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Childhood Obesity
OBESITY
Obesity is defined as the presence of excess adipose (fatty) tissue in the body. The term "overweight" may connote a milder degree of excess fat than "obesity," but there are no clearly defined criteria to distinguish between the two terms. Thus, the two terms are used interchangeably.
Although its underlying causes are not fully understood, obesity is a complex chronic disease involving genetics, metabolism, and physiology, as well as environmental and psychosocial factors. Unhealthy eating behaviors and low levels of physical activity are contributing to the continuing increase in the prevalence of obesity among children and adolescents.
Significance
Obesity is a major public health problem. Studies have shown a dramatic increase in the prevalence of obesity among children (including those younger than 5 years of age) and adolescents. Data from the National Center for Health Statistics (NCHS) indicate that more than 1 in 5 children and adolescents in the United States are overweight.
Few studies have examined the long-term effect of childhood or adolescent obesity on adult morbidity and mortality. Longitudinal studies of children followed into young adulthood suggest that overweight children may become overweight adults, particularly if obesity is present during adolescence. Overweight during adolescence affects blood pressure and blood lipid, lipoprotein, and insulin levels in adolescents. Perhaps the most widespread consequences of childhood and adolescent obesity are psychosocial, including discrimination.
Few studies have examined the long-term effect of childhood or adolescent obesity on adult morbidity and mortality. Longitudinal studies of children followed into young adulthood suggest that overweight children may become overweight adults, particularly if obesity is present during adolescence. Overweight during adolescence affects blood pressure and blood lipid, lipoprotein, and insulin levels in adolescents. Perhaps the most widespread consequences of childhood and adolescent obesity are psychosocial, including discrimination.
Health professionals need to be aware of the demographic and personal risk factors for childhood and adolescent obesity and be diligent in their prevention efforts and screening. Children and adolescents are considered at high risk for overweight if
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One or both parents are overweight.
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They are from families with low incomes.
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They have a chronic disease or disability that limits mobility.
In addition, members of certain racial/ethnic groups such as African-American female children and adolescents and Hispanic and American Indian/Alaska Native children and adolescents are considered at high risk for overweight.
Prevention
Enough is known to guide efforts to reverse the trend of increasing obesity. Because obesity is difficult to treat, efforts need to focus on prevention. Although genetic influences largely determine whether a child or adolescent will become overweight, environmental influences may determine the manifestation and extent of obesity.
The primary strategies for preventing obesity are healthy eating behaviors (see the Nutrition chapteer), regular physical activity, and reduced sedentary behaviors (e.g., watching television and videotapes, playing computer games). These strategies are part of a healthy lifestyle that should be developed during early childhood. The goal is to promote and model positive attitudes toward eating and physical activity without emphasizing body weight. Behavioral techniques are needed to encourage healthy eating and physical activity behaviors.
The primary strategies for preventing obesity are healthy eating behaviors (see the Nutrition chapteer), regular physical activity, and reduced sedentary behaviors (e.g., watching television and videotapes, playing computer games). These strategies are part of a healthy lifestyle that should be developed during early childhood. The goal is to promote and model positive attitudes toward eating and physical activity without emphasizing body weight. Behavioral techniques are needed to encourage healthy eating and physical activity behaviors.
Nutrition
Parents need information on how to encourage their children and adolescents to practice healthy eating behaviors, beginning in childhood. Suggestions include
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Gradually weaning infants from the bottle at about 9 to 10 months of age.
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Switching children from whole milk to reduced- fat, low-fat, or fat-free milk after 2 years of age.
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Gradually reducing children's fat intake to no more than 30 percent of their daily calories by age 5.
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Limiting the consumption of high-sugar foods, including juices.
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Being aware of portion sizes, especially of high-fat and high-sugar foods.
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Limiting the consumption of convenience and fast foods.
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Encouraging family members to drink water.
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Encouraging children and adolescents to make healthy food choices based on the Dietary Guidelines for Americans and the Food Guide Pyramid. (See the Nutrition chapter.)
Physical Activity
Moderate amounts of physical activity are recommended on all, if not most, days of the week.11 Children and adolescents can achieve this level of activity through intense activities (e.g., hiking for 30 minutes) or through shorter, more intense activities (e.g., jogging or playing basketball for 15 to 20 minutes). Parents, recreation program staff, and health professionals need to promote physical activity in children and adolescents and help them increase their physical activity levels and decrease sedentary activities. For example, parents can playfully chase their children around the yard or playground, or encourage their children and adolescents to dance to music before dinner or ride a stationary bike while watching television.2 Parents can also get their children and adolescents involved in physical activity programs or organized sports, which can help increase skill levels and self-confidence, foster teamwork, and increase energy expenditures.Screening
Body mass index (BMI) can be used to screen children and adolescents for obesity (Figure 6). BMI is calculated by dividing weight by the square of height (kg/m) and can be plotted on a standard growth chart (see Tool H: CDC Growth Charts). BMI reflects body mass rather than body fat but correlates with measures of subcutaneous and total body fat in children and adolescents. Some children and adolescents have a high BMI because of a large, lean body mass resulting from physical activity, high muscularity, or frame size. An elevated triceps skinfold (i.e., above the 95th percentile on the CDC growth chart) can confirm excess body fat in children and adolescents.
Health professionals can use the following screening guidelines to determine whether a child older than 2 years or an adolescent is overweight:
Health professionals can use the following screening guidelines to determine whether a child older than 2 years or an adolescent is overweight:
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Children and adolescents with a BMI at or above the 95th percentile for age and sex are considered overweight and should receive an in-depth assessment.
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Children and adolescents with a BMI between the 85th and 95th percentiles for age and sex are considered at risk for becoming overweight and should be screened and evaluated, with attention focused on family history and secondary complications of obesity, including hypertension and dyslipidemia.
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Children and adolescents with an annual increase of 3 to 4 BMI units should be evaluated.
