Child Obesity

Abstract

Obesity is a contentious topic in contemporary Western societies. While it is viewed as a medical and public health concern, it is accompanied by social connotations and moral judgments. To be obese is to be fat, overweight, plump, large, or big: these are all words that vary in meaning across time and place, as suggested by debates about how to accurately measure and differentiate overweight and obesity. Moreover, while obesity has been associated with wealth and affluence at different historical periods, in contemporary Western society it is historically linked with poverty and laziness, while leanness tends to be equated with discipline and moral virtue (Turner, 2012). People who are obese experience discrimination—for instance, in relation to employment hiring and even pay—while popular culture parodies, ridicules, and vilifies overweight individuals on television and in film. Moreover, treatments for weight loss (programs, pills, surgery) play on people's anxieties about obesity and send a message about its undesirability (Sanstad, 2006), while obesity and poor body image in their own rights, are linked to various mental health conditions (Guarnotta, 2023).

Overview

Obesity is a contentious topic in contemporary Western societies. While it is viewed as a medical and public health concern, it is accompanied by social connotations and moral judgments. To be obese is to be fat, overweight, plump, large, or big: these are all words that vary in meaning across time and place, as suggested by debates about how to accurately measure and differentiate overweight and obesity. Moreover, while obesity has been associated with wealth and affluence at different historical periods, in contemporary Western society it is historically linked with poverty and laziness, while leanness tends to be equated with discipline and moral virtue (Turner, 2012). People who are obese experience discrimination—for instance, in relation to employment hiring and even pay—while popular culture parodies, ridicules, and vilifies overweight individuals on television and in film. Moreover, treatments for weight loss—programs, pills, surgery—play on people's anxieties about obesity and send a message about its undesirability (Sanstad, 2006), while obesity and poor body image in their own rights, are linked to various mental health conditions (Guarnotta, 2023).

However, amid the contention about the cultural meanings attributed to obesity, there is public and professional concern about obesity in the United States and throughout the world. The Centers for Disease Control and Prevention (CDC) reported that from the early 1980s through 2011, obesity in children more than doubled. Between the 1980s and 2021, the obesity rate among adolescents more than tripled (World Health Organization, 2021). Indeed, some public health professionals and government agencies argue that this rise in child obesity reached epidemic proportions with about 18.5 percent of US children and adolescents obese in the 2010s, and by the 2020s, the total remained approximately the same, or higher, according to various reports. Obesity is problematic because it is correlated with hypertension, diabetes, heart disease, osteoarthritis, and other conditions that are costly in both dollars and in quality of life. Consequently, social, political, and economic responses to obesity have emerged that are, according to the Institute for the Future, transforming consumption, business, and health practices (Sanstad, 2006).

Measuring Obesity. According to the CDC, overweight and obesity refer to weight ranges that are greater than what is generally considered healthy for a given height. Overweight and obesity are gauged in terms of elevated Body Mass Index (BMI), which in adults is determined by first squaring one’s height in meters then dividing one’s weight in kilograms by the squared height. There are online calculators as well as conversion charts to simplify the procedure. For children and teens, height and weight are plotted against a gender-specific growth chart, which indicates the relative position of the child's BMI number among children of the same sex and age. Overweight for children is defined as having a BMI in the 85th to 95th percentile, while obesity for children is defined as having a BMI in the 95th percentile.

Some researchers (e.g., Ebbeling & Ludwig, 2008) have questioned the usefulness and accuracy of BMI in predicting obesity-related illness, since it does not provide key data such as body composition and fat distribution, nor do its interpreters routinely take confounding variables, such as racial and ethnic considerations, into account. Nonetheless, BMI has become the gold standard for measuring overweight and obesity. Using BMI, the US government has been tracking child height and weight since the 1970s as part of the National Health and Nutrition Examination Survey (NHANES). NHANES uses an in-person interview conducted in the home and in a private mobile examination center, where trained interviewers conduct a physical examination (including weight and height measures) and medical tests.

Rising Obesity Rates and a Leveling Off. According to data collected from a 2008 National Center for Health Statistics (NCHS) survey, the CDC reported a trend in increased obesity in the United States between 1980 and 2008, where the percentage of obese two- through five-year-olds more than doubled from 5 percent in 1980 to 10.4 percent in 2008. The percentage of obese six- to eleven-year-olds more than tripled during those years, from 6.5 percent in 1980 to 19.6 percent in 2008, as did the twelve- through nineteen-year-olds with 5 percent in 1980 and 18.1 percent in 2008. Data from a 2014 NCHS survey shows that the prevalence of obese two- through five-year-olds and six- through eleven-year-olds decreased to 8.4 percent and 17.7 percent, respectively, while the prevalence of obese twelve- to nineteen-year-olds increased to 20.5 percent.

This rise in obesity among children was seen as one of the fastest emerging public health issues in the United States. It was presented as "a relentless upward slope that threatens to undo progress on heart disease and exacerbate other killer illnesses influenced by weight, including diabetes, high blood pressure and some types of cancer" (Zarembo, 2008). Evidence from the CDC suggests, however, that obesity rates among children in the United States began leveling off, as there was not a significant rise in obesity levels between 2008 and 2012 (Ogden, Carroll, Kit, & Flegal, 2012; CDC 2014). Although this is taken as a positive sign by many, the goal to reduce childhood obesity rates is still unmet.

Racial disparities in child obesity are sharp. According to the CDC, in 2021, 24.8 percent of non-Hispanic Black children and 26.2 percent of Hispanic children were obese, compared with 16.6 percent of Whites and 9 percent of Asian children (Childhood obesity facts, 2022).

Obesity as a Global Issue. Childhood overweight and obesity are also problems seen on a global scale. For instance, childhood obesity levels in boys and girls between eleven and fifteen almost doubled in Britain between 1995, when 13.9 percent of boys and 15.5 percent of girls were obese, and 2004, when 24.3 percent of boys and 26.7 percent of girls were obese. From 2004 to 2011, however, those rates fell slightly in boys to 23.8 percent and more dramatically among girls to 16.5 percent (Eastwood, 2013). A May 2023 study from the Australian Bureau of Statistics reported that between 2018 and 2019, more than a quarter of children aged two to seventeen were overweight (Australian Bureau of Statistics, 2023). By 2022, this percentage did not shift dramatically, as 25 percent of Australian children were obese (Overweight and obesity, 2022).

The World Health Organization (WHO) has also identified obesity as an epidemic, even in developing countries—where it was estimated that the rate of increase for childhood was over 30 percent in the 2010s. In 2019 WHO reported that, worldwide, 41 million children five years old or younger were overweight or obese in 2016, compared to 32 million in 1990. By 2021, more than 39 million children under age five globally were overweight (World Health Organization, 2021). Obesity is especially a problem for children because their eating and physical activity habits become entrenched in ways that can contribute to life-long health problems.

Further Insights

Implications of Overweight & Obesity. Overweight and obesity contribute to a raft of health, social, and economic problems that are costly and sometimes debilitating (Sanstad, 2006). Elevated BMI is correlated with hypertension, diabetes, heart disease, osteoarthritis, and other conditions that are costly in both dollars and quality of life. According to the Surgeon General, "risk factors for heart disease, such as high cholesterol and high blood pressure, occur with increased frequency in overweight children and adolescents compared to children with a healthy weight," and overweight adolescents have a 70 percent chance of becoming overweight or obese adults. This increases to 80 percent if one or more parent is overweight or obese (Office of the Surgeon General, 2007).

One study found that being overweight was associated with the early appearance of cardiovascular disease risk factors among children between the ages of five and ten and with an increasing incidence of type 2 diabetes (Kaplan, Liverman & Kraak, 2005). Type 2 diabetes, previously considered an adult disease, has increased dramatically among children and adolescents. Diabetes is a leading cause of death in the United States according to the CDC, and increases the risk of heart disease and stroke, contributes to hypertension and nervous system diseases, and can cause blindness, kidney disease, peripheral vascular disease (potentially leading to amputation), and dental complications (Sanstad, 2006). One implication of the link between obesity and the early appearance of risk factors for these conditions is that children will live with the burden of disease for considerably longer periods of time than adults who develop these conditions. Researchers have shown that managing diabetes as a sixteen-year-old is quite distinct from managing it as an older person and has implications for self-identity and social status (e.g., Greene, McKiernan & Greene, 2008). Also, heart disease and other conditions take a physical toll that may contribute to comorbidity (Lobstein, 2008) and even reduced life expectancy.

However, children view social discrimination as the most immediate consequence of overweight and obesity, which in turn is associated with poor self-esteem and even depression. For instance, studies from Yale University and Monash University in Australia have reported that obese people experience a “culture of blame” in which they feel overwhelmed and disheartened by media portrayals of obesity (Doheny, 2008) and that women are more likely to feel prejudice if they are obese (Puhl & Andreyava, 2008).

Obesity also creates "significant economic burdens . . . [on] total health care costs in the United States" (Oliver & Lee, 2005, p. 924). It is estimated that hospital costs of treating children for obesity-associated conditions rose from US$35 million in 1979 to US$127 million in 1999 (Wang & Dietz, 2002) and rose again to $237.6 million in 2005 (Trasande & Liu, 2009). Overall, the economic costs of dealing with obesity related conditions are high, since this expenditure is funded mainly through Medicare and Medicaid (Sanstad, 2006).

The Causes of Obesity. There is considerable debate about the causes of obesity and overweight. On the one hand, obesity is viewed as a consequence of individual actions, such as poor nutritional choices and limited physical activity. On the other, there is some consensus that obese children especially are innocent victims of changes in their environment—in the food market, in schools and in childcare settings, and in the role of parents—that ill serve them (Anderson & Butcher, 2006). Overweight and obesity in children and adolescents is generally caused by a combination of the lack of physical activity and unhealthy eating patterns with genetics and lifestyle playing important roles in determining weight. Children who eat more "empty calories" and expend fewer calories through physical activity are more likely to be obese than other children (Anderson & Butcher, 2006). Moreover, contemporary Western societies have become very sedentary. For instance, children's leisure time typically involves access to television, computer, and video games, which, some suggest, have produced a generation of "couch potatoes."

Crouch, O'Dea, and Battisti identify the prevalence of an "obesogenic" environment, whereby modern lifestyles tend to foster an imbalance between energy intake and energy expenditure, resulting in excessive fat deposition (2006). The engendering of this environment is complex, but is, according to Paxson, Donahue, Orleans, and Grisso, attributable to a powerful cocktail that includes the proliferation of fast-food restaurants, many of which market their products to children through media campaigns organized around tie-ins to children's movies and TV shows (2006). In addition, there has been an increase in sugary and fat-laden foods displayed at children's eye level in supermarkets and advertised on television. Similarly, in some schools there is an increasing availability of energy-dense, high-calorie foods and drinks, while at the same time, physical education classes and recess opportunities have been reduced.

Additionally, changes in the family—particularly an increase in dual-career or single-parent working families—may have increased demand for food away from home or for pre-packaged foods (Anderson & Butcher, 2006). Indeed, market demands on working parents have made it difficult for many to find the time or energy to cook nutritious meals or supervise outdoor play. Grocery stores have shifted their locations from urban centers, reducing access to affordable fresh fruits and vegetables, especially for low-income households; and suburban sprawl and urban crime have limited the extent to which children engage in outdoor, physical activities, even such as walking to school (Paxson, Donahue, Orleans & Grisso, 2006). These problems engender an even greater obesity burden for ethnic minority and low-income groups (Kumanyika & Grier, 2006).

Viewpoints

Measures & Policies to Tackle Obesity. There is often the misperception that obesity is a moral failure. Hence, overweight and obese people are generally stigmatized for transgressing prevailing social ideals of appropriate body weight. Consequently, both public and professional opinion seem divided on whether overweight and obesity are individual and personal issues or whether government interventions should be instituted—such as regulating advertising aimed at children or monitoring public school lunches—to reduce the problems associated with childhood obesity and overweight. One 2005 study of public opinion found that Americans were generally less concerned by obesity as a public health problem than other issues such as cancer and heart disease, and although participants reported being aware of their own health (for instance, they exercised and paid attention to nutritional information), they were relatively unconcerned about obesity as a national health issue. Additionally, government intervention into the problems of obesity and overweight at both the national and state levels was limited at that time and was a low priority for most lawmakers (Oliver & Lee, 2005). By 2012, however, Americans considered obesity second to cancer as the nation’s most serious health issue, and obesity-related health concerns (such as diabetes and heart disease) were listed as third. And while the individuals surveyed did not support being taxed on “unhealthy” food nor did they support restrictions on consumer choices, they did support government intervention in the public schools (requiring, for example, more physical activity during the school day) and policies such as providing incentives to the food industry to create healthier choices (Associated Press–NORC, 2013).

In the United States, an expert committee comprised of representatives from fifteen professional organizations appointed experienced scientists and clinicians to recommend evidence-based approaches to the prevention, assessment, and treatment of childhood obesity and overweight (Washington, 2008). These recommendations emphasized obesity prevention messages, behavioral measures to promote healthy weight maintenance (accompanied by annual BMI monitoring), and weight-control interventions for those with excess weight. These measures focused on tracking individual children and offering messages and measures to prevent increases in or to maintain current weight. However, other interventions, which are supported by health, consumer, and public interest groups, focus on the cultural and physical environment and emphasize the role of regulatory constraints on what can be said—and how—about food.

In 2003, the US Food and Drug Administration (FDA) required that all trans fats be listed on the food labels of products, but only if there was more than one-half a gram of trans fats per serving. Ten years later, in November of 2013, the FDA announced that it would be instituting a timetable for the food industry to begin to completely remove all trans fats from their products. In June 2015, the FDA deemed partially hydrogenated oils, the main source of trans fat, no longer safe for use in food and ruled that companies would have until 2018 to remove them from all food products.

In the United States, some schools have eliminated soda machines, media coverage of obesity has proliferated, and even fast-food restaurants have introduced low-fat meals. For instance, "the Child Nutrition and WIC (Women, Infants, and Children) Reauthorization Act of 2004, required school districts that participate in the National School Lunch Program or School Breakfast Program to develop a local wellness policy by the beginning of the 2006-2007 school year" (Paxson, Donahue, Orleans & Grisso, 2006, p. 4).

Other proposals also include taxing sodas and snack foods, setting health mandates for school lunches, instituting standards for physical fitness education within schools, extending health and disability protections for the morbidly obese, requiring food labeling in restaurants, limiting food advertisements, and promoting greater levels of physical activity among adults through the creation of bike paths, sidewalks, or other programs (Oliver & Lee, 2005).

In 2010, President Barack Obama signed the Healthy, Hunger-Free Kids Act into law and First Lady Michelle Obama instituted the "Let's Move!" campaign with the goal of eradicating child obesity. Mandates of the act that were put into effect in the 2012–2013 school year included a requirement that children receive at least a half serving of fruits and vegetables with every meal served at school and that schools only serve fat-free or low-fat milk, whole grains, and reduced portions of meat. However, these adjustments also faced issues such as increased lunch prices and reductions in the number of children purchasing lunch at school. Part of the "Let's Move!" campaign aimed at offering more resources for nutritional education available to childcare providers; these trainings focused on daily physical activity, less screen time, and the encouragement of breastfeeding (Bobrovnyk, 2014).

Concern over childhood obesity has also prompted leaders outside of the United States to implement several initiatives. In England in 2005, for instance, the Department of Health (DH) announced a plan called the National Child Measurement Programme that would monitor and observe children’s weight and record a child’s weight and height upon entry into the school system and again in the final year of elementary school. In 2009, England implemented its first national marketing campaign, Change4Life, with the sole purpose of addressing the causes of obesity and promoting healthy behaviors in children and adults to prevent obesity and reduce obesity rates in that country.

In 2021, the World Health Organization (WHO) presented approaches to prevent childhood obesity, including individual measures and changes needed in the food industry (World Health Organization, 2021). WHO member countries were urged to analyze and take their respective cultures and political and economic climates into consideration when determining which approaches to implement. WHO suggested that to prevent obesity and overweight in children, governments should make population-wide policies such as requiring nutrition labeling on foods or restricting the marketing of unhealthy foods and beverages to children.

Overall, these measures point to a shift towards public regulation of private practices that have a bearing on individual health and that manage the public burden for disease (Sanstad, 2006). Government intervention in food markets and restaurant chains seems especially controversial. However, some researchers argue that markets and restaurants need to be persuaded to increase the information they provide to consumers to enable them to make more informed choices about the food they eat. Since children are not what Cawley calls "rational consumers" who can evaluate information and weigh the long-term costs, the government has a role to play in directing choices. Moreover, since society bears the economic costs of obesity, the government may have a role to play in lowering the cost to taxpayers.

Terms & Concepts

Body Mass Index: Calculated from measurements of height and weight, usually taken by health professionals—weight in kilograms divided by height in meters squared.

Comorbidity: The extent to which two conditions or diseases occur together in a given population.

Epidemic: When a condition or disease occurs in a population in numbers that exceed normal expectations.

Incidence: The number of new cases of a condition appearing in a population during a particular period.

Obesity: Range of weight that is greater than what is generally considered healthy for a given height. An adult with a BMI between twenty-five and twenty-nine is considered overweight.

Overweight: A range of weight that is greater than what is generally considered healthy for a given height. An adult with a BMI of over thirty is considered obese.

Prevalence: The number of cases of a condition that are present in a given population at a particular point in time.

Prevention: Averting the occurrence of health problems and diseases.

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Suggested Reading

Brownell, K.D., Puhl R., Schwartz, M.B. & Rudd, L. eds. (2005). Weight bias: Nature, consequences, and remedies. Guilford Publications.

Finkelstein, E.A., Fiebelkorn, I.C. & Wang, G. (2003). National medical spending attributable to overweight and obesity: How much, and who's paying? [Electronic version]. Health Affairs. Retrieved September 20, 2008, from http://content.healthaffairs.org/cgi/content/full/hlthaff.w3.219v1/DC1

Jackson, S. L., & Cunningham, S. A. (2015). Social competence and obesity in elementary school. American Journal of Public Health, 105(1), 153–158. Retrieved January 21, 2016, from EBSCO Online Database SocINDEX with Full Text. http://search.ebscohost.com/login.aspx?direct=true&db=sih&AN=99985231&site=ehost-live&scope=site

Mori, N., Armada, F., & Willcox, D. (2012). Walking to school in Japan and childhood obesity prevention: New lessons from an old policy. American Journal of Public Health, 102, 2068–2073. Retrieved November 4, 2013, from EBSCO Online Database SocIndex with Full Text. http://search.ebscohost.com/login.aspx?direct=true&db=sih&AN=82893844

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