The Perils of Childhood Obesity Sandra Bastin, PhD, RD Assistant Extension Professor University of Kentucky If there is an overweight child in your family, you’re not alone. The third National Health and Nutrition Examination Survey (NHANES III) conducted from 1988 to 1994, shows that 20% of children in the United States between the ages of 6 and 17, are overweight. In the last 30 years, that number has doubled. It appears children are just trying to keep up with their parents. The same study found that over one-third of adults are overweight as well. Pressuring children to be thin has not reduced the rate of obesity. It simply has resulted in a new set of health problems, including rampant body dissatisfaction, poor body image, low self-esteem and eating disorders.

Objectives What are the health risks of obese children? What are the causes of weight gain in children? What are healthy weight solutions for children that are easy to put into practice?

Childhood Overweight Definition Children at or above the 95th percentile of body mass index (BMI) by sex and age are considered overweight. BMI = Weight (kg)/Height2 (m) Technically the term obesity refers to an excess in body fat relative to lean muscle mass. But we often call these children obese. BMI measures how heavy the body is. The correlation between body fat and body heaviness is good, but not perfect. Some children who are growing normally may fall above these percentiles. So it is important for a health care professional to track and monitor a child’s growth.

National Growing Prevalence* Children Aged 6 to 11 Females Males White 9.2% 10.3% Black 16.4% 11.9% Mexican-American 14.3% 14.6% Children Aged 12 to 17 White 8.5% 11.1% Black 15.7% 10.7% Mexican-American 14.3% 13.7% *Troiana R, Flegal, KM. Overweight children and adolescents: Description, Epidemiology and Demographics. Pediatrics, 1998; 101(3): 497-503. Over the last 30 years, there has been a substantial increase in the number of children who are overweight in the United States. In the 1960s, it was 5%. In the 1990s, it was 11%.

Causes Heredity Ethnicity Poor Dietary Habits Family Lifestyle Socioeconomic Status Weight gain in children may be caused by many factors. Poor dietary habits, heredity, family lifestyle, socioeconomic status, and a child’s ethnicity, all play a role. Obesity is highest among Hispanic, African-American and American Indian children, especially girls. Researchers conclude that genetic tendencies, combined with habits that promote weight gain, make it more likely that a child will be overweight. Eating huge amounts of food isn’t the only way to put on excess weight. An extra 200 calories per day could cause a child to gain almost one-half pound a week. That’s just two homemade chocolate chip cookies per day. Over consumption of high-calorie soft drinks and fruit beverages may be adding to the problem. Soft drink consumption in school-age children has more than doubled in the past two decades, averaging almost 65 gallons of soft drinks per year. Fast food may also play a part in the growing number of overweight children. During infancy and adolescence, fat normally increases faster than muscle. So overeating and lack of activity may lead to excessive weight gain. Some overweight children do not need to lose weight as much as they need to gain weight at a slower rate. Although diet is a factor in weight control, lack of physical activity may play a greater role in childhood obesity. In 1996, the Surgeon General reported that nearly half the young people ages 12 to 21 were not vigorously active. The American College of Sports Medicine found that only one-third of schools now offer physical education classes, with the class period constantly being shortened. Researchers with the American Heart Association conclude that the lack of physical education classes in our schools and habitual television viewing and video-game playing are largely responsible for the increasing sedentary lifestyle of children. On average, children watch 26 hours of television a week. These hours don’t include time spent playing video and computer games.

Consequences Correlation between childhood and adult obesity Medical complications of extreme overweight children Psychological consequences of overweight There are health risks for obese children. The greatest risk may be children who remain overweight into adulthood. Fifty percent of overweight children remain overweight as adults. 26-41% of overweight preschool children will become overweight adults. Obese children who become obese adults are at a greater risk for developing heart disease, diabetes, high blood pressure, high cholesterol, gallbladder disease, arthritis, and certain cancers. Medical complications include an increase in stress on weight bearing joints, increased blood pressure; and risk of diabetes. Obese adults also face psychological and social stress. Children are at increased risk for low self-esteem and poor body image, as well as discrimination. Adolescent girls are less likely to be accepted into college, less likely to be married and less likely to be economically well off in adulthood.

Unchangeable Risk Factors Children with two obese parents Children with on obese parent Socio-demographic factors According to research, parental obesity has a good correlation on childhood obesity. Children with two obese parents are more than six times as likely to become obese than children with non obese parents. Children with only one obese parent are twice as likely to become obese adults. Among white children, being overweight is more likely to occur with parents of lower socioeconomic status. Girls without siblings are at a greater risk. Each sibling reduces the likelihood of being overweight by 14%. Girls with older mothers are at increased risk of being overweight.

Changeable Risk Factors Parenting style Physical activity Television watching Eating patterns A high degree of parental control of diet is linked to the inability of a child to regulate food intake, and to the amount of body fat in girls. Starting in adolescence, the physical activity of girls decreases 7.4% and boys decrease 2.7% a year. The American Academy of Pediatrics recommends a two hour limit on television viewing every day for children. Yet one in four children report watching four or more hours of television per day. With girls, eating while doing homework, watching television or when not hungry, and the purchase of snacks, led to a higher caloric intake than girls who did not report these behaviors.

Promote a Healthy Lifestyle Establish good eating habits. Help your child grow into their current body weight. Make exercise a regular and enjoyable part of your child’s life. Establish good eating habits. Good eating habits allow your child to develop normally while keeping their weight under control. The Food Guide Pyramid provides guidelines for eating an assortment of food which include fruits, vegetables, grains, skim milk, and fish, lean meat, poultry or beans. Choose foods that are lower in fat and added sugars and sodium. Using this plan, your child will get all the nutrients they need for normal growth and development. Help your child grow into their current body weight. It is not healthy for growing children to lose weight. So keep your child’s weight steady until they grow to the proper height for that weight. Then your child’s weight can increase to keep pace with normal growth. Make exercise a regular and enjoyable part of your child’s life. There are many activities that give children the exercise they need to burn extra calories they eat, and to tone their muscles. Your child needs to run, jump, skip, hop, and move around.

The Ideal Environment Parks with safe play equipment, bike/walking paths and sponsored activity programs. Community sports leagues. School physical education programs. Healthful school breakfast and lunch programs. Eat five servings of fruits and vegetables a day. Promotion of healthy eating and exercising habits by all. Limit television and video games to two hours per day. Promote gardening. Promote size acceptance. Regular healthcare. In the last century, we have created an environment of convenience, labor saving devices and readily available of high caloric density ~ all which can contribute to a less active, high fat lifestyle. It appears that children and adults will continue to gain weight. We need to make a concerted effort to promote a healthy lifestyle.