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U.S. Childhood Obesity Epidemic: Treatment and Prevention

Medically reviewed by Leigh Ann Anderson, PharmD. Last updated on May 3, 2022.

Childhood obesity is a national public health concern in the U.S., and a major worry for parents and clinicians alike. According to the latest data from the U.S. Centers for Disease Control and Prevention (CDC), the prevalence of obesity in children and adolescents aged 2 to 19 is 19.3% in the U.S., which equates to 14.4 million children.

Studies have shown rate of obesity among children age 5 to 11 rose during the COVID-19 pandemic as well, as a more sedentary lifestyle set in. On average, 5 year olds gained about 12.5% of their weight, while 11-year olds gained 6%. The percent of children in this age range considered overweight or obese skyrocketed from 36% to 45.7%.

And the costs of childhood obesity add up in terms of dollars, too. As published in Pediatrics from researchers at Duke University, childhood obesity costs roughly $14 billion each year. Expenses can balloon due to prescription drug fees, emergency room visits, and outpatient doctor appointments. The added cost per obese child over a lifetime equates to $19,000 when compared to children with normal weights for age and height.

Rates of obesity in children

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

Latinos and African-American children tend to have higher rates of obesity than White or Asian populations.

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

  • Non-hispanic blacks 24.2%
  • Hispanics 25.6%
  • Non-hispanic whites 16.1%
  • Non-hispanic Asians 8.7%

A study published in Pediatrics looked at data drawn from the National Health and Nutrition Examination Survey (NHANES) for years 1999 to 2016. The report stated that roughly 29% of children ages 2 to 19 were overweight in 1999; however, by 2016, that number had risen to 35%. 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 being overweight or obese 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.

How is Body Mass Index (BMI) calculated for children and adolescents?

Body Mass Index (BMI) is a screening tool used to assess weight issues in children. BMI is a person’s weight in kilograms divided by the square of height in meters. Obesity in children is defined as a BMI at or above the 95th percentile for children of the same age and gender (using the CDC sex-specific BMI-for-age growth charts). 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.

BMI helps to identify children who are gaining weight too slowly or quickly. 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.

The CDC has an online calculator that can be used to calculate BMI in children.

Childhood Body Mass Index Ranges (2 to 19 years of age)

Weight Status Category Corresponding BMI Percentile Range
Underweight Lower than the 5th percentile for age, gender, and height
Healthy weight At or above the 5th percentile to lower than the 85th percentile for age, gender, and height
Overweight At or above the 85th percentile and lower than the 95th percentile for age, gender, and height
Obesity At or above the 95th percentile for age, gender, and height
Severe obesity 120% of the 95th percentile

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

Health complications

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

Causes of childhood obesity

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. That's why it's important to consult with your doctor to make a long-term plan for weight loss for your child.

Tackling the causes of childhood obesity start 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.

Contributors to childhood obesity

Risk factors leading to weight gain in children involve types of diet, activity level, and social or economic matters.

  • 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.
  • Psychological factors, such as stress at home or at school can increase the risk for obesity.
  • Socioeconomic issues, such as lack of resources to buy fresh food or inability to have a safe area to play outside can contribute to weight gain.

Treatment of obesity in children

Treatment for weight concerns in children usually begin with changes in eating habits and amount of daily physical activity. Use of medication or weight loss surgery are other options your doctor might recommend, but are not used in most circumstances.

Weight loss

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.

For overweight children 2 years and older, the American Academy of Pediatrics (AAP) recommends a weight-maintenance program to slow weight gain, but still allow the child to grow taller. This will allow the BMI to normalize over time, as they gain height and weight gain slows.

Children who are obese and 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. This may be achieved by altering eating habits, as suggested above. Parents should remain involved to encourage diet modification and increased physical activity.

Appropriate choices by parents, such as selection of healthy grocery items, regular and well-balanced meals, limited snack allowance, and restrictions on screen time can promote weight loss. A few tips to help avoid excessive calories and weight gain include:

  • Offer more fruit and vegetables at mealtime instead of processed food
  • Use water to replace sugary drinks; select low-fat or far-free milk and dairy products
  • Children should help plan meals to learn about healthy choices
  • Allow children to leave food on their plate if they are full
  • Never use food as a punishment or reward
  • Cut back on TV or electronics time
  • Avoid fast-food
  • Enjoy mealtime together as a family away from the TV or computer; enjoy conversation, eat slowly
  • Be aware of portion sizes, especially at restaurants
  • Make sure kids get enough sleep; lack of sleep can lead to weight gain.

Activity

In addition to a healthy diet, physical activity is critical to help children reach and maintain any weight loss goals. Ways to increase activity levels include:

  • In general, limit electronic (TV, video, phone, computer) to no more than 1 hour per day for children 2 to 5 years of age. Children under the age of 2 should not watch any TV or use of electronics (except for limited video chatting).
  • Engage in a variety of fun, moderate to vigorous activities for at least one hour per day. Hiking, running around, playing at the park, swimming, riding the bike, or going for walks are all fun, calorie-burning activities.
  • Involve the family so active time or exercise is not focused on just one person.
  • The AAP suggests that parents and caregivers develop a tailored plan that looks at the health, education and entertainment needs of each individual child as well as the whole family; and then follow the family media plan together, revising it when necessary. The AAP electronic tool to develop a Family Media Plan can be found here.

Prevention

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 that obese children in kindergarten had a 4 to 5 times greater risk of being obese in eighth grade than their kindergarten classmates without weight issues.

Studies have also 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 -- for their children and for the entire family. Being a role model of good health will encourage the same in your children.

Active children are more likely to remain active into adulthood. Parents should adhere to the guidelines for activity levels and electronic usage in children to help their children maintain a healthy weight.

School lunches and weight gain

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 one-third to one-half of their daily calories at school, so healthy options at the cafeteria or in the lunch box are important.

In Feb 2022, the USDA announced stricter standards for school lunches, after an ease on fat and salt standards during the pandemic, according to the Washington Post. The goal is to reintroduce health goals that were cut during the Trump administration. Offerings will include low-fat or non-fat unflavored milk, more whole grains, and a 10% decrease in sodium for the 2023-2024 school year. As noted by the USDA, children from low-income families are affected by obesity at a higher level and are more likely to be fed unhealthy meals at home.

Bottom line for school lunches? Talk to your child about selecting healthy food choices at school, help them learn what food is healthy versus unhealthy, mirror that practice at home, and talk about what they ate at school each day.

Weight loss surgery in children

Up to 6% of American youth 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. Psychosocial issues can be involved, as well.

Your pediatrician can assess whether your teenager might be a candidate for weight loss surgery. If so, a referral for your child 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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