Childhood and Juvenile Obesity:

What is childhood obesity?

Childhood obesity can be loosely defined as an excessive amount of body weight. Just how much extra weight constitutes a problem is measured by the Body Mass Index (BMI), a figure derived from a formula using a child’s weight and height. (See Childhood Obesity Assessment Calculator for a tool to calculate your child’s BMI). If a child’s BMI is 95% or higher in comparison to other kids of his or her age, sex and height, then that child is usually considered obese. Being aware of the signs and symptoms of obesity in your child is also important to determine if his or her weight is becoming a health risk.

Knowing your child’s BMI alone should not be taken as confirmation of obesity. Growth patterns vary greatly among children, and the BMI doesn't consider things like being big-boned or more muscular. Individual histories of growth and development also need to be included in the assessment. Your doctor or healthcare provider will be able to determine where your child’s BMI falls on the national BMI-for-age growth chart, and make a valid diagnosis.

Causes of childhood obesity

Over the past 30 to 40 years there have been dramatic changes in the diet and lifestyle patterns of people in Western nations. Such modifiable factors are the biggest culprits in the alarming rise of childhood obesity. The three major causes are:

• Poor diet. Highly-processed, high-calorie meals and fast foods have become staples of the typical Western diet. Poor nutrition spells weight gain. More than 60% of American youth eat too many fatty foods, and less than 20% eat the recommended five or more servings of fruits and vegetables per day. Eating habits have also changed drastically: family meals have often been replaced by munching continuously throughout the day. Cookies, chips and other high-calorie snack foods are readily available for children to fill up on. Take a good look at what is consumed in your children’s day and see how you can encourage healthier eating.
• Lack of exercise. Our children’s leisure time has become increasingly sedentary. Television, video games and computers occupy vast amounts their free time, at the expense of physical activity. According to the National Institutes of Health, kids who watch the most hours of television have the highest incidence of obesity. The fact that kids usually munch on snack foods while watching t.v. only adds to the problem. If your child is not involved in organized sports or after-school playtime that involves cardiovascular exercise, you may want to add fitness to your family routine. The ratio of calories taken in to calories expended as energy needs to be favorable to counter any genetic tendencies towards overweight. Motivating girls to exercise is a bigger challenge, as they may be less prone to engage in physical play.
• Genetics. Family history plays a significant part in whether your child will develop a serious weight problem. From 25-40 percent of children inherit the tendency towards overweight. If you come from a family of heavy people, and high-calorie food is readily available yet exercise is not, your children are likely to become overweight.

Children from minority backgrounds are at greater risk of becoming obese. Looking at American children age 6-11, we see the following percentages of overweight kids by race:

• Whites (only)—11.9 percent of boys and 12.0 percent of girls.
• Blacks or African Americans (only)—17.6 percent of boys and 22.1 percent of girls.
• Mexican Americans—27.3 percent of boys and 19.6 percent of girls.

Poverty and obesity often go together because low-income parents may lack the time and resources to make healthy eating a family priority. Inexpensive carbohydrates are generally more fattening than more costly proteins. In addition, low-income areas typically have a limited amount of recreational facilities.

Risks to my child’s health from being overweight or obese

The negative health consequences to your seriously overweight child are both physical and emotional. Physical risk indicators that were previously not seen until adulthood are beginning to show up in childhood. The primary effect of obesity is a much greater risk of developing heart disease later on in life. According to an article published in Circulation: Journal of the American Heart Association, the arteries of overweight children act like those of middle-aged smokers, increasing their risk of an early heart attack or stroke. One study found that obese children are three to five times more likely than normal-weight children to suffer a heart attack or stroke before age 65.

Carrying extra weight can lead to other severe physical problems as well, including:

• Type 2 diabetes
• Sleep apnea
• Orthopedic problems
• Liver disease
• Asthma
• Cancer
• Osteoarthritis

More damaging to your child in the short run are the psychological and social effects of obesity. The Mayo Clinic cites the following effects that your overweight child is more likely to experience:

• Low self-esteem and bullying. Children often tease or bully their overweight peers, who suffer a loss of self-esteem and an increased risk of depression as a result. If you suspect that your child is getting picked on, contact the school to alert teachers and administrators about the problem and have it addressed.

• Behavior and learning problems. Overweight children tend to have more anxiety and poorer social skills than normal weight children. At one extreme, these problems may lead to acting out and disrupting the classroom. At the other, they may cause social withdrawal. Stress and anxiety also interfere with learning. School-related anxiety can create a vicious cycle in which ever-growing worry fuels ever-declining academic performance.

• Depression. Social isolation and low self-esteem create overwhelming feelings of hopelessness in some overweight children. When children lose hope that their lives will improve, they are well on the way to depression. A depressed child may lose interest in normal activities, sleep more than usual or cry a lot. Some depressed children hide their sadness and appear emotionally flat instead. Either way, depression is as serious in children as in adults. If you think your child is depressed, talk with him or her and share your concerns with his or her doctor and teacher.

Childhood obesity treatement

Rarely does treatment for childhood obesity focus on weight loss. Instead, the aim is to slow or stop weight gain so that a child can grow into his or her ideal weight. The main goal is to work on the energy balance—a healthy ratio of calories consumed (diet) to calories burned (exercise). Take heart! There is much you can do to influence your child’s eating habits and level of physical activity, and therefore directly contribute to his or her health.

How can I help my child eat a more healthy diet?

Begin eating healthy as a family. Changing the way your entire family eats is crucial, and it cannot become mere lip service. The emphasis here should be on what we can do as a family to improve our health, versus making it a problem that only affects your child. The fact is that your overweight child is going to need your support in many areas to achieve a healthy weight. He or she needs your encouragement, gentle discipline, and enthusiastic participation.

Start by getting a healthy food plan. The American Heart Association recommends some basic eating patterns for families to adopt:

• Reduce unhealthy foods. Eat foods low in saturated fat, trans fat, cholesterol, salt (sodium), and added sugars.
• Cut back on fat. Keep total fat intake between 30-35 percent of calories for children 2 to 3 years of age and between 25-35 percent of calories for children and adolescents 4 to 18 years of age. Most fats should come from sources of polyunsaturated and monounsaturated fatty acids, such as fish, nuts and vegetable oils.
• Choose a variety of foods to get enough carbohydrates, protein and other nutrients.
• Eat only enough calories to maintain a healthy weight for your height and build.
• Serve whole-grain breads and cereals rather than refined grain products. Look for “whole grain” as the first ingredient on the food label and make at least half your grain servings whole grain.
• Serve a variety of fruits and vegetables daily, while limiting juice intake. Each meal should contain at least 1 fruit or vegetable. Children’s recommended fruit intake ranges from 1 cup/day, between ages 1 and 3, to 2 cups for a 14–18-year-old boy. Recommended vegetable intake ranges from 3/4 cup a day at age one to 3 cups for a 14–18-year-old boy.
• Serve nonfat and low-fat dairy foods.
• Estimated calories needed by children range from 900/day for a 1-year-old to 1,800 for a 14–18-year-old girl and 2,200 for a 14–18-year-old boy.

How can I help my child transition to healthy eating?

These dietary changes cannot happen overnight. It is best to focus on small, gradual changes; this approach helps form habits that can last a lifetime. Introduce new eating habits slowly, yet stick to them after they have been made and do not turn back to old ways of eating. It may take 10 or more tries before a child accepts a new food, so do not give up if your child does not like a new food right away. Never use food as a reward or punishment, and do not place your child on a restricted diet, unless it is medically necessary and has been prescribed by your doctor. Emphasizing the negative aspects of eating—rather than focusing on the benefits from positive habits of eating—can lead to more overeating or possibly an eating disorder.

These ten tips from the American Heart Association offer sound advice for helping your child transition to healthy eating:

• Start by introducing healthier elements into foods that your child already likes. For example, offer blueberry pancakes, carrot muffins, fruit slices over a favorite cereal, chunks of bell pepper in a potato salad, or shredded veggies over rice.
• Include your kids in the prep work. By being involved in grocery shopping and food preparation, your kids will have more “buy-in.” If they feel some ownership over the meal, they may be more likely to eat it.
• Don’t buy unhealthy foods. Out of sight, out of mind. If the chips and cookies aren’t around, your kids can’t eat them. They may resist at first, but when they get hungry, they’ll start munching the carrot sticks. Keep healthy foods on hand — 100 percent juice instead of colas or sugary drinks, and a bag of apples instead of a bag of chips.
• Schedule snack time and stick to it. Most kids like routine. If your kids know they will only get food at certain times, they’ll eat what they get when they get it. Try to have snacks incorporate two food groups. For example, offer cheese and whole-grain crackers or apple slices with low-fat yogurt or cottage cheese.
• Have healthy finger foods available. Kids like to pick up foods, so give them foods they can handle. Fruit and veggie chunks (raw or cooked) are great finger-food options.
• Repeal the “clean your plate” rule. Kids know when they’re full, so let them stop. Overeating is one of the major reasons we get too many calories.
• Encourage kids to “eat their colors.” This game works well with younger kids. Food that’s bland in color often also lacks nutrients. Eating a variety of brightly colored foods provides more nutrients in greater variety.
• Don’t cut out treats altogether. Think moderation. A scoop of ice cream or a serving of Oreos is all right occasionally. If you cut out all the goodies, your kids will be more likely to overeat when they do get them. Make sure to moderate the treat consumption.
• Veg out at the dinner table, not the TV. Eating in front of the TV is distracting, and kids may not notice that they’re full because they’re wrapped up in the show. Eating as a family is a great time to catch up.
• Be a good role model. The best way to influence kids is by example. Don’t expect them to eat spinach if you won’t touch it.

Junk food snacks aren’t the only option when it comes to providing treats in your child’s diet. The Weight Control Information Network offers these healthy snack ideas:

• Dried fruit and nut mix
• Fresh, frozen, or canned vegetables or fruit served plain or with low-fat yogurt
• Rice cakes, whole grain crackers, or whole grain bread served with low-fat cheese, fruit spread, peanut butter, almond butter, or soy nut butter
• Pretzels or air-popped popcorn sprinkled with salt-free seasoning mix
• Homemade fruit smoothie made with low-fat milk or yogurt and frozen or fresh fruit
• Dry cereals served plain or with low-fat or non-fat milk

(Note: Children of preschool age and younger children can easily choke on foods that are hard to chew, small and round, or sticky, such as hard vegetables, whole grapes, hard chunks of cheese, raisins, nuts and seeds, and popcorn. Carefully select snacks for children in this age group.)

Make it a point to cut out sweetened beverages from your family’s diet, such as soft drinks and flavored drinks that do not contain 100% fruit juice. These beverages are filled with extra calories and do not provide any essential nutrients; thus, they are empty fillers, at best.

Helping my child get more exercise

Start exercising together. The best way you can ensure that your child gets plenty of aerobic play time is to lead the way. Again, this is a family affair. Become involved in your child’s daily exercise. Be enthusiastic and creative about finding ways to stay active. Play yourself! The example you set is key. Hopscotch and jump rope are great cardiovascular activities. Make sure your child knows that you are exercising, and encourage your child to keep up the habit. Show your child the value of being fit by small things such as parking farther away than necessary and walking to your destination, or taking the stairs instead of the elevator.

The American Heart Association recommends these exercise guidelines:

• 30 minutes of enjoyable, moderate intensity exercise per day for all kids age 2 and older, and
• 30 minutes of vigorous physical activities at least 3-4 times each week.

There are many creative ways to stimulate interest in physical activity and make it practical to fulfill the experts’ recommendations. The Mayo Clinic offers these suggestions for keeping your kids interested in exercise:

• Play games your elementary school child loves, like tag, cops and robbers, Simon Says and Red Light, Green Light. If you don't remember the rules for these games, make up your own or walk to your local library and check out a book on games.
• Let your toddlers and preschoolers see how much fun you can have while being active. Don't just run with them. Run like a gorilla. Walk like a spider. Hop like a bunny. Stretch like a cat.
• Plan your family vacations around physical activities—hiking, biking, skiing, snorkeling, swimming, walking the dog, or camping. Take along a ball or Frisbee disc to sneak in some activity at rest stops.
• Make chores a family affair. Who can pull the most weeds out of the vegetable garden? Who can collect the most litter in the neighborhood? Have your kids help shovel the snow off the driveway and use that excess snow to build a huge snow fort.
• Vary the activities. Let each child take a turn choosing the activity of the day or week. Batting cages, bowling and fast-food play areas all count. What matters is that you're doing something active as a family.
• Use physical activity to counter something your child doesn’t want to do. For instance, make it the routine that your child can ride a bike for 30 minutes before starting homework after school. Your child will beg for 20 more minutes outside just to put off the homework!

Effectively limiting how much television my child watches

Limiting television time leads indirectly to more exercise time. The experts say to keep television watching to less than two hours a day. By extension, this includes other sedentary activities like playing video games and spending non-academic time on the computer. These tips from the American Heart Association help you to set limits the smart way:

• Have a plan. Be prepared to offer alternative activities to TV or video games. You might consider family game night, shooting some hoops, walking the dog or exploring a nearby park.
• Be active with your kids. Experts say that what kids want more than anything else is time with their parents. To give them that, don’t just send them out to play — go play with them!
• Don’t position your furniture so the TV is the main focus of the room. Remove televisions and video games from bedrooms.
• Plan TV watching in advance. Go through the TV guide and pick the shows you want to watch. Turn the TV on for those shows and turn it off afterwards. Don’t just watch whatever comes on next.
• Avoid using TV as a reward or punishment.
• Practice what you preach. Your kids won’t accept being restricted to two hours of TV watching if you can veg out for four hours. The best way to influence your kids’ behavior is through example.

Always remember that your attitude matters greatly in whether your child succeeds in reversing a weight problem. Let your child know that he or she is loved and appreciated regardless of the progress made in losing weight.

References and resources for juvenile obesity

Overview

Understanding the Problem – Thorough treatment of the condition, including health statistics, physical activity suggestions and dietary guidelines. (American Heart Association)

Obesity and Overweight – Definitions, extent of the problem, and what we can do about it. (World Health Organization)

Childhood Obesity on the Rise – The online journal Word on Health explains the effects of childhood obesity and provides resources for keeping your child active. (National Institutes of Health)

Parent resources

What Can I Do? – Contains a great amount of practical information on how to work with your child in making healthy eating and regular physical exercise fun and desirable. Includes advice on how to best limit t.v. time and make fast food healthier. (American Heart Association)

Childhood Obesity: What Parents Can Do – Advice on how to involve the whole family in reversing the conditions for obesity, rather than just focusing on the overweight child. (Mayo Clinic)

Keeping Kids Active: Ideas for Parents – Many helpful suggestions for raising your child’s enthusiasm for activity, with consideration for his or her unique personality. (Mayo Clinic)

Parents Can Play a Role in Preventing Childhood Obesity (PDF) – Fact sheet gives an overview of what parents can do to help their overweight children. (Institute of Medicine)

7 (Sometimes Surprising) Secrets for Stopping Childhood Obesity – Registered dieticians Colleen Thompson and Ellen Shanley, co-authors of the book Overcoming Childhood Obesity, offer seven tips to reverse the problem of overweight in your child. Includes a link to lots of recipes at the bottom of the page. (RecipesToday.com)

Helping Your Child: Tips for Parents – More suggestions on how to promote healthy eating and exercise at home. (National Institutes of Health)

Childhood Obesity Assessment Calculator – Tool that let’s you calculate your child’s Body Mass Index (BMI), in either the English (pounds, inches) or metric system. (Shape Up America)

Kids’ sites

Healthier Generation – A website for kids to educate themselves about healthy food choices and to increase their motivation for more play time. Contains funny video clips and an interactive game show. (Alliance for a Healthier Generation Kids’ Site)

NSW Health: Childhood Obesity (Australian site) – Lets children calculate their Body Mass Index (BMI), as well as plug in their answers to health and lifestyle questions for a customized “Healthy Food and Activity Guide.” (NSW Government site)

Other resources that we used in writing this article

Healthy Active Living for Children and Youth – Explains the general causes of obesity among children and adolescents. (Canadian Paediatric Society)

Childhood Obesity – General treatment of the issue from a non-professional community of parents, whose goal is to provide caregivers knowledge and advice to better raise and educate children. (KidSource Online)

The Role of Media in Childhood Obesity (PDF) – Review of over 40 studies on the impact of media on childhood obesity. (Kaiser Family Foundation)

Childhood Obesity: A Call to Action for Fitness Professionals (PDF) – An article from the American College of Sports Medicine’s certified news journal, exploring prevention and treatment of juvenile obesity, primarily from a sports medicine perspective. (American College of Sports Medicine)

The Surgeon General’s Call to Action to Prevent and Decrease Overweight and Obesity – Covers statistics, causes and suggestions for healthy eating and promoting physical activity among young people. (U.S. Dept. of Health and Human Services)

Exercise Is Key to Reversing Obesity-Related Heart Risk in Children – Results of a study tracking the effectiveness of exercise on two populations of children being treated for obesity: a diet-only group and a diet-plus-exercise group. (American Heart Association)

Overweight in Children – Explains how obesity is defined in children and how to measure Body Mass Index (BMI). (American Heart Association)

Exercise (Physical Activity) and Children – Lists exercise guidelines for children. (American Heart Association)

Dietary Guidelines for Healthy Children – American Heart Association’s position paper on dietary recommendations for infants, children, and adolescents. (American Heart Association)