Quick Facts...
- Obesity in early childhood can lead to adult obesity.
- Genetics and family environment play a role in childhood obesity.
- The goal for obese children should be to maintain weight or reduce
the rate of gain.
- Encourage obese children to be active, turn off the television, and
develop healthful eating habits.
Obesity is a growing problem among U.S. children. In 1994, one in five
children between the ages of 6 and 17 was overweight. This is double the
rate of 30 years ago.1 This adverse trend has potentially profound effects
on children's health, including their long-term health.
Diagnosis
The terms "obese" and "overweight" often are used
interchangeably. Technically, "obesity" is the upper end of
"overweight."
Obesity is clinically diagnosed as:
greater than 90th percentile for weight for height; or
greater than or equal to the 95th percentile Body Mass Index (BMI),
age and sex specific.
The gold standard is becoming the BMI, since this is also used for adults.
Effects of Obesity
Obesity has wide-ranging impacts on a child's health.
Physical health. Obesity has been linked to several diseases and
conditions in adults, such as heart disease, cancer and diabetes. Many
risk factors associated with these diseases, such as high cholesterol,
blood pressure and triglyceride levels, can be followed from childhood
to adulthood. This points to a potential link between childhood health
and long-term adult health. Overweight children are more than two times
likely to have high levels of cholesterol. Aortic fatty streaks, the first
stages of atherosclerosis, begin to appear in childhood, maybe even as
early as three years old. Also, children with triceps skinfolds greater
than the 70th percentile have significantly higher blood pressures. In
the past few years, Type 2 diabetes has risen dramatically among children
and adolescents. Experts believe this increase is due to the high rate
of overweight and obesity.
Persistence into adulthood. One of the biggest concerns is that
obese children are more likely to become obese adults, with all of the
health, social and psychological ramifications. Three important factors
are age of onset, severity, and parental obesity. In a review of literature,
Serdula found the risk for adult obesity was greater among children who
had extreme levels of obesity. They also found that the risk was higher
for those who were obese at older ages, such as in adolescence (Serdula
2). Parental obesity may double the risk for adult obesity
too (Whittaker3).
Psychological and social health. Obesity has social, psychological
and emotional consequences. Our society emphasizes slimness, and we have
many misconceptions about overweight and obesity. As a result, obese children
often are treated differently. This may be the most devastating effect
of obesity on children. Obese children may feel isolated and lonely. This
can lead to self-esteem and identity problems. It is important to be sensitive
to this issue and to understand that an individual's confidence,
especially a child's, is affected by self-image and perceptions of
peers.
Causes
Preventing and treating obesity is difficult. Causes are different from
person to person and are still not fully understood. They include genetics,
the environment and behavior.
Genetics. It has been shown that children with obese parents are
more likely to be obese. But is it for genetic or environmental reasons?
One estimate says that heredity contributes between 5 and 25 percent of
the risk for obesity.4 The remaining risk is attributed to environmental
and behavioral factors. Others believe that genetics may play a bigger
role. Regardless, the interrelationship between genetics and the environment
is clear: Parents provide genes, role models, and food.
Dietary patterns. U.S. dietary patterns have changed significantly
over the past few decades. Overnutrition has replaced undernutrition as
the largest nutrition-related problem facing both children and adults.
Although the percent of calories from total fat have declined over the
past 30 years, total calories have increased. Soft drink consumption has
also boomed, adding more calories and less nutrients to Americans'
diets. Our environment also supports "oversize" through large
portion sizes at restaurants. These trends play roles in the increasing
rate of obesity, along with lack of physical activity.
Research studies differ on whether obese consume more energy (calories)
than non-obese individuals. Some show they do consume more; others show
they may consumer fewer calories. The big difference may be in the type
of nutrients that they consume, such as fat. For example, Gazzaniga, et
al5 found that the percentage of body fat was positively correlated with
total dietary fat. Still, other researchers suggest that the reasons are
metabolic in origin and that obese individuals "process" foods differently
resulting in an increase in body fat. Although how these factors affect
obesity are not fully understood, one thing is clear: Obesity results
when energy intake exceeds energy expenditure and is stored as fat.
Parent-child relationships. Ellyn Satter, author of Child
of Mine: Feeding with Love and Good Sense, firmly believes in the
importance of "the feeding relationship" and its implications
for obesity.6 The feeding relationship is the interaction that takes place
between parents and children around food. Obese children need to learn
to listen to their internal cues of hunger and appetite. Parents and childcare
providers must help them do so. This includes encouraging children to
eat according to these cues, while acknowledging the emotional aspect
of feeding and eating. A restrictive diet may make the child feel deprived
and neglected, and exacerbate the overeating problem.
Television. Children and adolescents who watched the most TV
were more obese than peers who watched it less.7 In general, the more
TV they watched, the greater the prevalence of obesity. There are several
ways television contributes to childhood obesity:
- Watching TV requires no energy above resting metabolic rates.
- TV reduces the time the child spends in energetic activities, such
as running and playing. In other words, it's not what the child
is doing but rather what he/she is not doing while watching TV.
- The foods most heavily advertised on TV are high in calories: candy
bars, sugared cereals, etc.
- The slim figures of TV stars may indirectly suggest to children that
high calorie food and drinks have little effect on weight.
- TV characters are typically snacking, not sitting down for well-balanced
meals.
Physical activity. Studies conducted in the last 20 to 30 years
show a strong correlationbetween obesity and lack of physical activity.
Nearly half of youths aged 12 to 21 years old are not vigorously active
on a regular basis (20 minutes, three times a week).8
Treatment
Lifestyles and behaviors are established early in life. Therefore, it
is important to focus early on healthful behaviors. The first step is
to assess the readiness of the child and family to engage in a weight-management
program. Review the child's diet and physical activity habits. The
primary goals of obesity therapy should be healthful eating and activity.
Involve the family. Begin treatment early, involve the family,
and make step-by-step permanent changes.9 "Parenting skills are the
foundation for successful intervention that puts in place gradual, targeted
increases in activity and targeted reductions in high-fat, high-calorie
foods. Ongoing support for families after the initial weight-management
program will help families maintain their new behaviors."9
Maintain weight. A goal of weight maintenance versus weight loss
depends on age, baseline BMI percentile, and whether the child has any
medical complications because of obesity (such as hypertension and high
cholesterol). Unless the child is severely obese, weight loss is not recommended
for the overweight school-age child. Severe caloric restriction could
compromise growth, delay the onset of maturity, and even enhance emotional
overeating. The goal generally is to maintain weight or reduce the rate
of gain. If weight is maintained while height increases, the percentage
of body fat will decrease without compromising lean body mass and growth.
Eat healthfully. There are several constructive ways for parents
to help their child slim down:
- Assess dietary intake. Monitor portion sizes.
- Modify food preparation if needed. Reduce the use of fats and sugars.
Learn to modify recipes.
- Use the Food Guide Pyramid as a guide for healthful eating. Base meals
and snacks on complex carbohydrates (breads, cereals, rice, pasta, grains).
- Wait a few minutes before giving additional servings. A break allows
for you and your child to determine if hunger is the issue.
- Don't impose expectations about what or how much a child should
eat.
- Encourage the child to listen to internal cues of satiety and hunger.
These changes may benefit all family members. Prudent diets have many
health advantages, only one of which is weight control.
Encourage physical activity. Increased physical activity can decrease
or at least slow the increase in fatty tissues in obese youth. Extended
inactivity is not appropriate for normal, healthy children. In addition,
inactivity in childhood has been linked to a sedentary adult lifestyle.
Time, intensity and variety are three important concepts to enhance the
impact of physical activity on health, as well as the child's interest
in it.10
- Time: Children should take part in at least 60 minutes of age-
and developmentally-appropriate activities every day.
- Intensity: Activity periods should last 10 to 15 minutes or
more and include a range of intensities (moderate to vigorous).
- Variety: Children should engage in a variety of physical activities
of various levels of intensity.
For best success, all family members should participate in the increased
activity. Physically active parents and siblings serve as role models.
They also provide good company for bike rides, walks or swims. Physical
activity should be fun and make children feel good, not a chore they must
do to lose weight.
The Centers for Disease Control have recommended that schools establish
policies that promote enjoyable, lifelong physical activity among young
people.11 Their guidelines state, "Physical education should emphasize
skills for lifetime physical activities (e.g., dance, strength training,
jogging, swimming, bicycling, cross-country skiing, walking, and hiking)
rather than those for competitive sports." These experts also recommend
that fitness-enhancing physical activities become an integral part of
the American family's lifestyle.
Be realistic. Ellyn Satter cautions that adults and children must
have a realistic picture of the chances of weight-loss success. She stresses,
"in weight reduction, there are very few Cinderella stories. Success
in terms of weight loss may be limited, but success in terms of enhancing
emotional well-being, nutritional status and physical capability may be
considerable."6
The following Extension Web sites contain additional information
about obesity particularly for parents:
www.extension.iastate.edu/Publications/NCR374.pdf
www.oznet.ksu.edu/library/FNTR2/NCR598K.PDF
References
1. National Center for Health Statistics, Centers for Disease Control.
Prevalence of Overweight among Children and Adolescents: United States,
1999. http://www.cdc.gov
2. Serdula, MK, Ivery, D, Coates, RJ, et al.: Do obese children become
obese adults? A review of the literature. Preventive Medicine 1993; 22:
167-177.
3. Whitaker, RC, Wright, JA, Pepe, MS, Seidel, KD, Dietz, WH. Predicting
obesity in young adulthood from childhood and parental obesity. New England
Journal of Medicine 1997; 337: 869-73.
4. Bouchard C, Perusse L. Genetic aspects of obesity. Annals of the New
York Academy of Sciences 1993; 699:26-35.
5. Gazzaniga J, Burns T. Relationship between diet composition and body
fatness, with adjustment for resting energy expenditure and physical activity,
in preadolescent children. American Journal of Clinical Nutrition 93 A.D.;
58:21-28.
6. Satter E. How to get your kid to eat ... but not too much. Palo, Alto,
CA: Bull Publishing Co., 1987.
7. Dietz WH, Gortmaker S. Do we fatten our children at the television
set? Obesity and television viewing in children and adolescents. Pediatrics
1985; 75:807-812.
8. U.S. Department of Health and Human Services, Centers for Disease
Control,
National Center for Chronic Disease Prevention and Health Promotion, The
President's
Council on Physical Fitness and Sports. A Report of the Surgeon General:
Physical
Activity and Health. 1996.
9. Barlow S, Dietz W. Obesity evaluation and treatment: Expert Committee
recommendations. Pediatrics 1998; 102:E2910.
10. The National Association for Sport and Physical Education (NASPE).
NASPE releases first ever physical activity guidelines for pre-adolescent
children. 1-2. 5-13-1998. NASPE.
11. Centers for Disease Control, Guidelines for School and Community
Programs to Promote Lifelong Physical Activity Among Young People. Morbidity
and Mortality Weekly Report 1997; 46 (RR-6); 1-36
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