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Childhood Obesity: Is a U.S. Epidemic Really Improving?

Medically reviewed by L. Anderson, PharmD. Last updated on Sep 3, 2018.

Childhood Obesity in America

Childhood obesity is a national public health concern for the U.S., and a major concern for parents. According to the latest data from the Centers for Disease Control and Prevention (CDC), the prevalence of obesity in children and adolescents aged two to 19 is 18.5% in the United States, which equates to 13.7 million children. Since the 1980s, the obesity rate has doubled among two to 11-year-olds, and quadrupled in teens aged 12 to 19. 

Body Mass Index (BMI) is a screening tool used to access weight issues in children. Obesity in children is defined as a BMI at or above the 95th percentile for children of the same age and gender. Although BMI in children over two years of age, adolescents, and teenagers is calculated in the same way as it is for adults, the way doctors interpret the results is different. 

How is Body Mass Index (BMI) Calculated for Children and Adolescents?

Just like adults, doctors use a child's height and weight to calculate their BMI. However, the growth chart used to interpret the results is different because certain factors, such as age and gender, affect the amount of body fat in a child.

The Centers for Disease Control (CDC) growth charts incorporate these differences and allow translation of a BMI number into a percentile rank based on a child's gender and age. For children and adolescents 2 to 19 years of age:

  • Underweight is defined as a BMI lower than the 5th percentile.
  • Healthy weight is defined as a BMI at or above the 5th percentile to lower than the 85th percentile.
  • Overweight is defined as a BMI at or above the 85th percentile and lower than the 95th percentile for children of the same age and gender.
  • Obesity is defined as a BMI at or above the 95th percentile for children of the same age and gender.

A pediatrician will determine your child's pediatric BMI at each yearly well visit. The CDC and the American Academy of Pediatrics suggest using the BMI tool at age two years and older.

For children, BMI is used to screen for obesity, overweight, healthy weight, or underweight. However, BMI is not a diagnostic tool. For example, a child may have a high BMI for age and sex, but to determine if excess fat is a problem, a health care provider would need to perform further assessments. These assessments might include:

  • Skinfold thickness measurements
  • Evaluations of diet and physical activity
  • Review of family history of weight-related health risks
  • Other appropriate health screenings

Why is Childhood Obesity Concerning?

Children who are obese are more likely to continue being obese as adults. This increases their risk of developing significant health problems such as:

And the costs add up in terms of dollars, too. According to the Endocrine Society, childhood obesity costs roughly $14 billion each year, due to added prescription drugs, emergency room visits, and outpatient doctor appointments.

Obesity Statistics in Children

Latinos and African-American children tend to have higher rates of obesity than White or Asian populations. Latino boys (28.0%) and Black girls (25.1%) are most likely to be obese. The determination of being overweight or obese in children is different than in adults.

In the United States, rates of obesity among children aged 2 to 19 as reported by the CDC are:

  • Non-hispanic Blacks 22%
  • Hispanics 25.8%
  • Non-hispanic whites 14.1%
  • Non-Hispanic Asians 11.0%

Are Rates of Obesity in Children Really Improving?

In 2013, the CDC published in the Vital Signs Report that rates of obesity in some U.S. children were on the decline. The youngest of kids -- preschoolers ages 2 to 4 and from low income families -- saw a small but significant decline in their obesity rates between 2008 and 2011.

However, the prevalence of childhood obesity in the U.S. remains high, with roughly 1 in 5 children having obesity.

A recent 2018 study published in Pediatrics looked at data drawn from the National Health and Nutrition Examination Survey (NHANES) for years 1999 to 2016. The report states that roughly 29% of children ages 2 to 19 were overweight in 1999; however, by 2016, that number had risen to 35%. In fact, researchers noted that children aged 2 to 5 years and adolescent females aged 16 to 19 years showed a steep increase in obesity prevalence from 2015 to 2016 compared with the previous cycle.

The prevalence of overweight and obesity also increased with age, with 41.5% of 16- to 19-year-old adolescents being reported as obese. Racial disparities are still an issue, as they have been in former reports: higher rates of obesity are seen in Hispanic and African-American across nearly all classes of obesity. Socioeconomic status continue to play a role, too, with poorer groups at higher risk for obesity. 

The concerns for overweight and obesity in children are substantial. Overweight or obese children run the risk of having serious health-related risks at an early age, such as:

  • High blood pressure and high cholesterol that can lead to heart disease
  • Impaired glucose control and insulin resistance can lead to type 2 diabetes
  • Excess weight can lead to joint problems
  • Fatty liver disease, gallstones and reflux disease
  • Psycho-social issues due to body image which may continue into adulthood

What Causes Childhood Obesity?

Tackling the causes of childhood obesity often starts with the family life at home. Good eating habits, eating as a family, daily exercise, and portion control are important habits that can be encouraged and practiced at home -- by children and parents.

Being overweight or obese usually stems from one main problem: eating too many calories and not getting adequate exercise to burn off the excess consumed calories. However, genetic and hormonal problems can contribute to the problem in children, too.

Contributors to Childhood Obesity

  • Selection and provision of unhealthy and calorie-laden food and beverages at home, school, and daycare.
  • Sugary drinks, vending machine and fast-food access are associated with excess calorie consumption.
  • Lack of daily exercise at home and at school; children should get at least one hour of aerobic, physical activity each day.
  • Inadequate portion control leads to excess calories at mealtime.
  • Lack of education and support for breastfeeding, which is associated with a reduced risk for childhood obesity.
  • Use of electronics, such as computers, phones, video game consoles, and television viewing can interfere with time for exercise.

Other factors that can play into the excess consumption of calories and weight gain in children include lack of exercise, psychological factors, and socioeconomic factors, as reported by the CDC

All hope is not lost: studies have shown that a healthy diet as a teenager may increase the chances of a lifetime of healthy food choices and healthy weight as an adult. It's a goal parents should aim for -- with themselves and their children.

Inappropriate choices by parents, such as selection of grocery items, meals, snack allowance, and excessive screen time can lead to weight gain. A few tips to help avoid excessive calories and weight gain include:

  • Offer more fruit and vegetables at mealtime
  • Don't insist that kids clean their plates, but the parent should be in charge of meal planning to allow 
  • Cut back on TV or electronics time
  • Use water to replace sugary drinks; select low-fat milk and dairy products
  • Make sure kids get enough sleep; lack of sleep can lead to weight gain.

Complications of Obesity in Children

The complications of being overweight or obese for children are similar as in adults:

  • Type 2 diabetes
  • Metabolic syndrome
  • High cholesterol and blood pressure
  • Sleep apnea, breathing problems, asthma
  • Nonalcoholic fatty liver disease (NAFLD)
  • Early puberty or menstruation
  • Low-self esteem, bullying
  • Behavioral or learning problems
  • Depression

An approprate diagnosis and a more healthy lifestyle change can make a difference for children. An alarming report from University of Texas Medical Center in Houston noted one of the youngest children ever diagnosed with type 2 diabetes was a three year old toddler. Both her weight and BMI were in the top five percent of all children her age. However, after adequate training for the parents on a healthy diet, treatment of the toddler with a liquid version of metformin (Glucophage), and a boost in physical activity, the child was able to stop medication six months after diagnosis. At that time she had dropped 25 percent of her body weight and had normal blood glucose levels.

Read More - Metformin: 10 Things You Should Know

Treatment of Obesity in Children

Gradual weight loss through diet is the rule for weight loss in children. However, only put your child on a weight loss diet if it is recommended and monitored by your pediatrician. Treatment of obesity in children may begin at an early age to help combat a lifetime of possible weight issues. A study published in the New England Journal of Medicine found the risk that obese children in kindergarten would be obese in eighth grade was four to five times that of their classmates without weight issues.

According to the American Academy of Pediatrics, children aged 6 to 11 years should not lose more than one pound (or 0.5 kg) per month, while older children can aim for 2 pounds (1 kg) per week.

Avoid crash diets and weight loss supplements; instead choose healthy eating, added physical activity, and a family approach to a nutritious diet. Tips for healthy eating include:

  • Select fresh fruits and vegetables at the store over processed food
  • Limit sweetened beverages and fruit juices that can load up on empty calories
  • Stay away from fast-food
  • Enjoy mealtime together as a family away from the TV or computer
  • Be aware of portion sizes and eat slowly; enjoy conversation
  • Allow children to leave food on their plate if they are full
  • Never use food as a punishment or reward

School Lunches and Obesity

Are you concerned about lunch at school and if it might contribute to weight gain in your child? The American Academy of Pediatrics reports that children get a third to half of their daily calories at school.

A recent study from the U.S. Food and Drug Administration (FDA) found that school lunch guidelines put in place back in 2012 are improving students' eating habits. The new guidelines aimed to provide students with more fruits, vegetables, whole grains, fat-free or low-fat milk, and lower amounts of salt and saturated fats.

The FDA found that there was a 4 percent decline in the total lunch calories. Calories from fat fell 18 percent and salt consumption decreased 8 percent. However, students who received free and reduced-price lunches were more likely to choose entrees with higher levels of fat. This is a concern as this pediatric demographic is most likely to have obesity-related health risks. Bottom line for school lunches? Talk to your child about healthy food choices at school, help them learn what food is healthy versus unhealthy, and talk about what they ate at school each day.

In 2017 the Trump administration reversed some of the nutritional school lunch benefits enacted under President Obama in 2012. Former First Lady Michelle Obama was an advocate for healthy food choices and helped champion healthier lunches. With Trump, the Department of Agriculture has noted that requirements were relaxed on salt, whole-grain, and fat content of flavored milk (1% flavored milk instead of fat-free flavored milk).

Changes implemented with the Obama administration may remain as many vendors have already changed their products, and some feel the Trump changes may not have a big impact. Others, such as experts from the American Academy of Pediatrics state that "salt has no nutrition benefit and can contribute to unhealthy diet as a whole" and "whole grains are important for growth and development." Future assessments should aim to evaluate how these changes affected nutrition.

Can Obese Children Have Weight Loss Surgery?

Up to 6 percent of American youths are severely obese, and these numbers may be rising. Weight loss surgery may be an option for some severely obese teenagers who have not lost weight with traditional weight loss measures. These teens may also end up with serious obesity-related medical conditions such as high blood pressure, diabetes, and sleep apnea.

Your pediatrician can assess whether your teenager might be a candidate for weight loss surgery. If your child is a candidate, a referral will be made to a weight loss surgeon and a team of experts. Your family will discuss the pros and cons of surgery, and any possible complications, with this team.

Weight loss surgeries can be expensive, so are they effective in teens? A study published in JAMA Surgery found that weight-loss surgery was not cost-effective over the first three years following the procedure, but it could become cost-effective over five years. The experts noted that life-altering weight loss could lead to prevention of disease and also allow patients to avoid lifelong social stigma that may come with obesity.

Learn More: Surgery for Weight Loss: What Are the Options?

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