Understanding the Pediatric Obesity Epidemic
Is your son or daughter overweight or obese? Is it indeed “baby fat”, and will they outgrow it? When infants are born they have a greater amount of fat to provide them with nutritional reserve when they are adjusting to life outside the womb. By 5 years of age, baby fat naturally decreases and children have the lowest body mass index or BMI- the relationship between height and weight. Thus, after 5 years of age, an overweight child should not be treated as if it is just “baby fat” and told they will outgrow it and not to worry. Overnutrition is in most cases responsible.
Overnutrition is defined as the overconsumption of nutrients and food to the point at which health is adversely affected. Overnutrition can develop into overweight and obesity. The Center for Disease Control (CDC) defines a BMI: as age plotted on the growth curve from the 5th percentile to the 85th percentile is normal weight status for a child. Overweight is from the 85th%tile to the 94.9%tile and Obese is the 95%tile and above. Early detection by physicians during physical exams with a referral to a registered dietitian is a critical first step in treatment.
Childhood obesity has increased since 1999, and is a serious problem in the United States putting children and adolescents at risk for poor health. Per the CDC, in 2017-2018 the prevalence of pediatric obesity was 19.3% and affected about 14.4 million children and teens. In the latest data, obesity also increased with age, rising from 26% among 2-5-year-olds to 41% for 16-to 19-year-olds, with Hispanic and African American children having the highest rates of obesity. Additionally, preliminary studies are showing the COVID-19 pandemic has led to worsening nutrition and lifestyle habits for vulnerable children and households. According to a new study, more than half of current children and teens in the US could be obese by the time they are 35. The risk that an obese five-year-old child remains obese as an adult is approximately 50%. This increases to more than 80% for obese adolescents. Unless the trend is reversed, this will have a devastating impact on the health of those Americans in years to come, along with the country’s healthcare system and economy.
What Are The Causes of Pediatric Obesity?
What are the causes of this epidemic in our children? There have been several dietary and lifestyle changes that have transpired over the last 20-30 years which have contributed to obesity. One major factor is the frequency with which people eat out. It is now estimated that approximately 40-50% of every dollar that is spent on food is spent eating outside of the home. These outside meals tend to be larger in portions and have more fat which contributes to excessive intake of calories. The consumption of soda by children has increased in the last 20 years by 300%. Box drinks, juice, fruit drinks, sports drinks, smoothies, and sugary coffee drinks present another significant problem. It is estimated that 20% of children who are currently overweight have excessive caloric intake from sugary beverages. Another major factor contributing to the pediatric obesity epidemic is the increased sedentary lifestyle of children. Currently, only 8% of elementary schools and less than 7% of middle and high schools have daily physical education in the U.S. Children are also more sedentary outside of school, spending time watching television, playing video games, or using their phones or computers. Only 50% of children 12-21 years of age regularly participate in rigorous physical activity and at least 26% of children are sedentary for at least 4 hours per day. The American Academy of Pediatrics recommends no more than 2 hours of sedentary activity daily and a minimum of 60+ minutes daily of physical activity for children and teens.
Health risks of childhood obesity include insulin resistance (the first step toward developing Type 2 Diabetes), hypertension, severe liver disease developing into cirrhosis (from excessive fat in the liver), and hyperlipidemia (elevated cholesterol and triglycerides). Other problems that can occur include joint problems, menstrual irregularities, gallbladder disease, sleep apnea, depression, anxiety, and social discrimination.
Treatment of Pediatric Obesity
Treatment of pediatric obesity needs to be family-based, individualized, and focus on three major areas: lifestyle, nutrition, and physical activity. If the child is the only one making changes, they are less likely to be successful. Parents and caregivers are of vital importance as they are the role models for their children. The dietitian will obtain a dietary, physical, and lifestyle history to address areas of concern for that child and family to best achieve their goals. For children 2-18 years of age with a BMI between 85-95% who have no complications, weight maintenance or slowing the rate of weight gain in relation to height growth is reasonable. For those with a BMI greater than the 95%tile who have associated comorbidity, weight loss should be strived for after maintenance is achieved. Gradual weight loss in a growing child is preferred, ideally not more than 1-2 pounds per week until BMI: age is <85 percentile. Close monitoring by a physician with referrals to specialists (such as psychologists, exercise specialists, endocrinologists, etc ) helps to focus the treatment plan for children and teens with associated health risks.
The great news about the treatment of pediatric obesity is that most of the significant comorbidities can be resolved with weight management and lifestyle changes within the family. Nutrition Healthworks has pediatric dietitians who specialize in wellness and weight management. Contact us today to schedule an appointment and get your family on the right track toward health!
RDN, LD - Mathews NC
Gina Gilchrist is a Registered Dietitian with a bachelor’s degree in Dietetics and has 24 years of experience in varied settings, including outpatient nutrition counseling, nutrition health coaching/private practice, research, and corporate health. READ MORE
Di Cesare, M., Sorić, M., Bovet, P. et al. The epidemiological burden of obesity in childhood: a worldwide epidemic requiring urgent action. BMC Med 17, 212 (2019). https://doi.org/10.1186/s12916-019-1449-8
Romanelli, R., Cecchi, N., Carbone, M.G. et al. Pediatric obesity: prevention is better than care. Ital J Pediatr 46, 103 (2020). https://doi.org/10.1186/s13052-020-00868-7
Zemrani, B., Gehri, M., Masserey, E. et al. A hidden side of the COVID-19 pandemic in children: the double burden of undernutrition and overnutrition. Int J Equity Health 20, 44 (2021). https://doi.org/10.1186/s12939-021-01390-w