Childhood Obesity: A BIG Problem

What causes childhood obesity?

Childhood obesity is the result of eating too many calories and not getting enough physical activity. The ratio of a person's weight to height is known as body mass index, or BMI. Children with a BMI at or higher than the 95th percentile (for their age) are considered obese. Children with a BMI at or higher than the 85th percentile are considered overweight. Today, almost 20 percent of kids ages 6 to 19 are overweight.Although there are some genetic and hormonal causes of childhood obesity, most of the time it's caused by kids eating too much and exercising too little.

Far less common than lifestyle issues are genetic diseases and hormonal disorders that can make a child more likely to be obese

Many factors — usually working in combination — increase your child's risk of becoming overweight:

• Diet. Regularly eating high-calorie foods, such as fast foods, baked goods and vending machine snacks, can easily cause your child to gain weight. Loading up on soft drinks containing sugar, candy and desserts also can cause weight gain. Foods and beverages like these are high in sugar, fat and calories.
• Lack of exercise. Children who don't exercise much 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.
• Family history. If your child comes from a family of overweight people, he or she may be more likely 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 to fight boredom. Their parents may have similar tendencies.
• Family factors. If many of the groceries you buy are convenience foods, such as cookies, chips and other high-calorie items, this can contribute to your child's weight gain. If you can control your child's access to high-calorie foods, you may be able to help your child lose weight.
• Socioeconomic factors. Foods that won't spoil quickly, such as frozen meals, crackers and cookies often contain a lot of salt and fats. These foods are often less expensive or an easier option than fresher, healthier foods.

Obesity in preschool?

Obesity may be declining among preschool-aged children living in low-income families in the United States, according to a study in the December 26 issue of JAMA.

"Obesity and extreme obesity in childhood, which are more prevalent among minority and low-income families, have been associated with other cardiovascular risk factors, increased health care costs, and premature death. Obesity and extreme obesity during early childhood are likely to continue into adulthood. Understanding trends in extreme obesity is important because the prevalence of cardiovascular risk factors increases with severity of childhood obesity," writes Liping Pan, M.D., M.P.H., of the Centers for Disease Control and Prevention, Atlanta, and colleagues. National trends in extreme obesity among young children living in low-income families have not been known.

As reported in a Research Letter, the authors analyzed data from the Pediatric Nutrition Surveillance System (PedNSS), which includes almost 50 percent of children eligible for federally funded maternal and child health and nutrition programs. The analysis for this study included 26.7 million children ages 2 through 4 years from 30 states and the District of Columbia that consistently reported data to PedNSS from 1998 through 2010. One routine clinic visit with demographic information and measured height and weight was randomly selected for each child. Obesity (body mass index [BMI] 95th percentile or greater for age and sex) and extreme obesity (BMI 120 percent or greater of the 95th percentile) were defined according to the 2000 CDC growth charts.

The 2010 study population was slightly younger and had proportionally more Hispanics and fewer non-Hispanic whites and blacks compared with the 1998 population. The researchers found that the prevalence of obesity increased from 13.05 percent in 1998 to 15.21 percent in 2003. The prevalence of extreme obesity increased from 1.75 percent in 1998 to 2.22 percent in 2003. However, the prevalence of obesity decreased slightly to 14.94 percent in 2010; and the prevalence of extreme obesity decreased to 2.07 percent in 2010.

"To our knowledge, this is the first national study to show that the prevalence of obesity and extreme obesity among young U.S. children may have begun to decline," the authors write. "The results of this study indicate modest recent progress of obesity prevention among young children. These findings may have important health implications because of the lifelong health risks of obesity and extreme obesity in early childhood."

Teens

At least three in four obese teens grow up to become obese adults, which predispose them to serious ailments such as degenerative arthritis, heart disease, stroke and several forms of cancer. Although these illnesses usually don’t strike until much later in life, other medical problems can emerge during the teen years for youngsters who are morbidly obese:

• hypercholesterolemia and hypertriglyceridemia
• skin infections, from fungi trapped in folds of skin and hard-to-clean areas, and bacteria
• pseudogynecomastia, in which excess fatty tissue gives boys the appearance of breasts
• back pain
• pain in the knee, hip or thigh from slipped capital femoral epiphysis
• ankle fracture
• chronically high blood pressure (hypertension), a risk factor for cardiovascular disease and kidney disease
• gallstones
• inflammation of the pancreas (pancreatitis)
• excessive insulin secretion (hyperinsulinism)
• insulin resistance, diabetes
• obstructive sleep apnea, a blockage of the upper airway that disrupts normal breathing during sleep

Even a moderate, sustained weight loss of approximately 10 percent can return elevated levels of blood pressure, insulin and blood sugar to normal, and all but eliminate the threat of gallstones, pancreatitis and the other conditions listed above.

However, the emotional damage accruing to being overweight in adolescence can be considerable and long lasting. To be sure, plenty of heavy set teenagers rank high in popularity with their peers. But in our thin-obsessed culture, the social stigma associated with obesity is too deeply ingrained for many large boys and girls to escape.

“It starts long before adolescence,” says Dr. Garry Sigman, director of the division of adolescent medicine at Advocate Lutheran General Children’s Hospital in Park Ridge, Illinois. “Studies show that children as young as age five begin to consider an overweight person as somehow ‘bad’ or less desirable than someone who’s thinner, based on the derogatory images and messages they’ve received.” The pervasive societal prejudice against heavy people has been called one of the last acceptable forms of bigotry; in fact, several studies have shown striking similarities between the psychological characteristics of obese teenage girls and victims of racism. Taunts and ridicule, feeling excluded from the social whirl of junior high and high school, inevitably leave their mark. “One of the normal developmental tasks of adolescence is to become comfortable with your body and your self-identity,” explains Dr. Sigman. Overweight youngsters are more likely to have a negative body image and low self-esteem, which may make them withdraw socially and possibly turn more than ever to food as a source of comfort. Parents should be aware that they are also prone to anxiety and depression

What are the Health Effects?

Overweight children, as compared to children with a healthy weight, are more likely to develop many health problems such as high cholesterol and high blood pressure, which are associated with heart disease in adults. Type 2 diabetes, previously considered an adult disease, has increased dramatically in overweight children and adolescents. Children at a healthy weight are free of these weight-related diseases and less at risk of developing these diseases in adulthood.

What are the Mental Health Effects?

The most immediate consequence of being overweight as perceived by children themselves is social discrimination and low-self-esteem. In a recent study by Schwimmer, et.al. (2003), obese children rated their quality of life with scores as low as those of young cancer patients on chemotherapy. In the study, 106 children aged 5 to 18 filled out a questionnaire used by pediatricians to evaluate quality of life issues. Children were asked to rate things like their ability to walk more than one block, play sports, sleep well, get along with others and keep up in school. The results indicated that that teasing at school, difficulties playing sports, fatigue, sleep apnea and other obesity-linked problems severely affected obese children's well-being. Interestingly, parents answered the same questionnaires, and their ratings of their children's well-being were even lower than the children's self-ratings.

Girls vs. Boys

Society, culture, and the media send children powerful messages about body weight and shape ideals. For girls, these include the "thin ideal" and an urging to diet and exercise. Messages to boys emphasize a muscular, "buff" body and pressure to body build and perhaps make use of potentially harmful dietary supplements and steroids. While gender has not been identified as a specific risk factor for obesity in children, the pressure upon girls to be thin may put them at greater risk for developing eating disordered behaviors and or related mood symptoms. Although society presents boys with a wider-range of acceptable body images, they are still at risk for developing disordered eating and body image disturbances.

What Are The Long Term Effects of Childhood Obesity?

Disturbingly, these medical conditions aren't just restricted to childhood. The effects of childhood obesity may continue to haunt a child well into adulthood where they may have a higher risk of adult obesity, diabetes, and heart disease. It's an unfortunate reality that most obese children will grow into obese adults with all of the associated medical problems.

Why Aren't More Children Being Treated?

Unfortunately, many parents are reluctant to accept the fact that their child may be overweight or obese despite the negative effects of childhood obesity on their child's health and well being. The best plan of treatment for these children is a combination approach that emphasizes increased physical activity along with dietary changes. In some cases, a nutritionist may be needed to help plan a nutritionally sound diet that supplies the vitamins and nutrients a growing child needs. It's also important to get the whole family involved in eating a healthier diet so the overweight child doesn't feel singled out.

What you can do.

Helping your children to have a healthy body weight is a family affair. Instead of putting the focus on the overweight child, the whole family should get involved in making healthy changes in activity and eating habits, experts say. As a parent, you are the most significant role model for your children, so it's important that you set an example with healthy lifestyle habits.

Check with your pediatrician about current screening recommendations for children and teens. Because of the immediate and long-term risks of being overweight or obese, the AAP now recommends that all children--regardless of family history--be screened for high cholesterol between ages 9 and 11, and again between ages 17 and 21. 

Get up and move:

• Physical activity is a great way for you to spend quality time with your children. Emphasize the fun of an activity rather than skill.
• Build family activity into every day, perhaps taking an after-dinner walk or bike ride or dancing to fast music in the living room.
• Plan active family outings, such as hikes, ice-skating, swimming, or playing Frisbee. Try a family vacation that emphasizes canoeing, bicycling, camping, or swimming.
• On birthdays, give presents that encourage activity, such as a jump rope, pogo stick, bicycle, in-line skates, or a basketball.
• Set guidelines for how long your children can watch television or play computer or video games. Limit children to 30 minutes or less per day in-front-of-the-screen activity whether TV, video game, or computer (homework is an exception).  Allow younger children to choose one half-hour program.

Choose healthy foods:

• Use the Choose My Plate plan as a guide for food choices. Serve fruits, vegetables, whole grains, beans, and lean meats and poultry. Use low-fat or nonfat milk products (except for children younger than 2 years old).
• Keep healthy snack foods in the house, such as fresh fruit, vegetables, and low-salt and low-fat pretzels.
• Don't purchase high-fat, high-sugar, or high-calorie snacks. If they aren't in the home, you won't be tempted to eat them yourself or distribute them to your children.
• Have your children start the day with a filling breakfast, such as whole-grain cereal with fruit and low-fat milk, whole wheat toast, or a fruit smoothie made with low-fat yogurt.
• Involve kids in shopping for and preparing meals. Children like to eat what they've helped prepare. At the grocery store, stick to the outer aisles where the healthiest options, such as fruit, vegetables, dairy, and whole grains, can be found. Don’t take them down the candy or snack food aisles.
• Don't keep unhealthy foods in the house. Teach your children about convenient, healthy foods that can be eaten every day.

Foster self-esteem

Children are more likely to make healthy changes when they feel good about themselves. Help your children find things to do that make them feel valuable. It might be community volunteer work, visiting the elderly neighbor down the street, helping Grandma clean her yard, or pursuing a special interest such as art or music. Point out your children's strengths and help them develop their own self esteem.

What can be done in schools?

7, 2010 — New policies that eliminate sugary beverages and junk foods from schools may help slow childhood obesity, according to a San Francisco State University study published in the March issue of the journal Health Affairs.

"This is one of the very first comprehensive investigations that examined whether childhood obesity trends changed after new statewide policies were enacted in California," said the study's first author Emma Sanchez-Vaznaugh, assistant professor of health education at SF State. The Robert Wood Johnson Foundation Healthy Eating Research, New Connections Program funded the $100,000 project.

Childhood obesity is increasingly prevalent in the United States, with obesity rates more than tripling during the last 30 years. Today, one in three children is either overweight or obese. Last year, Centers for Disease Control and Prevention researchers reported the first leveling of these child obesity rates. However, there were no reasons given as to why trends might have stalled.

Between 2003 and 2005, Governor Shwarzenegger signed SB 677, SB 965 and SB 12 into law, the first comprehensive set of statewide policies to eliminate sodas and other highly sweetened beverages and restrict the sale of junk foods in all of California's public schools. Although many other states subsequently enacted similar standards, potential effects on childhood obesity were uncertain.

Sanchez-Vaznaugh and co-investigators used eight years of body mass index (BMI) data from fifth and seventh grade students collected as part of California's annual Physical Fitnessgram testing. The study compared BMI trends in the years preceding the enactment of the legislation with the years following the legislation. The data show that before the policies took effect, the rate of overweight students was increasing among all groups in the study (girls and boys in fifth and seventh grades). However, in the three year period after the policies became effective, the increase in the number of overweight children was significantly reduced among fifth-grade boys and seventh-grade students of both sexes throughout California. The pre- and post-policy trends in overweight were not significantly different among fifth-grade girls.

The researchers also looked at children in the Los Angeles Unified School District (LAUSD) separately, because the district passed slightly stricter, but otherwise similar policies in their district the year before the passage of California's SB 677. Prior to the implementation of the policy there was an upward trend of overweight fifth and seventh-grade students in the Los Angeles area. When the researchers compared these trends in the period after the new policies were implemented, they found that the increasing trend in the number of overweight fifth-grade students in the Los Angeles significantly slowed. There were no significant changes among seventh-grade students in Los Angeles.

"Although policymakers cannot directly influence student behavior, our study shows that governmental policies can help define the environment in which children learn to make food choices and thus shape the food behaviors, influencing overweight trends in entire student populations," Sanchez-Vaznaugh said. She also cautions that there is still a lot to do to stem obesity in California's public schools.

She cites school campus proximity -- particularly in poorer neighborhoods -- to st

ores selling unhealthful foods and beverages that stand in opposition to nutritional objectives set by the U.S. Department of Agriculture. Limited resources and budget cuts hamper schools from offering both healthful, good-tasting alternatives and physical education programs. "Only about 40 percent of children in our study were considered physically fit," Sanchez-Vaznaugh said.

In addition to teaching at SF State, Sanchez-Vaznaugh is a Kellogg Health Scholar at the University of California San Francisco's Center on Social Disparities in Health. The study's senior author was Patricia Crawford, director of the Dr. Robert C. and Veronica Atkins Center for Weight and Health at University of California, Berkeley.

investigators were Brisa Sanchez and Jonggyu Baek from the University of Michigan

The bottom line is, parents you are in control of what your child eats in your presence and at school if you pack the lunch for school. It starts with you. Teach them young. If it's constant communication and education they will learn. My son is seven and he gets it already. His school also helps in his healthy eating by making it a requirement for parents to pack extremely healthy foods and drinks. Think about this; what if the only option was a healthy one? With you buying the food it can be.