Pediatric and Childhood Obesity
Pediatric obesity occurs when a child has too many fat cells storing unused energy in their body. Genetic, behavioral and environmental factors all contribute to pediatric obesity.
Results from the National Health and Nutrition Examination Survey show that 12.5 million (about 17%) of children and young adults between 2 and 19 years old are obese. That number has almost tripled since 1980.
Children’s bodies store extra calories when they eat more than their body uses. These extra calories are stored in fat cells to be used later for energy. However, when that child isn’t active, their body continues to develop fat cells. These fat cells can make a child overweight or eventually, obese.
Obesity is defined according to a child’s body mass index (BMI). BMI is calculated using height and weight. It doesn’t measure body fat directly, but is a good indicator for most children and teens.
Since the normal body fat of a child changes as he ages, your child’s status is found using categories that are age- and sex-specific. If your child’s BMI is above the 85th percentile and under the 95th percentile for children who are the same age, height, and gender, he is considered overweight. If your child is at or above the 95th percentile for BMI, she is considered obese.
- Have a 70-80% chance of becoming overweight or obese adults
- Are more than twice as likely than non-obese adolescents to die prematurely, before age 55
- More than twice as likely than non-obese adolescents to die prematurely, before age 55, of illness or self-inflicted injury
- Face a 10-20-year shorter life span and may develop health problems in their twenties that are typically seen in 40-60-year-olds
- Have medical problems such as obstructive sleep apnea, type 2 diabetes, severe depression, nonalcoholic fatty liver disease, significant hypertension, and an enlarged heart
- More likely to develop social isolation
Obesity results from energy imbalances when too many calories are consumed and too little physical activity takes place.
- Behavior, culture, economic status - consumption of food, drinking high-calorie beverages and/or using food to cope with emotions. Watching excessive TV and poor sleep habits are also contributing behavioral factors to obesity in children.
- Environment - a child’s home, school and community life all contribute to obesity, as well as their level of physical activity and interaction with others.
- Inherited / genetic - the genes of the child’s parent can contribute to a child’s obesity. Children can inherit the ability to gain weight easily from parents or grandparents.
Obesity in childhood can lead to major medical concerns in both the near- and long-term. One of the most often seen and possibly the most concerning over time is an increased risk for developing Type 2 diabetes. This can lead to many health issues, such as pain from nerve damage, amputation of parts of the body because of blood vessel disease, and blindness.
Other medical impacts of obesity can include such things as:
- Breathing issues, including asthma and periods where breathing stops during sleep (apnea)
- Menstrual irregularity and infertility once a girl hits puberty
- High cholesterol, lipids and blood pressure that can lead to an early heart attack or stroke. In one study, 70% of obese children had at least one risk factor, and 39% had two or more
- Bone issues, such as bowed legs or instability of the hip
- Increase in nonalcoholic fatty liver disease, gallstones, and heartburn - known as gastroesophageal reflux, or GERD
Studies have shown that those who were obese in childhood or in their teen years are much more likely to continue to be overweight as adults. This compounds the medical problems seen in children.
Tests and Diagnosis
Obesity is different in children and teens than it is for adults. Children are growing, and boys and girls mature at different rates. Because of this, BMIs are calculated by comparing height and weight against growth charts that account for these age and sex-related differences. The BMI-for-age percentile shows how your child’s BMI compares with others of the same age and gender.
Your child’s doctors may also get blood tests to measure hormones that could affect weight if they are not normal. Hypothyroidism results when your thyroid gland under-produces certain important hormones that slow down metabolism. Too much cortisol (Cushing's syndrome) is a condition during which your body is over-exposed to the hormone cortisol, resulting in a buildup of fatty tissue. Both of these are treatable and may resolve the obesity. However, medical reasons are not a leading cause of obesity.
Not every child needs all these tests. Your physician will tell you exactly what the next steps are. Each year, specialists at Children’s Health see more than 12,000 pediatric patients for childhood obesity and other endocrine-related conditions. We have the skill and resources necessary to provide comprehensive and compassionate care for your child too.
- Social causes - These may be related to limited athletic opportunities, especially when combined with an emphasis on passive activities, such as gaming, TV use and social network participation
- Cultural outlooks - For example, while healthier fare is served in some Asian or Mediterranean households, and smaller portions of higher-fat foods are served in European families, the Americanization of foods generally means “bigger portions” and processed food
- Chronic steroid use - The use of some types of antidepressant or antipsychotic medication and other prescription drugs have also been linked to some extent with obesity in children and teenagers
- Overeating - Some children overeat to deal with emotional and psychological stress. Extra weight might then add to the problem
If your child is obese, the first step should be a complete medical exam by the pediatrician. In most cases, physical problems will be ruled out and treatment can begin.
With medical issues ruled out, the only way to lose weight is to reduce the number of calories being eaten while also increasing the level of physical activity. Since obesity often is seen in more than one family member, dietary and exercise changes taken on as a family often improve the chances that all members will successfully lose weight.
Registered Dietitians (RDs) are the food and nutrition experts. Our RDs apply their expertise to disease prevention and health management. Referring patients to see the dietitian can improve the patient's health and well-being, improve quality of life, and lower health-care costs.
Patients are seen on an ongoing basis to monitor and evaluate their progress. Nutrition education and counseling provided over a series of visits are essential components of a comprehensive health care program.
Weight Loss Tips
- Changing eating habits, such as eating more slowly, so the body has time for digestion and can sense a feeling of fullness
- Working with your child to plan meals and make better food selections, such as eating fewer fatty foods and avoiding junk or fast foods
- Talking about controlling portions to consume less calories
- Helping your child to increase physical activity and have a more active lifestyle. Something as easy as walking can take off pounds. It is suggested that your child participate in 60 minutes of exercise daily
- Talking with your children about what they eat at school to help them understand the best way to eat sensibly away from home
- Eating meals together as a family instead of while doing other things, such as watching television or being at the computer while eating
- Not using food as a reward for good behavior
- Limiting snacks in general and working with your child to have healthy snacks, such as vegetables or fruits, as an option
- Setting realistic goals for weight loss in consultation with your child’s doctor. This makes it less likely that your child will not be able to lose weight quickly enough and then becomes discouraged
Obesity is a lifelong issue that can continue throughout adulthood. The most common reason a person gains back lost weight is a return to their bad habits of eating too much and exercising too little.
Surgical intervention is a proven way to provide substantial weight loss in these adolescents. When combined with lifestyle changes, bariatric surgery can help adolescents reach a healthier weight, increase self-esteem, and reduce the likelihood of chronic disease.
For more information about childhood obesity, please visit these sites:
- The Centers for Disease Control and Prevention have a BMI calculator for those less than 19 years old here.
- For facts about childhood obesity – the risks, the causes and what can be done about it: Centers for Disease Control and Prevention
- For lots of ideas about how to help your child develop healthy habits: American Heart Association
- This site has a quick overview of things you can do to help your child manage his or her weight U.S. National Library of Medicine
- Here’s a worksheet to help you evaluate what happens at your house and what changes might be helpful: American Academy of Pediatrics