Understanding Youth and Adolescent Overweight and Obesity: Resources for Families and Communities (page 4)
Over the past three decades, the number of young people who are obese has nearly tripled (National Center for Health Statistics, 2006). Currently, approximately 17.4% of adolescents (ages 12-19) and 18.8% of children (ages 6-11) are considered overweight (National Center for Health Statistics, 2006). In 2004, the U.S. Institute of Medicine called the prevention of childhood obesity a national priority.
The consequences of childhood overweight and obesity are serious. Being overweight or obese increases the risk for heart problems, high blood pressure, and other medical problems (e.g., Sothern et al., 2000), and the psychological impact of being overweight can be devastating. Obesity during childhood and adolescence has been associated with higher rates of sickness and death in adulthood, even when adult weight is considered (Must, Jaques, Dallal, Bajema, & Dietz, 1992). This means that overweight kids may be putting themselves at serious risk of lifelong health problems--even more so than adults who become obese. Furthermore, childhood overweight and obesity, if not treated, can lead to overweight and obesity in adulthood (Freedman, Khan, Dietz, Srinivasan, & Berenson, 2001). Adult overweight and obesity are difficult to treat successfully over the long term (Jeffery et al., 2000), and are associated with life-threatening health problems, such as heart problems, stroke, diabetes, and high blood pressure.
Why is Obesity Increasing?
It is rare for overweight and obesity to be caused by hormonal or genetic defects (Moran, 1999). So what is causing this increase in overweight and obesity? Although the most common reason for being overweight is clear (people eat more calories in food than they burn in exercise), the reasons for the dramatic, nationwide increase in overweight and obesity in children and adolescents are unclear (Troiano & Flegal, 1998). One theory is that as our society has become more successful, convenience foods that are high in fat and calories, such as candy, chips, and sugary drinks, are produced and consumed more frequently (Goran & Treuth, 2001). Another is that our children are leading more inactive lifestyles than in the past. Rather than playing outside, children watch television, play video games, and sit at the computer (Robinson & Killen, 2001). Although our technology may be advancing, our children are sitting more and exercising less.
How is Obesity Identified and Measured?
All individuals have and need fat tissue in the body; however, when there is too much body fat, the result is obesity. Health professionals identify overweight and obesity using the Body Mass Index (BMI). BMI is calculated by measuring the proportion of weight to height. It is calculated the same way for adults and children. However, the criteria used to categorize BMI for children are age- and sex-specific and are often referred to as BMI-for-age. The Centers for Disease Control and Prevention (CDC) recommends using the terms "at risk for overweight" and "overweight" (rather than overweight and obese, which are the terms used with adults) to describe children (Centers for Disease Control and Prevention, 2006).
Calculating BMI for Adults
How do we determine who is overweight? Let's consider the example of a woman who is 5'4" and weighs 165 pounds. When we apply the formula used to compute BMI (weight (lb) / [height (in)]2 x 703), we find that this woman has a BMI of 28.3. A healthy BMI ranges from 18.5 to 24.9, so the woman is considered overweight.
For adults, if a BMI score is between 25 and 29.9, a person is considered overweight. If a BMI score is 30 or above, this is deemed obesity. You can find a BMI calculator for adults online at http://www.cdc.gov/nccdphp/dnpa/bmi/adult_BMI/english_bmi_calculator/bmi_calculator.htm . A BMI calculator for children and teens is at http://apps.nccd.cdc.gov/dnpabmi/Calculator.aspx .
There are three categories of obesity. Class I obesity is defined as a BMI score of 30-34.9, and Class II obesity is defined as a BMI of 35-39.9. Lastly, Class III obesity, also known as morbid obesity or severe obesity, is defined as a BMI score of 40 or higher. Based on these numbers, as many as one-third of all Americans are considered obese.
Calculating BMI for Children and Adolescents
Now let's consider the example of a child who is 13 years old, 5'4", and weighs 180 pounds. Based on her height and weight, this child's BMI is 30.9, placing her BMI-for-age at the 98th percentile for girls her age. According to the table below, because this teen's body mass is above the 95th percentile, she may be overweight. She should be seen by a healthcare provider for further assessment.
BMI-for-age weight status categories and the corresponding percentiles are shown in the following table.
|Weight Status Category
|Less than the
|5th percentile to less
than the 85th percentile
|At risk of overweight
|85th percentile to less
than the 95th percentile
|Equal to or greater than
the 95th percentile
Who is Most Affected?
Rates of youth obesity vary among different groups. According to the National Health and Nutrition Examination Survey (NHANES), African-American, non-Hispanic girls and Mexican-American boys are the groups most likely to be obese (Mullen & Shield, 2004). In the 2006 review of the NHANES, these populations continued to have the largest numbers of adolescents classified as "at risk for overweight" or "overweight" (Ogden et al, 2006, p.1551). 13% of the Caucasian adolescent girls studied were obese, but 24% of African American girls and 20% of the Mexican-American girls were obese (Kumanyika & Grier, 2006). African-American females remain at the highest risk, and have substantial rates of obesity-related diseases and causes of death. However, Mexican-American males are more likely to be obese than African-American males. Native Americans also exhibit higher risk of obesity (Mullen & Shield, 2004). Asian-American adolescents have the lowest rates of overweight and obesity.
Influences and Causes of the Problem
Obesity rates are increasing among all ages, educational levels, and ethnic groups. There are many factors that can increase the risk of adolescent obesity, including school pressures, family conflict, and environmental influences. However, parents, the community, and schools can make a difference when it comes to preventing and solving the problem of overweight and obesity in adolescents.
Parents play the key role in developing a healthy home environment. They shape their children's environment by deciding on the quality and quantity of foods that they provide to them. They decide when children should eat and help determine the amount and type of exercise children receive. As the number of dual-earner families has increased, changes to the family system have emerged. Overall, parents are spending less time being active with their children, cooking less nutritious food, and letting their children spend more time in front of the computer or television.
How much children exercise, how they eat, and whether or not they are overweight often has a lot to do with the examples set by their parents. It is not uncommon for obesity to run in families. Research shows that children who have one or two obese parents are more likely to be obese as adults (Guo, Roche, Chumlea, Gardner, & Siervogel, 1994). Genetics may play a part, but so does the example that parents set. Research has shown that eating dinner together as a family promotes healthful eating habits among children and adolescents. This practice increases children's consumption of whole grains, fruits, and vegetables and decreases their consumption of soft drinks and fats (Goran & Sothern, 2006).
The local community is the first social group that youth encounter beyond their families, and it plays a central role in their development. Many communities have taken active steps in response to the increase in obesity in youth and the general population. For instance, some have changed town planning practices to encourage more walking, more green space, and more recreational activities. Other communities have made policies limiting the number of fast food restaurants and vending machines in areas where youth gather, such as in and near schools and recreation centers.
Researchers are also looking at the connections between children's surroundings and their behavior. If children do not have a safe place to play near their homes, they may spend more time indoors being inactive. Unfortunately, as the numbers of pedestrian injuries and deaths climb, parents become more cautious about safety, and are more likely to keep their children away from natural environments. The community environment can affect children's weight by shaping their eating habits and level of physical activity.
Schools have more continuous and intensive contact with children during their first two decades of life than any other institution (Story, Kaphingst & French, 2006). Schools can make a positive impact on children's health by promoting physical activity, providing healthy foods, and educating children on nutrition. Hunger and inadequate nutritional status can interfere with cognitive functioning and lead to lower academic achievement. Severely overweight children and adolescents are four times more likely than their healthy-weight peers to report impaired school functioning related to health issues (Story et al., 2006).
Research has shown that treatment for overweight and obesity is more likely to be successful in childhood than in adolescence or adulthood (Styne, 2001). Intervention programs targeting youngsters have been shown to be more effective than adult programs, and programs with children tend to have more long-term success.
Within the child population, different age groups respond differently to treatment. Adolescents who are overweight or obese are more likely to remain so in adulthood than pre-adolescents ages 10-14 (Centers for Disease Control and Prevention, 2006), who are less likely to remain overweight and obese in adulthood if they obtain treatment (Styne, 2001). Also, children younger than 10 are less likely to understand nutrition education and healthy lifestyle information. These children have not reached the cognitive developmental level associated with successful lifestyle change (Levine & Smolak, 2001). Overall, weight management programs appear to be most successful in the pre-adolescent population, in both the short-term and long-term.
So far, many prevention efforts have been school-based. They tend to include an educational curriculum, changes in physical education, changes in food service, and parent and/or family changes (Robinson & Killen, 2001). Although parent participation and education appears to be important to success, it is often hard to get and maintain parent participation (Faith, Saelens, Wilfley, & Allison, 2001). These school-based programs have been found to have limited success, and the modest effects they achieve appear to disappear rapidly after the program has been completed (Robinson & Killen, 2001).
There are a variety of treatment approaches available for overweight and obesity in children and adolescents, including medical, educational, school-based, and family-based treatments. Research indicates that family-based behavioral treatment programs offer the best short- and long-term success for weight management. Parental participation in child weight management is crucial for short-term and long-term success (Dietz, 1999). Individualized treatment should focus not only on changing the child, but also on providing a family environment that supports a healthy lifestyle.
Reprinted with the permission of the University of Florida. © 2008 University of Florida.
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