Weight-for-height and Body Mass index-for-age: Methods and Development. Geneva: World Health Organization, 2006.
American Heart Association. “Dietary Recommendations for Children and Adolescents: AHA Scientific Statement.” Circulation 112 (2005):2061–2075. < http://circ.ahajournals.org/cgi/content/full/112/13/2061>
MacNeil, Jane S. “Pediatric Standards for BMI Miss 2.1 Million Overweight Teenagers.” Clinical Psychiatry News 32, no. 6 (June 1, 2004):39.
Strauss, Richard S. and Judith Knight. “Influence of the Home Environment on the Development of Obesity in Childhood.” Pediatrics 103 no.6 (June 1999):e85.
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American Academy of Pediatrics. 14 Northwest Point Blvd. Elk Grove, IL 60007. Telephone: (874)434–4000. Website: <http://www.aap.org>
American Heart Association. 7272 Greenville Avenue, Dallas, TX 75231. Telephone: (800) 242–8721. Website: <http://www.americanheart.org>
American Obesity Association. 1250 24th Street, NW, Suite 300, Washington, DC 20037. Telephone: (202) 776–7711. Fax: (202) 776-7712. Website: <http://www.obesity.org>
Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30333. Telephone CDC Contact Center: (800) CDC-INFO TTY: (888) 232-6348. Website: <http://www.cdc.gov>
Weight-control Information Network (WIN). 1 WIN Way, Bethesda, MD 20892-3665. Telephone: (877)946-4627 or (202) 828-1025. Fax: (202) 828-1028. Website: <http://win.niddk.nih.gov>
American Heart Association. “Dietary Guidelines for Healthy Children.” undated, accessed April 11, 2007. <http://www.americanheart.org/presenter.jhtml?identifier=4575>
Centers for Disease Control and Prevention. “About BMI for Children and Teens.” National Institutes of Health. August 26, 2006 <http://www.cdc.gov/nccdphp/dnpa/bmi/childrens_BMI/about_childrens_BMI.htm>
Centers for Disease Control and Prevention. “BMI Percentile Calculator for Child and Teen.” National Institutes of Health. August 26, 2006 <http://apps.nccd.cdc.gov/dnpabmi/Calculator.aspx>
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Tish Davidson, A.M.