Understanding the Childhood Obesity Epidemic

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Enjoy this informative article authored by Dr. Jo Dee Baer in the New England Journal of Medicine

Doctor measuring overweight boy in clinic

“Doctor, is my child overweight?” “Oh no, it is just baby fat and he’ll grow out it.” Is your son or daughter obese or overweight? Is it indeed just baby fat, and will they outgrow it?

Pediatric obesity is now of epidemic proportions in the United States. Pediatric overweight and obesity now affects more than 42 percent of children, making it the most common chronic disease of childhood.

Pediatric obesity is not just a cosmetic problem; it is a real health problem that can be associated with significant issues in childhood and in adulthood. Therefore, parents of overweight young children should not just ignore this issue, but should actively seek out help to determine why their child is overweight and what they can do to help rectify the situation.

Understanding Obesity in Children

When infants are born, they have comparatively more fat; however, this is normal and appropriate. This relatively greater amount of fat provides the infant with some nutritional reserve when they are most vulnerable and adjusting to life outside the womb. This greater amount of fat decreases as the infant grows older and throughout the first several years of life.

Around five years of age, children have the lowest amount of fat and have the lowest body mass index (BMI) — a relationship between weight and height. If a child is getting overweight between two and five years of age, this is not normal and it is not just “baby fat.”

In reality, if your child is overweight or obese, you do have a cause for worry. The earlier in the child’s life that you make changes a child’s lifestyle in regards to nutrition and physical activity, the easier it is.

Measuring Obesity in Children

The normal range of BMI for adults is 18.5-24.9. A BMI of less than 18.5 is considered underweight. A

BMI between 25 and 29.9 is considered overweight while a BMI of 30 and over is considered obese. Some also define morbid obesity as a BMI greater than 40.

For children, BMI is calculated in the same fashion as for adults, but there are no absolute numbers of BMI defining normal and overweight. Instead, you have to calculate BMI and plot it on a BMI curve and find the percentile for a child. There is a BMI curve for males and a separate one for females, ages two to 18 years.

The exact definition does not matter as much as knowing what the BMI percentile of the child is and if it is normal or abnormal, increasing or decreasing. For simplicity sake, we will use overweight and obese interchangeably.

Causes of Childhood Obesity

Changes in the living environment (how we live, eat and act) is the major factor that has contributed to the current problem. There have been several dietary changes that have transpired over the last 20 to 30 years which have contributed to obesity.

One major factor is the frequency with which people eat out. It is now estimated that approximately 40 to 50 percent of every dollar that is spent on food is spent on food outside the home (i.e. restaurants, cafeterias, sporting events, etc.).

Portion sizes have also increased. This is true for packaged foods and fast food restaurants. Also, soda sizes have significantly increased

Scientific studies have documented a 60 percent increase risk of obesity for every regular soda consumed per day.

Another major factor in contributing to the pediatric obesity epidemic is the increased sedentary lifestyle of children.

Children are also more sedentary outside of school, which is due to increased time spent doing sedentary activities such as watching television, playing video games or using the computer. Only 50 percent of children, 12 to 21 years of age, regularly participate in rigorous physical activity, while 25 percent of children report no physical activity. The average child spends two hours a day watching television, but 26 percent of children watch at least four hours of television per day.

Childhood obesity also has adverse effects on health during childhood. The most common consequence of childhood obesity is the psychosocial effect. It has been shown that obese adolescents have higher rates of poor self esteem, and this negative self image may carry over into adulthood. There may also be increased rates of depression in children who are overweight.

Health Risks of Childhood Obesity

There are multiple medical conditions associated with obesity in childhood. The most common include insulin resistance (the first step towards developing diabetes), hypertension, liver problems and hyperlipidemia (elevated cholesterol and/or triglyceride). While these typically do not cause many problems in childhood, some children will develop diabetes or severe liver disease, including cirrhosis. Other problems that can occur include joint problems, menstrual problems, gallbladder disease, sleep apnea and headaches.

Treating Childhood Obesity

Treatment of pediatric obesity is a family affair and needs to be directed at the family, not just the child. This is extremely important since the home environment and family support are important factors when trying to address pediatric obesity.

Similarly, if there is a lot of stress in the family at that time it is not ideal to try and tackle yet another major issue. In some situations where there is significant depression or stress, it may be most appropriate for the child and the family to seek counseling to address these issues. In addition, if parents express little concern regarding their child being overweight, they are not ready to make the necessary changes.

Treatment of pediatric obesity is not accomplished by just dieting. You need to address multiple aspects of the child’s and the family’s lifestyle, nutrition and physical activity patterns.

Treatment Goals

The goals of treatment of pediatric obesity can be divided into three major areas: behavioral goals, medical goals and weight goals. The behavioral goals are to promote lifelong healthy eating and activity behaviors. Medical goals are to prevent complications of obesity in childhood and potentially adulthood, as well as improve or resolve existing complications of obesity. The weight goals are dependent on the child’s age and the presence or absence of associated co-morbidities.

Gradual weight-loss is preferable to rapid weight-loss. It is better to make gradual changes that can be maintained over time, resulting in gradual weight-loss. Ideally, you should not try to lose more than one to two pounds per week.

Here are tips to help change a family’s lifestyle, nutrition habits and activity level:


Eat as a family.

Slow down the eating process.

Have special family time that is physically active.

Limit eating out or getting take-out food.

Pack lunch for school instead of buying lunch.

Do not have a television in the child’s bedroom.

Limit computer time to a maximum of 1-2 hours per day.

Do not eat in front of the television.

Do not use food as a reward.


Eat healthy, well balanced meals and snacks.

Plan meals and snacks in advance.

Offer the child a choice of healthy foods to eat. Limit intake of calories from beverages.

Eat appropriate portion size for the child’s age.

Limit calorically dense foods (i.e. high fat, high sugary foods).

Limit treats, but do not eliminate them.

Physical Activity

Encourage daily physical activity.

Have a variety of physical activities that can be done.

Be physically active with others. Limit sedentary activity.

Three Major Areas Treatment

Treatment of pediatric obesity needs to focus on three major areas: lifestyle, nutrition and physical activity.

Medications and Childhood Obesity

There are a number of medications both over-the-counter and prescription that are available for the treatment of obesity. These are not frequently used in the initial phase of treatment of pediatric obesity; however, the primary treatment modality is behavior modification and nutritional lifestyle changes.

Surgery and Treating Childhood Obesity

Bariatric surgery (weight-loss surgery) for adults with severe obesity is now being done with increased frequency. This surgery is safe and effective, but is to be used only for those with morbid obesity who meet specific criteria. At this time bariatric surgery should be considered investigational and should only be done in institutions with a comprehensive pediatric weight management program and by surgeons experienced with this type of surgery in children.

For More Information/Presentations on Childhood Obesity–—


Jo Dee Baer | Certified health Coach | jodee@healthcoachjodee.com