Childhood obesity

DEFINITION: Having a body mass index (BMI) above the normal range for age and sex in children

ANATOMY OR SYSTEM AFFECTED: Abdomen, blood vessels, circulatory system, endocrine system, gastrointestinal system, heart, intestines, joints, psychic-emotional system, respiratory system, stomach

Causes and Symptoms

A chronic or recurrent imbalance between energy expended (how active one is) and energy ingested (how much one eats and drinks) will lead to overweight and obesity. This will have short- and long-term impacts on health outcomes. When ingestion regularly exceeds expenditure, the unused energy is stored in adipose tissue, or body fat. From an evolutionary standpoint, animal species that developed the capacity to store fat had a better chance of surviving times of scarcity. Chronic storage of excessive energy, as commonly occurs when levels of physical activity are less, produces its own physical pathology. Almost every person who eats and drinks more than they use in energy (usually calculated in calories) will produce adipose tissue to store the excess energy.

Peptide hormones such as leptin and adiponectin regulate and balance energy expended with energy ingested. When leptin is absent (leptin deficiency), massive obesity is present; this condition improves when people are given leptin. Adiponectin, the most abundant hormone in fat cells, is also an insulin sensitizer and an anti-inflammatory signaler. Leptin and adiponectin, along with other peptide hormones, initiate a series of signaling processes that eventually lead to signaling hormones that turn on the food-seeking abilities of organs and muscles.

There is no international consensus on clinically meaningful cutoffs for the classification of overweight and obese children. Commonly used criteria include 110 to 120 percent of ideal weight for height; weight-for-height z-scores of > 1 and > 2; and the 85th, 90th, 95th, 97th percentiles for body mass index (BMI), which is calculated by dividing weight in kilograms by the square of height in meters squared. The US Centers for Disease Control and Prevention (CDC) recommendations in 2022 suggested that a BMI that is equal to or greater than the 85th percentile but less than the 95th percentile for sex and age should be considered overweight, a BMI equal to or greater than the 95th percentile for sex and age should be considered obese. In 2023 the American Academy of Pediatrics (AAP) recommended that all children between the ages of two and eighteen be screened for obesity.

Childhood obesity has many detrimental effects and comorbidities (associated diseases and disorders) that often extend into adolescence and adulthood. It is simplistic to say that obese children will become obese adults. Still, childhood obesity often produces a metabolic syndrome that greatly increases the risk that the individual will remain obese into adolescence and adulthood. This syndrome has serious implications for quality of life and life expectancy. Metabolic syndrome is a combination of hyperinsulinemia (high insulin levels), obesity, hypertension (high blood pressure), and dyslipidemia (abnormal lipid levels). Metabolic syndrome initiates a process that leads to an excess of insulin production, which in turn promotes hypertension and dyslipidemia. Together, these produce aortic and coronary atherosclerosis (hardening of the arteries) and clogging of the arteries by fatty deposits in the blood. According to the CDC, obese children are more likely to have risk factors for cardiovascular disease, such as hypercholesterolemia (high cholesterol) or hypertension. Obese adolescents are more likely to have prediabetes, a condition in which blood glucose levels indicate a high risk for the development of diabetes.

Genetic factors play a fundamental role in childhood obesity, as genetically obese families illustrate. People cannot exchange the genes that they have inherited, but environmental factors are also important, and these are the only ones that can be altered for the purpose of weight management. Societal factors also play a role. Studies have shown a link between the increased availability and consumption of ultraprocessed foods (UPFs) starting in the mid-twentieth century and an increase in obesity rates, including those among children and teens. In 2021, the Journal of the American Medical Association Pediatrics published a seventeen-year study that followed over 9,000 UK children who were born in the 1990s from ages seven to twenty-four. The study found that those who ate UPFs such as frozen pizzas and soft drinks were more likely to be overweight or obese as adults and that UPFs had comprised more than 60 percent of the children's diets.

The psychosocial impact of childhood obesity is no less serious than physical syndromes. It can contribute to poor body image, low self-esteem, social isolation, recurrent anger, early forms of eating disorders, clinical depression, and negatively acting out in school and other social settings. Promoting physical activity is as important an intervention to lessen the psychological harm of obesity as is controlling the amount and type of food and drink.

Treatment and Therapy

The most effective treatment for child obesity is prevention, which can begin shortly after birth. Research shows that breastfed children have significantly lower rates of obesity in later years. All children must gain weight as they grow, and having an adequate amount of fat cells during early antenatal development is critically important for maximal growth of key organs. Baby fat is important; its absence is problematic. As infants become toddlers and toddlers become children, the differences between healthy weight gains and weight gains that suggest the onset of obesity often require the expert eye of a pediatrician or family physician. A healthy five-pound weight gain in one five-year-old child may not be healthy in another child of the same age.

It is not until adolescence that children begin to play a significant role in choosing and purchasing their own food. Until then, whatever children eat is most likely what adults have purchased or provided. Preventing obesity and correcting it when it occurs requires thoughtful selection of food and beverage items at home and school. Fast food and take-out food are easy solutions to busy, hectic family schedules, but they are almost always obesity promoting. Junk-food snacks, also a quick solution to the transient hunger pangs of youth, are similarly harmful.

Prevention and treatment are almost one and the same when dealing with child obesity. For the most part, parents control their children's food, and making available a variety of healthy choices becomes an important part of achieving and maintaining healthy bodies that have modest amounts of adipose tissue. (It is worth noting that children with a BMI of less than 20 are considered underweight and also unhealthy.) Obesity is much less likely to occur in families and schools that support healthy lifestyles: balanced nutritional consumption, physical activity and exercise, and sufficient sleep. (As a group, children who consistently get less sleep than they need are more likely to be obese than are children who sleep enough. The specific number of hours any child might need is a function of several factors, including age.)

Successful school-based interventions in the management of obesity include a prioritization of physical education classes, healthy choices on the student menu and in vending machines, proportional servings, encouraging water as the main beverage, and the ready availability of after-school activities that involve physical activity, such as intramural sports. When these elements are not present, effective weight management for school-age children is difficult.

The key to successful long-term obesity prevention and treatment involves awareness of and respect for the individual child’s personal preferences and enjoyments, as nothing will enhance motivation more. Decreasing sitting time and the active encouragement of free play is far more effective than mandates to exercise or reduce food intake. Even in families where genetics play a major role in obesity, a healthy lifestyle will decrease the negative impact that obesity can have on the children’s overall health.

Perspective and Prospects

According to the CDC, in 2020 19.7 percent of US children and adolescents between the ages of two and nineteen were obesel this amounted to 14.7 million young people. Although the CDC reported that obesity in children between the ages of two and five decreased from 13.9 percent in 2003–4 to 13.4 percent in 2017–18, childhood obesity remains an epidemic that has achieved the status of a public health crisis. In 2023, these percentages generally remained the same with small increases indicated in the years 2018-2023 for each age group. This indicated, however, that the issue of childhood obesity was still a persistent problem in the United States. According to the World Health Organization (WHO), in 2022 more than 390 million children and adolescents between the ages of five and nineteen were overweight in 2022; 160 million of these young people were obese.

The global coronavirus 2019 (COVID-19) pandemic contributed to a rise in US rates of childhood obesity. According to a 2021 CDC study that examined 432,302 US children and teens between the ages of two and nineteen, the obesity rate increased from 19 percent before the pandemic (January 2018–February 2020) to 22 percent during the pandemic (March 2020 to November 2020). The authors of the study posited that school closures, sleep disruptions, altered physical activity schedules, stress, and social isolation all likely contributed to the increase.

Many socio-economic factors come into play with childhood obesity. People of color in the United States, particularly Blacks and Hispanics, show a higher prevalence of obesity. Communities formed of people of color are more likely to reside in economically challenged locations. What results are challenges to healthy dietary intake stemming from conditions such as the under-availability of large grocery chains. These communities may also lack access to free or low-cost recreational infrastructures that exist in greater numbers in more affluent areas. Similar conditions transcend beyond racial demographics and show themselves in rural areas. In these communities, the availability of sidewalks, biking lanes, and public parks can be much lower than in urban areas. Interestingly, the same demographics shown to be more vulnerable to higher obesity rates also showed higher incidences of Covid-19. These varied, but also inter-connected challenges result in a greater complexity needed to enact effective solutions.

Obesity has profound impacts on children’s long-term physical and psychological health and, more often than not, leads to serious comorbidities in adulthood that are costly to treat and difficult to control. Strategies that focus on modifying behavior and the slow but steady acquisition of healthy habits are the only ways children will learn to reliably manage the balance between calories consumed and burned. Adult habits, good and bad, are usually fostered during childhood. They reflect the level of care, attention, and perseverance of caregivers. Childhood obesity can be a problem of adult mismanagement much more than it is a problem of choices by children. Parents, caregivers, and teachers make a major contribution to children when they provide a health-oriented environment in which children are more likely to acquire the habits that will promote wellness throughout their lives.

Bibliography

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"Evidence-Based Guidelines for Childhood Obesity." Centers for Disease Control and Prevention, 7 May 2024, www.cdc.gov/obesity/hcp/about/evidence-based-guidelines.html. Accessed 25 Jul. 2024.

Laurence, Emily. "Obesity Statistics in 2023." Forbes,www.forbes.com/health/body/obesity-statistics/#. Accessed 5 Aug. 2023.

Neuman, Scott. "Children and Teens Gained Weight at an Alarming Rate During the Pandemic, the CDC Says." NPR, 17 Sept. 2021, www.npr.org/sections/coronavirus-live-updates/2021/09/17/1038211236/weight-gain-obesity-children-teens-pandemic. Accessed 28 Feb. 2022.

"Noncommunicable Diseases: Childhood Overweight and Obesity." World Health Organization, 19 Oct. 2020, www.who.int/news-room/q-a-detail/noncommunicable-diseases-childhood-overweight-and-obesity. Accessed 14 Jan. 2021.

"Obesity and Overweight." World Health Organization, 1 Mar. 2024, www.who.int/news-room/fact-sheets/detail/obesity-and-overweight. Accessed 25 Jul. 2024.