Childhood Obesity – Risk Factors, Complications, and Prevention

Overview

Childhood obesity is a complex disease that can occur when your child is above a healthy weight for their age and height. The medical definition of childhood obesity is having a body mass index (BMI) at or above the 95th percentile on the Centers for Disease Control and Prevention’s (CDC) specific growth charts. Children’s BMI factors differ from adults. For children, BMI is age- and sex-specific because their body compositions vary as they age. They also vary between children assigned male at birth and children assigned female at birth.

You can calculate your child’s BMI by dividing their weight in kilograms by their height in meters squared (kg/m2). For instance, if your 10-year-old child weighs 102 pounds (46.2 kg) and is 56 inches tall (1.4 m), their BMI would be 23.6 kg/m2. This places them in the 95th percentile for BMI-for-age, which means they have obesity.

Healthcare providers use BMI-for-age growth charts to measure size and growth patterns in children. A high BMI may be a sign of high body fat. BMI doesn’t measure body fat directly. But it alerts your child’s healthcare provider your child may need more tests to see if excess fat is a problem. BMI percentile cutoffs define a level above which your child may be more likely to develop weight-related health issues.

What causes childhood obesity?

Childhood obesity is a complicated disease that has many contributing factors. It’s not laziness or a lack of willpower. Your child needs a certain number of calories for growth and development. But when they take in more calories than they use, their body stores the extra calories as fat. Children gain excess weight for many of the same reasons adults do. Causes of childhood obesity include:

Behavior

Shared family behaviors such as eating habits and being inactive can contribute to childhood obesity. The balance of calories consumed with calories burned plays a role in determining your child’s weight.

Busy families are consuming more foods and beverages high in fat, sugar and calories. These foods and beverages tend to be low in vitamins, minerals and other vital nutrients. At the same time, many children are spending less time outdoors and more time indoors being inactive. As video games, tablets and smartphones continue to grow in popularity, the number of hours of inactivity may only increase.

Genetics

Genetic factors can increase the likelihood that a child will have obesity. Children whose parents or siblings have obesity may be at an increased risk of developing the condition themselves. Studies have shown various genes may contribute to weight gain. Although weight problems run in families, not all children with a family history of obesity will develop it.

Socioeconomics and community

Where your child lives can have a direct effect on their risk of developing obesity. The foods and drinks that schools and daycare centers serve your child have a direct effect on their diet. They also contribute to the amount of physical activity your child gets every day. Other socioeconomic factors that contribute to childhood obesity include:

• The cost and accessibility of healthy food options.
• Your network or social support system.
• Limited access to recreational facilities or parks in your community, or other safe places to be active.

Cultural factors

Advertising for fast food chains and unhealthy snack foods can contribute to childhood obesity. Children see commercials on TV and advertisements splashed across billboards in their neighborhoods. More often than not, these foods have lots of calories and/or come in large portion sizes.

A combination of these factors can cause childhood obesity. Hormone disorders are another risk factor for childhood obesity. However, diseases are rarely the cause of childhood obesity. A physical examination and some blood tests will rule out the possibility of a medical condition. Some medications can increase the risk for increased body weight and obesity.

Risk factors

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 cause your child to gain weight. Candy and desserts also can cause weight gain, and more and more evidence point to sugary drinks, including fruit juices and sports drinks, as culprits in obesity in some people.
• Lack of exercise. Children who don’t exercise much are more likely to gain weight because they don’t burn as many calories. Too much time spent in sedentary activities, such as watching television or playing video games, also contributes to the problem. TV shows also often feature ads for unhealthy foods.
• Family factors. If your child comes from a family of overweight people, he or she may be more likely to put on weight. This is especially true in an environment where high-calorie foods are always available and physical activity isn’t encouraged.
• Psychological factors. Personal, parental and family stress can increase a child’s risk of obesity. Some children overeat to cope with problems or to deal with emotions, such as stress, or to fight boredom. Their parents might have similar tendencies.
• Socioeconomic factors. People in some communities have limited resources and limited access to supermarkets. As a result, they might buy convenience foods that don’t spoil quickly, such as frozen meals, crackers and cookies. Also, people who live in lower income neighborhoods might not have access to a safe place to exercise.
• Certain medications. Some prescription drugs can increase the risk of developing obesity. They include prednisone, lithium, amitriptyline, paroxetine (Paxil), gabapentin (Neurontin, Gralise, Horizant) and propranolol (Inderal, Hemangeol).

What are the Signs and Symptoms of Childhood Obesity?

In addition to excessive body weight, typical signs and symptoms of childhood obesity include:

• Shortness of breath
• Fatigue
• Increased sweating
• Sleep apnea and snoring
• Joint pain
• Dislocated hips
• Flat feet and knock knees
• Skin rashes and irritation
• Stretch marks on hips, abdomen, and back (though these can occur in non-obese children as well)
• Acanthosis nigricans, which is dark, velvety skin around the neck and in other areas
• Fat tissue in the breast area (which can be particularly challenging for boys)
• Constipation
• Gastroesophageal reflux (also called acid reflux)
• Early puberty in girls
• Delayed puberty in boys

What are the Psychological Complications of Childhood Obesity?

Obesity can have a significant negative effect on a child’s mental health, contributing to problems including:

• Anxiety
• Depression
• Low self-esteem
• Being bullied or socially isolated from peers
• Prejudice from adults in their lives like relatives, teachers, and health care provider

Diagnosis of Childhood Obesity

As part of regular well-child care, the doctor calculates your child’s BMI and determines where it falls on the BMI-for-age growth chart. The BMI helps indicate 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 with other children of the same sex and age. For example, if your child is in the 80th percentile, it means that compared with other children of the same sex and age, 80% have a lower BMI.

Cutoff points on these growth charts, established by the Centers for Disease Control and Prevention, help classify the severity of a child’s weight problem:

• BMI between 85th and 94th percentiles — overweight
• BMI 95th percentile or above — obesity
• BMI 99th percentile or higher — severe obesity

Because BMI doesn’t consider things such as being muscular or having a larger than average body frame and because growth patterns vary greatly among children, your doctor also factors in your child’s growth and development. 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 evaluates:

• Your family’s history of obesity and weight-related health problems, such as diabetes
• Your child’s eating habits
• Your child’s activity level
• Other health conditions your child has

Psychosocial history, including incidences of depression, sleep disturbances, and sadness and whether your child feels isolated or alone or is the target of bullying

Blood tests

Your child’s doctor might order blood tests that may include:

• A cholesterol tests
• A blood sugar test

Other blood tests to check for hormone imbalances or other conditions associated with obesity

Some of these tests require that your child not eat or drink anything before the test. Ask if your child needs to fast before a blood test and for how long.

Treatment of Childhood Obesity

Treatment for childhood obesity is based on your child’s age and whether he or she has other medical conditions. Treatment usually includes changes in your child’s eating habits and physical activity level. In certain circumstances, treatment might include medications or weight-loss surgery.

Treatment for children with BMIs between the 85th and 94th percentiles (overweight)

The American Academy of Pediatrics recommends that children older than 2 whose weight falls in the overweight category be put on a weight-maintenance program to slow the progress of weight gain. This strategy allows the child to add inches in height but not pounds, causing the BMI to drop over time into a healthier range.

Treatment for children with BMIs at the 95th percentile or above (obesity)

Children ages 6 to 11 whose weight falls into the obesity category might be encouraged to modify their eating habits for gradual weight loss of no more than 1 pound (or about 0.5 kilogram) a month. Older children and adolescents who have obesity or severe obesity might be encouraged to modify their eating habits to aim for weight loss of up to 2 pounds (or about 1 kilogram) a week.

The methods for maintaining your child’s current weight or losing weight are the same: Your child needs to eat a healthy diet — both in terms of type and amount of food — and increase physical activity. Success depends largely on your commitment to helping your child make these changes.

Healthy eating

Parents are the ones who buy groceries, cook meals and decide where the food is eaten. Even small changes can make a big difference in your child’s health.

• Prioritize fruits and vegetables. When food shopping, cut back on convenience foods — such as cookies, crackers and prepared meals — which are often high in sugar, fat and calories.
• Limit sweetened beverages. This includes beverages that contain fruit juice. These drinks provide little nutritional value in exchange for their high calories. They can also make your child feel too full to eat healthier foods.
• Avoid fast food. Most of the menu options are high in fat and calories.
• Sit down together for family meals. Make it an event — a time to share news and tell stories. Discourage eating in front of a TV, computer or video game screen, which can lead to fast eating and lowered awareness of the amount eaten.
• Serve appropriate portion sizes. Children don’t need as much food as adults do. Start with a small portion and your child can ask for more if they’re still hungry. Allow your child to eat only until full, even if that means leaving food on the plate. And remember, when you eat out, restaurant portion sizes are often way too large.

Physical activity

A critical part of achieving and maintaining a healthy weight, especially for children, is physical activity. It burns calories, strengthens bones and muscles, and helps children sleep well at night and stay alert during the day.

Good habits established in childhood help adolescents maintain healthy weights And active children are more likely to become fit adults.

To increase your child’s activity level:

• Limit TV time. Recreational screen time — in front of a TV, computer, tablet or smart phone — should be limited to no more than two hours a day for children older than 2. Children younger than 2 should have no screen time at all.
• Emphasize activity, not exercise. Children should be moderately to vigorously active for at least an hour a day. Your child’s activity doesn’t have to be a structured exercise program — the object is 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. 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.

Medications

Medication might be prescribed for some children and adolescents as part of an overall weight-loss plan.

Weight-loss surgery

Weight-loss surgery might be an option for adolescents with severe obesity, who have been unable to lose weight through lifestyle changes. However, as with any type of surgery, there are potential risks and long-term complications. Discuss the pros and cons with your child’s doctor.

Your doctor might recommend this surgery if your child’s weight poses a greater health threat than do the potential risks of surgery. It’s important that a child being considered for weight-loss surgery meet with a team of pediatric specialists, including an obesity medicine expert, psychologist and dietitian.

Weight-loss surgery isn’t a miracle cure. It doesn’t guarantee that an adolescent will lose their excess weight or be able to keep it off long term. And surgery doesn’t replace the need for a healthy diet and regular physical activity.

Prevention of Childhood Obesity

According to WHO, childhood obesity is one of the most serious public health challenges of the 21st century. Prevention of childhood obesity is vital, especially since we know that the treatment of obesity is extremely difficult. Proven and simple strategies to prevent obesity include:

• Increase fruit and vegetable intake.
• Reducing TV viewing. Eating while viewing TV is a major cause of excess food intake. TV commercials lead children towards fast foods,
• Reduce sugar intake. Sugar is now called the new ‘tobacco’ and must be limited at all ages. Water is encouraged instead of sweetened drinks.
• Encourage physical activity. It is a struggle to ensure active lives in children, due to limited time and academic pressures. Parents need to facilitate physical activity in young children, and 60 minutes of daily vigorous physical activity in older children.