is very much in the news for two basic reasons: Doctors have become
increasingly aware of the serious health problems it can cause,
and more and more people are becoming overweight. Children are not
immune to this overall trend; the percentage of seriously overweight
children and adolescents has never been so high.
in childhood obesity is accompanied by serious health consequences
so that diseases that typically afflict adults, such as high blood
pressure and atherosclerosis (blockage of the arteries), are now
seen in young people as well. Indeed, drastic solutions to obesity,
once resorted to only by adults, are now being adopted by teenagers.
For example, some insurance companies are financing a very risky
procedure called stomach stapling in which the useable portion of
the stomach is surgically reduced.
Is Obesity Measured?
do pediatricians mean when they say that a child is obese? The most
widely used measure of obesity is the body mass index. A child's
weight is divided by his or her height squared (See the formula
in the chart called The Body Mass Index). The number gives physicians
a sense of how heavy a child is for her or his height. A simple
chart (a separate one is used for boys and girls) is then used to
determine if the BMI is too high. Twenty-five years ago, only 5%
of children of any given age had a BMI that fell above the red line
on the chart above (the 95 th percentile of a generation ago) and
were classified as obese. Now the number is 15%.
the BMI isn't a foolproof way of determining whether a child is
seriously overweight. After all, children do vary in terms of how
muscular they are and in bone size. But the great majority of children
whose BMI is above the 95 th percentile are carrying a great deal
of excess weight. Many have abnormally high blood pressure and high
cholesterol and are at risk for serious health problems in the future.
Are More Children Obese Today?
one sense, the reason why more and more children are overweight
is very clear. They must be consuming more calories (food) than
they can use. The excess calories -- those not consumed by physical
activity -- are converted into fat. Why this is so is not quite
so clear, but surveys indicate that children are exercising less
and engaging more in pastimes like watching television and playing
video games. At the same time snack foods are more widely available
and come in larger portions than ever before. Have you noticed the
change in the size of soft drinks? A report in the Journal of the
American Medical Association concluded that the average drink served
has increased from 13 to 20 ounces in the last twenty years.
problem of childhood obesity in children is not limited to the United
States -- it is now a problem for traditionally poor countries where
recent prosperity has caused people to eat more and exercise less.
In Chinese cities the percentage of obese children has increased
from 1.5 to 12.6 percent in the last ten years!
young people become obese while others don't is not completely clear.
The problem runs in families -- if even one parent is obese the
children are much more likely to develop obesity. Behavioral and
lifestyle factors probably combine with many of our genes to influence
our tendency to become obese. One reason that breast feeding is
so highly encouraged is that infants who are breast fed are less
likely to become obese. The World Health Organization has recently
summarized the scientific data as to the causes of obesity in children
(See Chart #3). The best evidence indicates that a decline in physical
activity among children is the culprit.
Consequences of Obesity in Children
adolescents are at increased risk for developing type II diabetes,
a disease that normally is not seen until middle age. The patient
with this condition does not respond normally to insulin, which
circulates in the blood. This causes glucose levels in the blood
to soar, greatly increasing the risk of serious heart problems.
Other diseases now seen to be much more prevalent among children
due to obesity included asthma, specific kinds of liver complications,
and obstructive sleep apnea.
of childhood obesity are not just physical. Obese children or adolescents
can be stigmatized by their peer groups. Or their appearance may
become an unfair barrier to full participation in sports and social
events. The possibly severe effects of obesity on children's self-esteem
should not be ignored. Nor should the fact that obese children,
at least those over five years of age, are much more likely to become
obese adults and therefore be at increased risk for many diseases
throughout their lifetimes.
Should I Do If I Think My Child Is Obese?
are worried that your child is obese, it is a good idea to consult
with your pediatrician. He or she can be helpful in assessing your
child's weight problem, if any, and also can check for any potential
complications like high blood pressure or diabetes. If the physician
agrees that a problem exists, you can discuss strategies for weight
loss should be tailored to your child's unique needs and environment.
All weight loss plans will consist of modest changes in lifestyle
and eating habits -- they will not contain punishments or penalties
for overeating, but will foster and reinforce positive and constructive
you want to encourage physical activity. Plan family activities
that involve both exercise and enjoyment: walks in the neighborhood,
games in the yard, visits to the park. Provide a safe environment
for physical activities -- be they outdoor games around the house,
participation in organized sports, swimming lessons, etc. Children
imitate their parents, and if you are more active, they will likely
be so, too.
well-established that children who watch a great deal of television
are much more likely to be obese. Limiting television watching to
two hours a day or less is a way of indirectly encouraging physical
activity and avoiding the constant advertisements for fast food
that children are exposed to while viewing.
other side of the coin is limiting food intake. Crash diets are
never recommended. Children's diets are largely a product of habit.
They eat not only what they like, but also what is readily available.
To encourage healthy eating habits, parents should keep fruits,
nuts, and vegetables on hand as snack foods rather than fast foods
like potato chips and cookies. Soft drinks should be avoided --
they are loaded with added sugar. The sugars that are added to soft
drinks, cakes, and cookies have a tendency to increase our appetite.
Remember that only a fairly modest reduction in your child's calorie
intake is needed to change her or his weight profile -- after all,
children are still growing! Interestingly, families who eat meals
together are less at risk for obesity, so make a special effort
to eat with your children as often as you can.