What parents need to know about childhood obesity
According to the Centers for Disease Control and Prevention, roughly 14.7 million U.S. children and adolescents between the ages of 2 and 19 are impacted by childhood obesity, which has a prevalence rate of 19.7%. This year the American Academy of Pediatrics (AAP) issued new clinical guidelines addressing treatment options like bariatric surgery and weight-loss drugs for youth, while a recent report in the journal Pediatrics considered whether childhood obesity should be treated as a public health emergency.
At what point is a child deemed to have obesity, and what are the health risks associated with it? And amid growing evidence that weight stigmas negatively affects children with obesity, how can kids get help without being pushed to lose weight? Here's what parents need to know.
What is considered obesity in children?
When medical professionals suspect a child is overweight, they look at their body mass index (BMI). The BMI uses the child’s height and weight to calculate whether they are within the healthy range for age and sex.
If a child’s BMI is between the 85th to 95th percentile, they are considered “overweight,” and if it's above the 95th percentile, they are considered “obese” — meaning children in the top 5% of the BMI are considered obese. Meanwhile, “severe obesity” is defined as a BMI above the 120th percentile.
Strictly speaking, a diagnosis of childhood obesity is a medical term that does not paint a complete picture surrounding a child’s overall physical health. It's worth noting that BMI has been under increased scrutiny as a tool for evaluating health, and some youth with a higher BMI are considered perfectly healthy.
Kelsey M. Latimer, a psychologist specializing in child and adolescent development and neuropsychology and a certified eating disorder specialist based in Palm Beach, Fla., says that only using weight and the BMI conversion chart gives insufficient information about the child’s overall health.
“There are many factors that influence weight and shape, including [their] cultural background, what their parents look like and their socioeconomic status and access to food,” she says. “It is far more important to look at trends over time in an individual.”
Dr. Whitney Lyn, lead family medicine physician at the John Sengstacke Clinic at Provident Hospital in Chicago, agrees. “There are many factors that can contribute to childhood obesity, such as socioeconomic or income level, where they live and genetics,” Lyn tells Yahoo Life. “Approximately 19% of obese children come from the lowest income level. Healthy food is more expensive than unhealthy food, [making] it more difficult for families with a lower income to access healthier options.”
Instead of focusing on the number on the scale, Latimer suggests that parents and their child’s medical professionals consider these qualitative questions to get the overall picture of their health:
Have they fallen off their own growth curve?
Have they suddenly gained a lot of weight at one particular time?
“Many children who may be over the 85th percentile, when looked at individually, are the ‘picture of health,’” Latimer says. "They are happy, have friends, blood work looks great and their growth curve has not changed significantly — therefore, they may simply be ‘healthy’ living in a larger body. On the other hand, there are countless children who may be deemed ‘a healthy weight’ per the number on the scale, but internal trends might tell a different story. They may be starving themselves, or have underlying issues with their blood work and they may have fallen off their growth curve.”
What causes childhood obesity?
A variety of factors and situations can influence a child’s weight, such as genetics, nutrition, physical activity, a family’s access to affordable nutritious food and sources of toxic stress such as exposure to racism. “Toxic stress can affect the hormones that regulate weight, among other health effects,” according to the AAP.
“Environment is a factor,” adds Lyn. “Where a child lives can impact their access to those healthier food choices [like] if they live in a food desert where there are fewer options to access fresh fruits and vegetables.”
Recent research indicates that external factors such as maternal smoking and air pollution inside the home increase the risk for a higher BMI in children. And that’s not all.
“The CDC states that children who don’t get enough sleep are at risk for unhealthy weight gain,” Lyn says. “Children not getting enough sleep will eat more and lack energy. Keeping a consistent sleep schedule, even on the weekends, helps [curb] weight gain." She adds that kids ages 6 to 12 should have between nine and 12 hours of uninterrupted sleep at night, while those ages 13 to 18 need eight to 10 hours.
Other environmental risk factors include higher instances of adverse childhood experiences, like abuse, and living closer to a convenience store — both of which mean the child has a higher chance of developing unhealthy eating behaviors. Additionally, longer sleep times are associated with a lower BMI, while more screen time and less walking may mean a higher BMI.
What does the research say?
The most recent relevant studies reveal:
A Swedish study published in PLOS Medicine found that those who experienced childhood obesity had an almost three times greater risk of all-cause mortality (death due to any cause) than those who did not experience childhood obesity.
More kids are getting weight-loss surgery than ever before. A study published in JAMA Pediatrics showed an 18.85% increase in metabolic and bariatric surgery rates in youth from 2020 to 2021.
In a peer-reviewed study published in the journal PLOS One, researchers found that only 1% of children with obesity moved to a healthy weight range. However, 23% of those with overweight moved into the healthy weight range.
According to a study published in the International Journal of Obesity, early treatment of childhood obesity is effective. This and previous studies on preschool-aged children showed that caregiver education was key.
A study published in JAMA Network Open showed that drinking less soda may help combat childhood overweight and obesity. (Drinking fruit juice before age 2 is also linked to developing childhood obesity.)
Using the right words when discussing childhood obesity is crucial, according to a study published in the journal Pediatrics, which indicated that it is important to consider youth preferences when discussing weight-related health.
What are the risks of pediatric obesity?
According to the CDC, childhood obesity has been linked with:
Higher risk of anxiety and depression
Lower self-esteem and self-reported quality of life
Higher prevalence of bullying and stigma
Obesity in adulthood
For both children and adults, obesity increases the risk of:
Breathing issues
Joint problems
Gallstones and gallbladder disease
High blood pressure and high cholesterol
Additionally, obese adults are at a higher risk for mental illnesses such as clinical depression and anxiety, premature death, stroke and various types of cancers.
What can parents do?
Some families may explore intensive treatments like bariatric surgery or weight-loss drugs if their child has been diagnosed with severe obesity, a complex and sensitive decision that should be made with input from the child's doctor. The experts who spoke to Yahoo Life, meanwhile, agree on one major thing: Don’t focus on their weight. Here's what they recommend.
Talk about healthy living with kids
“It’s best to focus on healthy living — moving a bit more and eating a bit more healthily, and keeping things positive,” says Dr. Stephen Pont, a childhood obesity expert and public health physician at the Texas Department of State Health Services.
Why keep it positive? “Focusing on the weight can increase anxiety and other negative emotions,” explains Pont, who points out that most kids and teens are still growing vertically and building more muscle mass.
Don’t use stigmatizing language
Meanwhile, Dr. Joanna Dolgoff, a pediatrician with Wellstar Health System and spokesperson for the AAP, recommends not using “overweight” or “obese" with kids. Additionally, she reminds families that it's important to “praise children as often as possible to increase their self-esteem.” This can be done by pointing out all the positive choices that kids already make each day, independent of their weight.
Focus on healthy eating as a family
Pont, who co-authored the AAP policy statement about stigmas attached to childhood obesity, says that it’s crucial for families to make changes together. “Then the whole family will benefit from the healthy changes, the one child won’t feel singled out and all are far more likely to be able to maintain the changes,” he says.
Dolgoff advises parents to cut back on unhealthy snacks and make healthier choices whenever possible. “I like to talk about feeding our bodies healthy fuel and getting the right amount of movement or exercise each day,” she says. “Junk food should really be occasional treats and not everyday occurrences.”
Additionally, Lyn recommends reintroducing healthier foods that children might not like in other ways, diluting fruit juice with water to decrease sugar intake and reminding parents (especially those living in a food desert) that “frozen vegetables can be just as healthy as fresh ones” since they can last longer and are more easily accessible.
Latimer emphasizes teaching your child how to have meals that incorporate balance, moderation and variety. Begin by asking your family: "Does this meal have a variety of colors? Are there many different types of things, like starches, vegetables and proteins? What does the meal smell like, look like and taste like? How would you describe it: salty, sweet or bitter?"
“This is so helpful because our children today are often bombarded with time crunches or they may eat in front of their devices, and they may not stop to notice what they are eating and if they even like it, or to allow their brain to process, ‘Am I even full or satisfied with the meal?’” she explains.
Encourage being active
Various research has found that societal factors such as having access to green spaces increase physical activity and decrease time watching television and weight classification in kids. That said, many families face barriers to being active.
“Some families are not able to have children go outside and play due to neighborhood or safety concerns,” Lyn says. “Giving parents other options for activities, either in the home or participating in activities in the school, helps parents understand the options [they do have] out there.”
“It is helpful to come up with suggestions for the whole family to find times to fit increased movement into their days,” adds Dolgoff. Even simple things, such as a quick dance break or taking the stairs instead of an elevator, can have a positive impact on a child’s overall movement goals.
The takeaway
While doctors are increasingly concerned about the rising levels of obesity in children, other factors impact a child’s overall health. Doctors emphasize that the way to a healthier weight is through avoiding stigmatizing language and focusing on healthy living as a family.
“You never want to single out an overweight child,” says Dolgoff.
