Childhood Obesity Takes a Toll on Kids' Mental Health, Too

Childhood weight issues have a domino effect on our kids' well-being, contributing to anxiety, depression, and even suicidal thoughts.

In a busy children’s clinic in Atlanta, medical staff are noticing a worrying increase in children with a BMI greater than the 85th and 95th percentiles both with and without weight-related illnesses. The clinic’s waitlist for treatment is currently months long. And, concerningly, a disproportionate number of their patient population are Black families.

Dr. Traci Williams, Assistant Professor at Emory University and Pediatric Psychologist at Children’s Healthcare of Atlanta, is one of the clinicians working tirelessly to mitigate the emotional, mental, and behavioral factors associated with weight issues in children. She is particularly concerned about how it impacts Black children. “The reality is that African American adults and children have the highest rates of obesity or being overweight compared to other families.”

According to recent data, one in six children aged between 10 and 17 are above their recommended BMI. Of these children, Black children account for 22.9%–the highest percentage among all racial groups. In 2009, the NAACP declared childhood obesity an emergency and outlined a resolution that maintains relevance today.

She explains that there are multiple reasons for this–called obesogenic factors–which are behavioral, environmental, and economic contributors. For instance, in 2018, African Americans were 20% less likely to engage in active physical activity compared to non-Hispanic white people. Dr. Williams attributes this to “differences in work demands, life stressors, and access to safe spaces for physical activity. Also, consuming packaged, sugary, fatty, nutrient-poor foods is easier and significantly cheaper than fresh, nutritious foods”.

While there are a host of physical problems that come with a lack of weight management including joint pain, breathing problems, difficulties with sleep, diabetes, and hypertension, often overlooked are the social and emotional effects that can have long-term consequences into adulthood. Earlier this year, the American Academy of Pediatrics published its first comprehensive guidance in 15 years for the evaluation and treatment of children and adolescents with weight issues. Importantly, the guidelines highlighted the necessity of evaluating the emotional health of these children.

Mental health providers, like Dr. Williams, are key players in weight management settings. They can help determine and address risk factors for weight gain, and the socio-emotional consequences of being overweight, and help families develop healthier habits–together. She says that she now spends her days screening for mental health disorders. “Our patients are prone to experiencing depression and anxiety, behavior problems, attention deficit hyperactivity disorder (ADHD), and disordered eating behavior. Lower school performance is also common in our patients.”

Children and teens struggling with their weight are more likely to experience low self-esteem, discrimination by others, and engage in emotional eating, which then exacerbates the problem of managing their weight. “Unfortunately, experiencing teasing and bullying is common for my patients. Some tearfully share the mean things peers say to them. During the pandemic shutdown, many of our kids were able to escape teasing and bullying. Now, we are faced with kids who do not want to return to in-person learning,” she explains. “Many of these kids who remain homeschooled go on to be socially isolated, have few, if any friends, and tend not to engage in peer group activities.”

Dr. Williams acknowledges that to work on weight management, all aspects of children’s well-being need to be addressed. A typical clinic day involves working alongside her multidisciplinary team and seeing ten or more patients and their caregivers. “All patients meet with a medical provider, psychologist, nutritionist, and exercise physiologist,” she says. “It is important to me to become familiar with my kids’ lives, their routines, and the people in their world. That helps me help them. With each family, I typically cover how the child or teen is doing emotionally and discuss any behavior issues that might be occurring in response to their weight management goals.”

Sadly, Dr. Williams says she has been conducting suicide risk assessments more frequently. This week she’s done at least three in young people who report having suicidal thoughts. “At regular intervals, I formally assess kids 12 and older for symptoms of depression and anxiety, including assessing their risk for self-harm, suicidal thoughts, and behaviors,” Dr. Williams says. “If my patients are struggling emotionally, I help them and their families access mental health services.”

Her role also involves helping parents address eating-related behavioral issues, like getting teens off their phones at mealtime, or what to do if a child is regularly sneaking food or snacks. She walks families through creating plans to reduce kids’ sedentary behaviors such as watching TV and playing video games. She previously shared insights on the importance of outdoor play which she discusses with each of her patients and their families. “Talk with your kids about the types of physical activity they would like to engage in. They will be more likely to enjoy it and do it consistently,” she advises.

She acknowledges that minority families are more likely to live in neighborhoods where it may not be safe to play and exercise outside. In these instances, “we talk about ways to increase families’ physical activity safely, such as walking at a nearby park, or using online kid-friendly exercise videos at home.”

Dr. Williams stresses that it’s important to commit, as a family, to make healthy changes. “You can make small changes over time. Set goals together like increasing how often you eat fruits and vegetables, reducing the amount of packaged and processed foods you buy and drinking more water.” If cost is a prohibitive factor, she suggests accessing local community food banks for fresh produce.

“Our cultural identities and family histories are blended into the foods we traditionally eat. Mealtimes are significant bonding experiences for families,” she mentions. “I discuss the importance of moderation versus elimination with my patients’ parents. We don’t have to cut out the delicious cornbread and fried chicken that Grandma makes, but it will help to eat it less often. We discuss the expectations around food and mealtime. For instance, it is common for adults to tell kids they must “clean that plate.” This can encourage overeating and affect kids’ abilities to recognize fullness.”

Cooking and eating meals together as a family–traditional in Black households–is encouraged. There are several benefits to family meals, including healthier nutritional choices, mindful eating practices, social engagement, and passing on family values.

In Black culture, there is also a lot of emphasis on body size, with relatives and friends openly commenting on your body. Certain physical attributes are deemed more desirable than others. This is something Dr. Williams discusses with her patients and their families. “Some kids and teens want the adults in their life to know that these discussions make them uncomfortable, and I help them share that message.”

If parents are concerned about their child’s weight and overall health, they should consult with their pediatrician. If necessary, your child’s doctor can refer you to a multidisciplinary weight-management program, often located within major children’s hospitals.

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