Wednesday, October 18, 2006


Childhood Obesity

Obesity in children and adolescents is a serious issue with many health and social consequences that often continue into adulthood. Implementing prevention programs and getting a better understanding of treatment for youngsters is important to controlling the obesity epidemic.
Many parents are rightly concerned about their child's weight and how it affects them. They look for specific answers for prevention and treatment options. Unfortunately, the state of the science is a lot less precise than we would like. Are kids too concerned about their weight? What are the best strategies for prevention? What treatments work over a long time? Researchers are trying to answer those and many other questions. In many cases, common sense works well.
In situations where there are serious health, psychological or social problems, parents should seek out the best possible advice.
Note: The term "childhood obesity" may refer to both children and adolescents. In general, we use the word, "children" to refer to 6 to 11 years of age, and "adolescents" to 12 to 17 years of age. If otherwise, and when possible, we will use a specific age or age range.

Prevalence and Identification

About 15.5 percent of adolescents (ages 12 to 19) and 15.3 percent of children (ages 6 to 11) are obese. The increase in obesity among American youth over the past two decades is dramatic, as shown in the tables below.

Table 1. Prevalence of Obese Children (Ages 6 to 11) at the 95th percentile of Body Mass Index (BMI)
1999 to 2000
1988 to 1994
1976 to 1980

Table 2. Prevalence of Obese Adolescents(Ages 12 to 19) at the95th percentile of Body Mass Index (BMI)
1999 to 2000
1988 to 1994
1976 to 1980
A measurement called percentile of Body Mass Index (BMI) is used to identify overweight and obesity in children and adolescents. The Centers for Disease Control (CDC), the supplier of national growth charts and prevalence data, avoids using the word "obesity" for children and adolescents. Instead, they suggest two levels of overweight: 1) the 85th percentile, an "at risk" level, and 2) the 95th percentile, the more severe level.
The American Obesity Association uses the 85th percentile of BMI as a reference point for overweight and the 95th percentile for obesity.
We do so, because the 95th percentile:
corresponds to a BMI of 30, which is the marker for obesity in adults. The 85th percentile corresponds to the overweight reference point for adults, which is a BMI of 25.
is recommended as a marker for children and adolescents to have an in-depth medical assessment.
identifies children that are very likely to have obesity persist into adulthood.
is associated with elevated blood pressure and lipids in older adolescents, and increases their risk of diseases.
is a criteria for more aggressive treatment.
is a criteria in clinical research trials of childhood obesity treatments. Growth Charts - Identifying Obesity in Your Child
Parents and healthcare professionals in the U.S. have used growth charts since the late 1970's to follow the progress in physical growth of infants, children and adolescents. In May 2001, the CDC developed new growth charts to include BMI.


There are many factors that contribute to causing child and adolescent obesity - some are modifiable and others are not.
Modifiable causes include:
Physical Activity - Lack of regular exercise.
Sedentary behavior - High frequency of television viewing, computer usage, and similar behavior that takes up time that can be used for physical activity.
Socioeconomic Status - Low family incomes and non-working parents.
Eating Habits - Over-consumption of high-calorie foods. Some eating patterns that have been associated with this behavior are eating when not hungry, eating while watching TV or doing homework.
Environment - Some factors are over-exposure to advertising of foods that promote high-calorie foods and lack of recreational facilities. Non-changeable causes include:
Genetics - Greater risk of obesity has been found in children of obese and overweight parents.


Teaching healthy behaviors at a young age is important since change becomes more difficult with age. Behaviors involving physical activity and nutrition are the cornerstone of preventing obesity in children and adolescents. Families and schools are the two most critical links in providing the foundation for those behaviors.
FamiliesParents are the most important role models for children. Results from an American Obesity Association survey show that:
The majority of parents in the U.S. (78 percent) believe that physical education or recess should not be reduced or replaced with academic classes.
Almost 30 percent of parents said that they are "somewhat" or "very" concerned about their children's weight.
12 percent of parents considered their child overweight.
Comparing their own childhood health habits to their children's, 27 percent of parents said their children eat less nutritiously, and 24 percent said their children are less physically active.
35 percent of parents rated their children's school programs for teaching good patterns of eating and physical activity to prevent obesity as "poor," "non-existent," or "don't know."
Among six choices of what they believed to be the greatest risk to their children's long-term health and quality of life, 5.6 percent of parents chose "being overweight or obese." More parents selected other choices as the greatest risk: alcohol (6.1 percent), sexually transmitted disease (10 percent), smoking (13.3 percent), violence (20.3 percent), and illegal drugs (24 percent).
In terms of their own behavior, 61 percent of parents said that it would be either "not very difficult" or "not at all difficult" to change their eating and/or physical activity patterns if it would help prevent obesity in any of their children. The AOA's survey results indicate that parents understand the importance of regular physical education for their children. Their unfamiliarity or inadequate rating of their children's school obesity prevention program is likely due to the lack of programs across the nation.
Parents appear to underestimate the health risk of excess weight to their children, and the difficulty in achieving and maintaining behavioral changes associated with obesity prevention. Additional studies are needed to develop appropriate public health programs to better educate parents in identifying and understanding changes in their children's weight, to incorporate the family in prevention efforts, and to improve school-based obesity prevention programs that include increasing physical education classes.
Here are some ways that parents can establish a lifetime of healthy habits for their family:
Create an Active Environment:
Make time for the entire family to participate in regular physical activities that everyone enjoys. Try walking, bicycling or rollerblading.
Plan special active family-outings such as a hiking or ski trip.
Start an active neighborhood program. Join together with other families for group activities like touch-football, basketball, tag or hide-and-seek.
Assign active chores to every family member such as vacuuming, washing the car or mowing the lawn. Rotate the schedule of chores to avoid boredom from routine.
Enroll your child in a structured activity that he or she enjoys, such as tennis, gymnastics, martial arts, etc.
Instill an interest in your child to try a new sport by joining a team at school or in your community.
Limit the amount of TV watching.
Create a Healthy Eating Environment:
Implement the same healthy diet (rich in fruits, vegetables and grains) for your entire family, not just for select individuals.
Plan times when you prepare foods together. Children enjoy participating and can learn about healthy cooking and food preparation.
Eat meals together at the dinner table at regular times.
Avoid rushing to finish meals. Eating too quickly does not allow enough time to digest and to feel a sense of fullness.
Avoid other activities during mealtimes such as watching TV.
Avoid foods that are high in calories, fat or sugar.
Have snack foods available that are low-calorie and nutritious. Fruit, vegetables and yogurt are some examples.
Avoid serving portions that are too large.
Avoid forcing your child to eat if he/she is not hungry. If your child shows atypical signs of not eating, consult a healthcare professional.
Limit the frequency of fast-food eating to no more than once per week.
Avoid using food as a reward or the lack of food as punishment.
Outside of the home, children and adolescents spend the majority of their time in school. So, it makes sense that schools provide an environment that promotes healthy nutrition and physical activity habits. Only a few creative programs are being tested in schools across the country.
Overweight and Obesity
Results of a 1999 national survey showed that 16 percent of high school students were overweight (Body Mass Index (BMI) greater than the 85th percentile and below the 95th percentile) and nearly 10 percent were obese (BMI more than or equal to the 95th percentile). Self-reported height and weight was used. The survey, called the Youth Risk Behavioral Surveillance System (YRBSS), is conducted by the Centers for Disease Control and Prevention (CDC), and uses a nationally representative sample of students in grades 9 to 12.
Here are more results from the 1999 YRBSS:
More male students (17 percent) were overweight than female students (14 percent), and obese (12 percent of males and 8 percent of females).
More black students (22 percent) were overweight than white students (14 percent).
More black and Hispanic female students (23 and 18 percent, respectively) were overweight than white female students (12 percent).
Self-Perception of Weight
When asked to describe their weight, 30 percent of students thought of themselves as overweight.
More female students (36 percent) than male students (24 percent) considered themselves overweight.
More Hispanic students (37 percent) than white and black students (29 and 25 percent, respectively) considered themselves overweight.
Weight Loss Attempts
43 percent of students reported that they were trying to lose weight.
More female students (59 percent) than male students (26 percent) reported that they were trying to lose weight.
More Hispanic students (51 percent) reported that they were trying to lose weight than white students (43 percent) and black students (36 percent).
Methods of Weight Loss:
More than half (58 percent) of students reported the use of exercise (during the 30 days before the survey) to lose weight or to avoid gaining weight.
More female students (67 percent) reported the use of exercise for weight loss or maintenance than male students (49 percent). More white female students (70 percent) reported the use of exercise for weight loss or maintenance than black female students (59 percent).
Change of Eating Behaviors
40 percent of students reported that they ate less food, fewer calories, or foods low in fat (during the 30 days before the survey) to lose weight or to avoid gaining weight.
More female students (56 percent) reported that they ate less food, fewer calories, or foods low in fat than male students (25 percent) to lose weight or to avoid gaining weight.
More white students (42 percent) reported that they ate less food, fewer calories, or foods low in fat than black students (34 percent) to lose weight or to avoid gaining weight.
More white female students (60 percent) reported that they ate less food, fewer calories, or foods low in fat than Hispanic female students (51 percent) and black female students (43 percent) to lose weight or to avoid gaining weight.
13 percent of students reported fasting ("without eating for 24 hours or more" ) to lose weight or to avoid gaining weight.
More female students (19 percent) reported fasting than male students (6 percent) to lose weight or to avoid gaining weight
Use of Dietary Supplements
8 percent of students reported taking diet pills, powders, or liquids without a doctor's advice to lose weight or to avoid gaining weight.
More female students (11 percent) reported taking diet pills, powders, or liquids without a doctor's advice than male students (4 percent) to lose weight or to avoid gaining weight.
More white female students (12 percent) reported taking diet pills, powders, or liquids without a doctor's advice than black female students (6.9 percent) to lose weight or to avoid gaining weight.
Purging / Laxative Use
5 percent of students reported vomiting or taking laxatives to lose weight or to avoid gaining weight.
More female students (7 percent) reported vomiting or taking laxatives than male students (2 percent) to lose weight or to avoid gaining weight

Health Risks, Diagnosis and Treatment

Determining if a child or adolescent has a weight problem can be challenging. How do you know if the excess weight your child has is part of the natural growth process, and will your child just "grow out of?" How do you know if your child's weight may be negatively affecting his or her health?
Health Risks
Along with the rise in childhood obesity, there has been an increase in the incidence and prevalence of medical conditions in children and adolescents that had been rare in the past. Pediatricians and childhood obesity researchers are reporting more frequent cases of obesity-related diseases such as type 2 diabetes, asthma and hypertension that once were considered adult conditions.
Read more about obesity-related health risks for children and adolescents in the AOA Fact Sheet, Obesity in Youth.
Read about the relationship of obesity and type 2 diabetes in children at the CDC's Children and Diabetes web page.
DiagnosisThere are some signs that may help you determine if your child has or is at risk for childhood obesity, such as:
Family history of obesity.
Family history of obesity-related health risks such as early cardiovascular disease, high cholesterol, high blood pressure levels, type 2 diabetes.
Family history of cigarette smoking and sedentary behaviors.
Signs in the child of obesity-related health risks from a pediatrician's evaluation including:
Cardiac Risk Factors. Studies of children with obesity show higher than average blood pressure, heart rate and cardiac output when compared to children without obesity.
Type 2 Diabetes Risk Factors. This involves glucose intolerance and insulin levels that are higher than average.
Orthopedic Problems. Some symptoms include weight stress in the joints of the lower limbs, tibial torsion and bowed legs, and slipped capital femoral epiphysis (especially in boys).
Skin disorders. Some are heat rash, intertrigo, monilial dermatitis and acanthosis nigricans.
Psychological / Psychiatric Issues. Poor self-esteem, negative self-image, depression, and withdrawal from peers have been associated with obesity.
Patterns of sedentary behavior (such as too much television viewing) and low physical activity levels.
Taller height - children with obesity are often above the 50th percentile in height.
Smoking initiation. Research studies show that youngsters use smoking as a method of weight control. Parents, pediatricians and schools should work together to discourage smoking as a weight control behavior for three main reasons: a) smoking is not likely to be successful in controlling weight, b) smoking is itself harmful, and c) smoking is associated with a decrease in sound nutrition and physical activity patterns.
Read the abstract about this study. Smoking and weight loss attempts in overweight and normal-weight adolescents. Strauss RS, Mir HM.
Read the abstract about this study. Weight concerns, weight control behaviors, and smoking initiation. Tomeo CA, Field AE, Berkey CS, Colditz GA, Frazier AL.
An important part of treating obesity among children and adolescents is for parents and healthcare professionals to be sensitive to the youngsters and focus on the positive. Small and achievable weight loss goals should be set to avoid discouragement and to allow for the normal growth process.
Involvement of the entire family is also a motivating factor. Weight control programs that involve both parents and the child have shown improvement in long-term effectiveness compared to directing the program only to the child.
There are some structured weight loss programs such as Weight Watchers and Jenny Craig that allow older children and adolescents to participate with parental and medical permission.
Once the need for obesity treatment has been identified, your medical professional may suggest one or more options.
Read Obesity Evaluation and Treatment: Expert Committee Recommendations, guidelines established for healthcare professionals by a committee of pediatric obesity experts brought together by The Maternal and Child Health Bureau, Health Resources and Services Administration, the Department of Health and Human Services.
1. Dietary TherapyAccording to the U.S. Department of Agriculture (USDA), there is a steady decline in the diet quality of children and adolescents as they get older.
Consultation with a dietitian / nutritionist that specializes in children's needs is often a valuable part of obesity treatment. Nutrition consultants can outline specific and appropriate nutritional needs for healthy growth.
As with adults, a nutrition consultant may or may not recommend reducing the number of calories the child eats and implementing strategies like learning to read nutrition labels and the food guide pyramid, selecting proper portion sizes, and prepared foods. Some eating behaviors that nutrition consultants typically encourage include taking smaller bites, chewing food longer, and to avoid eating too quickly by putting the utensil down between bites.
2. Physical ActivityThe U.S. Surgeon General recommends moderate physical activity for children every day for at least 60 minutes. If a child is unable to meet that goal, than an individualized program should be designed according to fitness level, using the general guideline as an ultimate goal.
3. Behavior Therapy Behavior therapy involves changes in diet and physical activity habits to one that promote a healthy weight. Some behavioral therapy strategies for children and adolescents should include parent and family involvement.
Some behavioral therapy strategies for children are to:
Record diet and exercise patterns in a diary to keep track of types and amount of foods eaten and exercise performed as well as the location and time that foods are eaten and exercise takes place. The diary useful to determine any problem areas in eating and exercise behavior.
Use the National Heart, Lung and Blood Institute's Daily Food and Activity Diary.
Identify high-risk situations (such as having too many high-calorie foods in the house), and consciously avoid them. Watching TV during meal times is another high-risk situation that encourages eating every time the TV is on.
Reward specific positive actions. Examples of such actions include meeting an exercise duration goal or eating less of a certain type of food.
Rewards for achieving goals can be decided by children and parents together, and should revolve around something that encourages positive behavior. For example, giving sporting equipment as a reward may encourage more physically active behavior.
Avoid using food as a reward, especially high-calories foods. Making them a reward may only make them more desirable. Parents and health professionals should regularly use verbal praise.
Change unrealistic goals and false beliefs about weight loss and body image to realistic and positive ones.
The family can work as a team to set weekly activity goals. Making a contract and having every family member sign it encourages commitment to a goal. Parents can also help a child adopt or maintain a positive attitude about new behaviors in addition to helping the child cope with any negative remarks from peers.
Develop a social support network (family, friends or neighbors) that can encourage weight loss in a positive and motivating manner.
4. Drug TreatmentThe U.S. Food and Drug Administration has not yet approved the use of any drugs to treat obesity in children. However, clinical trials are under way.
5. SurgerySurgical procedures such as gastric bypass have been performed successfully on adolescents. However surgery for adolescents is usually considered only when severe medical conditions are present that can improve with the surgery.

Source:American Obesity Association

<< Home

This page is powered by Blogger. Isn't yours?

Lost weight jeans Free counter and web stats Health Blogs - Blog Top Sites