Kids Won’t ‘Grow Out’ of Obesity: the Growing Obesity Epidemic

obese-children

Health Risks Associated with Excess Weight Are High, Children Developing Adult Illnesses Early in Life

          Why is childhood obesity on the rise and furthermore, what happens when parents don’t know their kids are grossly overweight or when fat kids don’t know they are fat?

            First, the obesity rate among kids worldwide is at an alarmingly all-time high. Second, childhood obesity has both immediate and terminal effects on health and well-being. Finally, the home environment has a big influence on what kids eat and how active they are.

OBESITY RATE AT ALL-TIME HIGH

            First, the obesity rate among kids worldwide is at an alarmingly all-time high. Nearly a third of children in the U.S. are overweight – almost four in ten kids in the UK aged 11 to 15, are at risk from damaging levels of fat.[i] In an average sized class, that’s almost 50% of students.

            In an average US public school class of approximately 27 students, birthdays could be celebrated well over 20 times a year.  Putting aside all the other sugary treats kids receive at school from teacher rewards or classroom parties, that’s 6,000 extra calories per child per year (20 x 300 calories). Now multiply that figure by six years of elementary school and, assuming a pound of fat equals 3,500 calories[ii], a child in public school could gain over 10 extra pounds from birthday cupcakes alone.

            Obesity increased almost a quarter among kindergarteners from low-and middle-income households over the course of a decade, from 11.6 percent in the 1998-99 school year to 13.9 percent in 2009-10.[iii] At the same time, the study showed the obesity rate of kindergartners from the wealthiest households fell 2.4 percentage points from 1999 to 2010.[iv]

            Half of America’s obese youth don’t know they’re obese, according to the Center for Disease Control. But it’s the rising lack of self-awareness that is arguably what is most troubling.

            The immediate danger resulting from poor self-awareness among overweight children is pretty clear: It’s hard enough to lose weight when you know that you should. You can imagine how the difficulty compounds when you don’t – and you are 11 years old.

But that lack of self-awareness among kids is made worse by the fact that mothers and fathers are becoming more oblivious too. A new study revealed that many parents are in denial when it comes to their child’s weight problems.[v] One reason parents may have difficulty perceiving their child’s weight is because of the “new normal.” Throughout the developed world and even in some developing countries, children are generally becoming heavier. Once a parent acknowledges the child has a weight problem, you have to deal with it. Do I become the food police? Do I have to change my diet and walk the walk? Or, perhaps the parents are resigned to being overweight, or they cannot figure out a diet that fits all in the family.

OBESITY’S IMMEDIATE & LONG-TERM EFFECTS ON HEALTH

            Second, childhood obesity has both immediate and long-term effects on health and well-being. With an almost four-fold increase in the rate of obesity since the 1960s, The United States is, by almost any measure, one of the fattest countries in the developed world. While being overweight doesn’t automatically mean that you are unhealthy, the health and economic costs of the American obesity epidemic are well documented. [vi]

            Obese youth are more likely to have risk factors for cardiovascular disease, such as high cholesterol or high blood pressure. In a population-based sample of 5- to 17-year olds, 70% of obese youth had at least one risk factor for cardiovascular disease. Obese adolescents are more likely to have pre-diabetes, a condition in which blood glucose levels indicate a high risk for development of diabetes. Children and adolescents who are obese are at greater risk for bone, joint problems, and sleep apnea.

            Overweight children are likely to be obese as adults and are therefore more at risk for adult health problems such as heart disease, type 2 diabetes, stroke, and osteoarthritis. One study showed that children who became obese as early as age 2 were more likely to be obese as adults. Overweight and obesity are associated with increased risk for many types of cancer, including cancer of the breast, colon, endometrium, esophagus, kidney, pancreas, gall bladder, thyroid, ovary, cervix, and prostate, as well as multiple myeloma and Hodgkin’s lymphoma.

            How should pediatricians and parents mitigate the risks associated with childhood obesity?  Risk factors for childhood obesity can begin before a child is even born. Doctors should be aware of “prenatal risk factors” including parents’ obesity or a mother smoking during pregnancy. An infant who is never breastfeddoesn’t sleep enough, and gains weight rapidly also faces increased risk. From a child’s birth through age two, doctors should use World Health Organization growth charts to measure the progress of height and weight. In older toddlers and children, the AAP recommends using the CDC’s Body Mass Index charts and plotting height and weight at every visit, so that obesity prevention measures can start before children are too far above recommended levels. The last official study showed that only 46 percent of pediatricians routinely did so.

INFLUENCE OF HOME ENVIRONMENT ON OBESITY

            Finally, the home environment has a big influence on what kids eat and how active they are. Exercise and healthy diets are critical in fighting childhood obesity, a considerable problem in the United States, where over a quarter of kids ages two to five are already overweight or obese. The home environment and parenting can influence a child’s health by shaping dietary and physical behaviors, such as providing access to fruits and vegetables or encouraging kids to play outside.

            Researchers studied data from 190 kids, ages two to five, whose mothers were overweight or obese. They collected information on the children’s food intake over the past week, with foods rated as junk food or healthy food. To gauge their levels of physical activity, the children wore accelerometers for a week, which measured moderate to vigorous physical activity as well as sedentary time. When they analyzed the data, the researchers found significant associations between these environmental measures and the preschoolers’ physical activity and healthy versus junk food intake.[vii] This study reminds parents that their children are watching and learning from observing their behaviors, both good and bad. The researchers also looked at socioeconomic factors of the mothers, which did not affect their kids’ physical activity, but had mixed results when it came to their dietary habits.

            Dr. Stephen Daniels, chairman of the AAP nutrition committee suggests that parents make healthier foods visible, buy fewer sweetened beverages, reduce opportunities for sedentary entertainment, and make sure that children get enough sleep. Parents should set a “good example with their own eating and exercising habits, even parents who are struggling with weight issues themselves,” Daniels said.

            Educating parents and children about healthy eating habits is also important, but just lecturing alone is not enough. It’s a reminder to physicians and to families that nutrition and lifestyle should be a discussion at every well visit with your doctor. For example, in communities where access to fresh vegetables and fruits is limited, informing families about farmers’ markets or local grocery stores that have a good supply of frozen or canned vegetables and fruits may help.

            Pediatricians should also become familiar with federal food assistance programs, such as the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and the Supplemental Nutrition Assistance Program (SNAP)[viii]. Encourage families to buy fewer sweetened beverages (including fruit- flavored drinks), high-caloric-density snacks, or sweets. Replace a cookie jar with a fruit bowl, and store treats out of children’s sight.

            Finally, parents should reduce opportunities for sedentary entertainment. This means incorporating 60 minutes of active play time a day and no more than two hours a day of “screen time” using computers, video games and TV. Most importantly, “family-based” interventions work better than focusing on a child alone.

RESOLUTION

        With the number of overweight or obese children worldwide estimated to be 70 million by 2025, the most important take home message is that successful strategies have to be developed now, for both our children’s and our grandchildren’s future health. In a world that offers many options to achieve better health, the simplest and least costly recommendations may be best. Play at the park and don’t ditch your water.

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