Childhood obesity

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at July 29, 2016
StartDiseasesChildhood obesity

The rate of obesity in children has tripled since the 1980s. According to the National Collaborative on Childhood Obesity Research, 1$4 billion will be spent on health care costs related to childhood obesity. Obese children will lose an average of five years from their life expectancy.

Contents

Definition & Facts

Childhood obesity is obesity occurring in children or adolescents. Obesity in children is especially concerning because the majority of obese children grow into obese adults, and obese adults experience a shorter life expectancy due to increased risk of cancer, stroke, diabetes, and heart disease. Obese children also miss more days of school and are less likely to participate in sports and activities than other children, which can put them at an academic disadvantage.

Symptoms & Complaints

The primary symptom of childhood obesity is body weight that is too high for the child's height and age. Many secondary symptoms are associated with childhood obesity, such as lack of energy, reduced sleep quality, and shortness of breath.

Aches and pains are a common complaint for obese children due to increased stress on bones, muscles and joints from the child's excess weight. Many other health conditions are strongly associated with childhood obesity. Obese children are twice as likely to develop asthma as normal weight children, and more than two-thirds of obese children have at least one heart disease risk factor.

Half of all type 2 diabetes cases diagnosed in children are caused by obesity. Adolescents who struggle with obesity during puberty may experience hormonal abnormalities such as polycystic ovarian syndrome, irregular menstruation and heavy periods (menorrhagia).

Mental health problems are also common in obese children, with depression and anxiety being the most common. Excess weight can cause chemical changes in the brain that lead to depression, and poor body image as well as bullying from peers/societal expectations exacerbate these mental health problems.

Causes

The majority of childhood obesity cases are caused by consuming more calories than needed, which causes the body to store fat and gain weight. Obese children eat too much and do not exercise enough to offset the amount of excessive calories they consume. A quarter of obese children do not participate in any physical activity at all.

Only two percent of children in the United States regularly eat a healthy diet. Compared to 50 years ago, before the obesity epidemic began, children today lead a much more sedentary lifestyle, spending less time playing and more time snacking. Play is more likely to occur on an electronic device than on a playground. Preschool children consume an average of three snacks per day, plus meals that often come from a fast food restaurant or are highly processed.

An obese child's diet is usually comprised of foods that have little nutritional value, such as cookies, snack cakes, chips, fast food and microwave dinners. The child consumes too many calories because these foods are calorie dense and lack substances like protein and fiber which increase satiety. Many obese children also suffer from malnutrition.

Poverty is an indirect cause of obesity in both children and adults because low-quality, high-calorie foods are often much cheaper than healthy, nutritious foods. Childhood obesity occurs less frequently as a secondary condition to diseases like hypothyroidism and Prader-Willi syndrome or as a side effect of medication.

Diagnosis & Tests

Diagnosing obesity in children is more complicated than in adults. Testing for childhood obesity begins by measuring the child's height and weight to calculate his or her body mass index, or BMI. This measurement is then compared to the average for other children in the same age group to determine the child's BMI percentile. A BMI in the 95th percentile or above is indicative of childhood obesity, but most doctors consider other factors before making the diagnosis.

Some children, for example, gain weight temporarily in preparation for puberty or a growth spurt. Most doctors will make a diagnosis of childhood obesity if the child is experiencing obesity-related symptoms and has maintained a BMI above the 95th percentile for an extended period of time.

A blood test called a metabolic panel is often conducted to check for diseases that cause obesity and to examine health markers like blood sugar, cholesterol, and triglycerides. Most obese children have high levels of bad cholesterol (LDL), low levels of good cholesterol (HDL), high blood pressure and high blood sugar.

Treatment & Therapy

Treatment for childhood obesity focuses on helping the patient achieve and maintain a healthy weight. This involves making big lifestyle changes, and the whole family has to be on board for treatment to successful. The child's parents or guardians learn how to teach the child to eat a healthy diet and to get regular exercise.

Obese children should never be told they are "fat" or that they need to lose weight. The child's focus should be on health rather than appearance to reduce the risk of developing negative body image, poor self-esteem, body dysmorphic disorder, or an eating disorder.

Dietary changes should focus on adding healthy, low-calorie foods like vegetables, fruits and lean meats, and eliminating foods that are high in calories and low in nutrients. Foods that are not allowed for the child should be removed from the home to reduce temptation. The child's doctor may recommend physical therapy or a structured exercise program to get the child moving.

Medications to suppress appetite may be prescribed in some cases. Bariatric surgeries, such as the lap band procedure or gastric bypass surgery, are rarely performed in children. However, bariatric surgery may be suggested for extreme cases of obesity in older children or adolescents.

Prevention & Prophylaxis

The best way to prevent childhood obesity is to encourage healthy eating and physical activity from the beginning. Studies suggest that breastfeeding can reduce the risk of both childhood and adult obesity.

Parents can help prevent childhood obesity by prohibiting soda and sugary drinks, and only allowing the consumption of junk food in moderation. Parents should encourage physical activity through play, sports and exploring outdoors and place strict limits on screen time, including televisions, tablets, smartphones and computers.

To the extent that childhood obesity is a product of poverty, public health initiatives and social policy may address the problem from this prism.