Childhood Obesity  | submitted: 07/06/07 4:38pm
Introduction

The incidence of childhood obesity is rapidly rising throughout the world. The obesity epidemic is especially evident in industrialized nations where many people live sedentary lives and eat more convenience foods, which are typically high in calories and low in nutritional value. In just two decades, the prevalence of overweight doubled for U.S. children ages 6 to 11 — and tripled for American teenagers. The annual National Health and Nutrition Examination Survey by the Centers for Disease Control and Prevention found that about one-third of U.S. children are overweight or at risk of becoming overweight. In total, about 25 million U.S. children and adolescents are overweight or nearly overweight.

How do you know if your child's weight gain is normal and when it's leading to childhood obesity? Children, unlike adults, need extra nutrients and calories to fuel their growth and development. So if they consume about the number of calories they need for daily activities, growth and metabolism, they add pounds in proportion to their added inches. But children who eat more calories than they need gain weight beyond what's needed to support their growing frames. In these cases, the added weight increases their risk of obesity and weight-related health problems. Childhood obesity is particularly troubling because the extra pounds often start kids on the path to health problems that were once confined to adults, such as diabetes, high blood pressure and high cholesterol. One of the best strategies to combat excess weight in your children is to improve the diet and exercise levels of your entire family. This helps protect the health of your children now and in the future.
Causes

Although there are some genetic and hormonal causes of childhood obesity, most excess weight is caused by kids eating too much and exercising too little. If children consume more calories than they expend through exercise and normal physical development, they gain weight. Far less common than lifestyle issues are genetic diseases that can predispose a child to obesity. These diseases, such as Prader-Willi syndrome and Bardet-Biedl syndrome, affect a very small proportion of children. In the general population, eating and exercise habits play a much larger role.
Risk factors

Many factors — usually working in combination — increase your child's risk of becoming overweight:
Diet. Regular consumption of high-calorie foods, such as fast foods, baked goods and vending-machine snacks, contribute to weight gain. High-fat foods are dense in calories. Loading up on soft drinks, candy and desserts can also cause weight gain. Foods and beverages like these are high in sugar and calories.
Inactivity. Sedentary kids are more likely to gain weight because they don't burn calories through physical activity. Inactive leisure activities, such as watching television or playing video games, contribute to the problem.
Genetics. If your child comes from a family of overweight people, he or she may be genetically predisposed to put on excess weight, especially in an environment where high-calorie food is always available and physical activity isn't encouraged.
Psychological factors. Some children overeat to cope with problems or to deal with emotions, such as stress or boredom. Their parents may have similar tendencies.
Family/social factors. Most children don't shop for the family's groceries. Indeed, parents are responsible for putting healthy foods in the kitchen at home and leaving unhealthy foods at the store. You can't blame your kids for being attracted to sweet, salty and fatty foods; after all they taste good. But you can control much of their access to these foods, especially at home. Certain hard-to-control factors also can contribute to your child's risk of becoming obese. For example, children from minority or low-income backgrounds are at greater risk of becoming obese. Poverty and obesity often go hand in hand because low-income parents may lack the time and resources to make healthy eating and exercise a family priority.
When to seek medical advice Not all children carrying extra pounds are overweight or obese. Some children have larger-than-average body frames. And children normally carry different amounts of body fat at the various stages of development. So you might not know just by looking at your child if his or her weight is a health concern.

If you're worried that your child is putting on too much weight, talk to his or her doctor or health care provider. He or she can provide a complete weight assessment, taking into account your child's individual history of growth and development, your family's weight-for-height history, and where your child lands on the growth charts. These evaluations help determine if your child's weight is in an unhealthy range.
Screening and diagnosis. As part of regular well-child care, the doctor calculates your child's body mass index (BMI) and determines where it falls on the national BMI-for-age growth chart. The BMI indicates if your child is overweight for his or her age and height.

Using the growth chart, your doctor determines your child's percentile, meaning how your child compares to other children of the same sex and age. So, for example, you might be told that your child is in the 80th percentile. This means that compared with other children of the same sex and age, 80 percent have a lower BMI.

Cutoff points on these growth charts, established by the Centers for Disease Control and Prevention (CDC), help identify overweight children:
BMI-for-age between 85th and 95th percentiles — at risk of overweight
BMI-for-age over 95th percentile — overweight Because BMI doesn't consider things like being muscular or having a larger-than-average body frame and because growth patterns vary greatly among children, your doctor also factors your child's growth and development into the overall weight assessment. This helps determine whether your child's weight is a health concern.

In addition to BMI and charting weight on the growth charts, the doctor also evaluates:
Your family's history of obesity and weight-related health problems, such as diabetes
Your child's eating habits and calorie intake
Your child's activity level
Other health conditions your child may have
Complications

Obese children can develop serious health problems, such as diabetes and heart disease, often carrying these conditions into an obese adulthood. Overweight children are at higher risk of developing:
Type 2 diabetes
Metabolic syndrome
High blood pressure
Asthma and other respiratory problems
Sleep disorders
Liver disease
Early puberty or menarche
Eating disorders
Skin infections

The social and emotional fallout also can hurt your child. Being overweight can cause:
Low self-esteem and bullying. Children often tease or bully their overweight peers, who suffer a loss of self-esteem and an increased risk of depression as a result.
Behavior and learning problems. Overweight children tend to have more anxiety and poorer social skills than normal-weight children have. At one extreme, these problems may lead to acting out and disrupting the classroom. At the other, they may cause social withdrawal. Stress and anxiety also interfere with learning. School-related anxiety can create a vicious cycle in which ever-growing worry fuels ever-declining academic performance.
Depression. Social isolation and low self-esteem create overwhelming feelings of hopelessness in some overweight children. When children lose hope that their lives will improve, they're well on the way to depression. A depressed child may lose interest in normal activities, sleep more than usual or cry a lot. Some depressed children hide their sadness and appear emotionally flat instead. Either way, depression is as serious in children as in adults. If you think your child is depressed, talk with him or her and share your concerns with his or her doctor and teacher.
Treatment

Children, unlike adults, need extra nutrients and calories to fuel their growth and development. Even so, weight is the balance of calories in versus calories burned. Children who eat about the number of calories they need for daily activities and normal development gain weight in proportion to their added height. But children who eat more calories than they need gain weight beyond what's needed to support their growing frames. In these cases, the BMI-for-age increases as does their risk of obesity and weight-related health problems. For children under age 7 who have no other health concerns, the goal of treatment may be weight maintenance rather than weight loss. This strategy allows the child to add inches but not pounds, causing BMI-for-age to drop over time into a healthier range. However, for an obese child, maintaining weight while waiting to grow taller may be as difficult as losing weight for older persons.

Weight loss is typically recommended for children over age 7 or for younger children who have related health concerns. Weight loss should be slow and steady — anywhere from 1 pound a week to 1 pound a month, depending on your child's situation. The methods for maintaining weight or losing weight are the same: Your child needs to eat a healthy diet and increase his or her physical activity. Success depends largely on your commitment to helping your child make these changes. Think of eating habits and exercise habits as two sides of the same coin: When you consider one, you also need to consider the other.

Eat a healthy diet
Parents are the ones who buy the food, cook the food and decide where the food is eaten. Even small changes can make a big difference in your child's health.
When buying groceries, choose fruits and vegetables over convenience foods high in sugar and fat. Always have healthy snacks available. And never use food as a reward or punishment.
Limit sweetened beverages, including those containing fruit juice. These drinks provide little nutritional value in exchange for their high calories. They also can make your child feel too full to eat healthier foods.
Select recipes and methods of cooking that are lower in fat. For example, bake chicken instead of frying it.
Put colorful food on the table: green and yellow vegetables, fruits of various colors, and brown (whole-grain) breads. Limit white carbohydrates: rice, pasta, bleached bread and sugar (desserts).
Sit down together for family meals. Make it an event — a time to share news and tell stories. Don't eat in front of the television or computer, which fosters mindless munching.
Limit the number of times you eat out, especially at fast-food restaurants. Many of the menu options are high in fat and calories.
Discourage eating in front of a screen, such as a television, computer or video game. This leads to fast eating and lowered awareness of how much you're eating.

Increase physical activity
A critical component of weight loss, especially for children, is physical activity. It not only burns calories, but also builds strong bones and muscles and helps children sleep well at night and stay alert during the day. Such habits established in childhood help adolescents maintain healthy weight despite the hormonal changes, rapid growth and social influences that often lead to overeating. And active children are more likely to become fit adults.

To increase your child's activity level:
Limit recreational screen time to fewer than two hours a day. A surefire way to increase your child's activity levels is to limit the number of hours he or she is allowed to watch television each day. Other sedentary activities — playing video and computer games or talking on the phone — also should be limited.
Emphasize activity not exercise. Your child's activity doesn't have to be a structured exercise program — the object is just to get him or her moving. Free-play activities such as playing hide-and-seek, tag or jump-rope can be great for burning calories and improving fitness.
Find activities your child likes to do. For instance, if your child is artistically inclined, go on a nature hike to collect leaves and rocks that your child can use to make a collage. If your child likes to climb, head for the nearest neighborhood jungle gym or climbing wall. If your child likes to read, then walk or bike to the neighborhood library for a book.
If you want an active child, be active yourself. Take the stairs instead of the elevator and park the car farther away from stores. Never make exercise seem a punishment or a chore. Find fun activities that the whole family can do together.
Make chores a family affair. Who can pull the most weeds out of the vegetable garden? Who can collect the most litter? Have your kids help shovel the snow off the driveway and use that excess snow to build a snow fort.
Vary the activities. Let each child take a turn choosing the activity of the day or week. Batting practice, bowling and swimming all count. What matters is that you're doing something active.

Make a family commitment
Children can't change their exercise and eating habits by themselves. They need the support and encouragement of their family and other caregivers. To increase the odds that your child finds success:
Commit to new healthy habits and behaviors as a family, with all members sticking to the plan. If not, your child may feel singled-out, deprived or resentful.
Be ready to make changes. Small, gradual changes are easiest to follow and incorporate into your daily lives.
Focus on long-term diet and exercise changes, not quick fixes or fad diets aimed at rapid weight loss. The goal is healthier eating and lifestyle changes not pounds lost.
Set achievable goals for your child and family. For example, your child's goal might be to reduce the number of sugar-sweetened beverages he or she drinks. The family's goal might be to eat meals at the table every night instead of in front of the television.

Surgery and medications
If your child has been struggling with his or her weight for a long time, you might think that surgery or medications can help. But these treatments aren't often used for children.

Weight-loss surgery
Because of the risks involved and possible long-term complications, weight-loss (bariatric) surgery is rarely considered for obese adolescents. The effects of surgery on adolescents' growing minds and bodies are largely unknown. However, if your child's severe weight poses greater health threats than the potential risks of surgery, your doctor may consider weight-loss surgery as an option.

Even so, surgery isn't the easy answer for weight loss. It doesn't guarantee that your child loses all of his or her excess weight or that your child keeps it off long term. It also doesn't replace the need for following a healthy diet and regular physical activity program.

Medications
Two prescription weight-loss drugs are available for adolescents: sibutramine (Meridia) and orlistat (Xenical). Sibutramine, which is approved for adolescents older than 16, alters the brain's chemistry to make the body feel fuller more quickly. Orlistat, which is approved for adolescents older than 12, prevents the absorption of fat in the intestines.

Though available, these drugs are rarely prescribed to adolescents. The risks of taking the medications long term are still unknown, and their effect on weight loss and weight maintenance for adolescents is still questioned. And, once again, weight-loss drugs don't replace the need to adopt a healthy diet and exercise regimen.
Prevention

Whether your child is at risk of becoming overweight or currently at a healthy weight, you can take proactive measures to get or keep things on the right track. Start setting a good example by making sure your own diet is consistent with maintaining healthy weight. Then, be active, and invite your child to join you.

Try not to engage in food-related power struggles with your child. You might unintentionally lay the groundwork for such battles by providing or withholding certain foods — sweets, for instance — as rewards or punishments. As a general rule, foods aren't recommended for behavior modification in children.

Keep in mind that many overweight children grow into their extra pounds as they get taller. Realize, too, that an intense focus on your child's eating habits and weight can easily backfire, leading a child to overeat even more, or possibly making him or her more prone to developing an eating disorder.

Rather than being critical, emphasize what's positive — the fun of playing outside, the variety of fresh fruit you can get year-round. Emphasize the benefits of exercise apart from helping to manage their weight, for example, it makes their heart, lungs and other muscles stronger. If you foster your child's natural inclination to run around, explore and eat only when hungry — not out of boredom — a healthy weight should take care of itself.
Coping skills

Parents play a crucial role in helping children who are obese feel loved and in control of their weight. Take advantage of every opportunity to build your child's self-esteem. Overweight children are at increased risk of low self-esteem because of the social emphasis on appearance and being slim. Don't be afraid to bring up the topic of health and fitness, but do be sensitive that a child may view your concern as an insult. Talk to your kids directly, openly and without being critical or judgmental.

In addition, consider the following advice:
Find reasons to praise your child's efforts. Celebrate small, incremental changes, but don't reward with food. Choose other ways to mark your child's accomplishments, such as going to the bowling alley or a local park.
Talk to your child about his or her feelings. Help your child find ways to deal with his or her emotions that don't involve eating.
Help your child focus on positive goals. For example, point out that he or she can now bike for more than 20 minutes without getting tired or can run the required number of laps in physical education class.

By Mayo Clinic Staff
Mar 31, 2006
© 1998-2007 Mayo Foundation for Medical Education and Research (MFMER). All rights reserved. A single copy of these materials may be reprinted for noncommercial personal use only. "Mayo," "Mayo Clinic," "MayoClinic.com," "EmbodyHealth," "Reliable tools for healthier lives," "Enhance your life," and the triple-shield Mayo Clinic logo are trademarks of Mayo Foundation for Medical Education and Research.