It's a paradox that a problem like childhood obesity should crop up in a country like America where we are flooded with information about nutrition. At any age, obesity is generally considered a lifestyle disorder. Only a small percentage of patients suffer from hormonal issues, for example. For everyone else, weight gain is related to choices that we can make and unmake.
The implication is that children are now making the same bad choices that adults do, joining the epidemic of obesity that is associated in the long run with considerable health risks from diabetes, hypertension and heart disease. Yet the paradox goes deeper. The world teeters on the edge of drastic food shortages in the coming decades, while at the same time childhood obesity has spread beyond the developed world.
Here's what the overall picture looks like. In the U.S., about 17 percent of all kids (ages 2-19) are obese. In the EU, about a third of all children are overweight, and of those, 300,000 are obese. Developing nations including China, Brazil, Thailand, South Africa and many others are now facing epidemics of their own.
Prevention, as always, is the best cure. It's far better not to put on the pounds than to try and lose them afterwards. In the case of childhood overeating, starting the bad pattern early makes it all the more difficult to change. Children can't be expected to break habits on their own, or to make good lifestyle choices without guidance. Parents bear the sole responsibility along with schools.
It seems undeniable that parents are training their children to gain weight and that the body's natural balancing mechanism, which tells us when we are actually hungry, has been thrown off. Balance is automatic -- we each have a metabolic set point that regulates how many calories are burned every day -- but it can be overridden by imbalancing factors, including the following:
- Ignoring the body's signals for hunger and satiation
- Using food as a fix
- Covering up unwanted feelings through eating
- Unconscious habits like snacking at night
- Sedentary lifestyle
- Eating while watching TV or playing video games
- Conforming to the family's unhealthy eating habits
- Creeping increases in portion size at fast-food chains
- Over-reliance on salt, which increases appetite
Getting these factors under control requires awareness, because all are gradual tendencies that over time throw off the body's natural balance. Realistically, if it takes years to grow into bad habits, it will take a considerable period to break those habits.
Let's break the problem down to see what the best approach might be.
How can you know if your child is obese?
Currently, the standard tool used to evaluate body composition is the body mass index (BMI). BMI is calculated differently for children and adolescents than it is for adults. In children, the normal amount of body fat changes with age and also differs between girls and boys, so there is no universal normal range.
A child's BMI number is calculated based on his or her weight and height. That number is plotted on the BMI-for-age growth charts to obtain a percentile ranking, which shows how the child or teen compares to others of the same age and sex. For instance, a BMI-for-age percentile ranking of 90 percent means that the child's weight is greater than that of 90 percent of other children of the same age and sex. You can find your child's BMI using the Center for Disease Control's BMI Calculator for Child and Teen.
If your child's BMI is in an unhealthy range, you should take them to a health care professional, who will probably assess your child's condition further by looking at personal and family history, plotting weight and height on a growth chart, measuring skinfold thickness with a caliper and evaluating physical activity and eating habits.
America has reached the point where we cannot take our lifestyle choices for granted. Strong social trends often have hidden or seemingly innocent causes. In the last 30 years or so, obesity has doubled in children aged 2-5 and 12-19 and tripled in children aged 6-11. Although genetics may play a part in some cases, heredity alone can't account for this explosion of overweight, and the glandular disorders some parents blame for their children's weight problems are very rare.
Up to 80 percent of obese youth become obese adults. But solving the problem is generally easier for kids than it is for adults. For one thing, they're still growing, and growing uses up a lot of energy. Also, most obese kids haven't yet developed the many chronic disorders that accompany adult obesity. They can bounce back more easily than adults can. And kids are generally more flexible than adults -- their habits aren't so ingrained.
In your child's case, look to see which factors are coming together at the same time:
- Fast food. The rise of cheap, low-nutrition, highly-processed foods is a major factor in child obesity. Regularly eating food from fast-food restaurants, instead of home-cooked meals, has become the norm for many kids.
- Portion sizes. The sizes of typical portions have risen drastically in the last 20 or 30 years, both in restaurants and at home. As an example, the original size of a soda bottle was 8 oz., and it contained 97 calories. Today the average size of a soda bottle is 20 oz., containing about 250 calories. The same holds true for servings of French fries, sandwiches, burgers, chips -- just about any food or drink you can name.
- Snacking. Many kids get most of their calories they consume on a given day from snacks, not from regular meals. The snacks tend to be unhealthy chips, cookies, candy and sodas. Kids drink, on average, 24 oz. of soda a day.
- Inactivity. The growth of unhealthy eating has been paralleled by the rise of inactivity. As every parent is aware, kids spend a huge amount of time using computers, TVs and video games these days. In the U.S., kids use these devices almost 8 hours a day.
- Gym classes have been disappearing from schools, too: One-half of public elementary schools have PE only 1-2 days per week./li>
- Ads. Kids are barraged with ads for unhealthy foods on TV, on the Internet, in text messages and in podcasts. The average child sees more than 40,000 commercials a year, most of them for junk food.
- Less sleep. Kids are sleeping less than they used to, and that, studies have found, increases the risk that a child will become overweight or obese -- even for infants and toddlers.
It used to be thought that fat was inert: that its only function was the passive one of energy storage. Now, we know better. Fat is an organ, and it is very metabolically active. Fat tissue produces literally dozens of hormones, including leptin, which controls appetite, and adiponectin, which affects insulin sensitivity and blood sugar levels. The hormones and messenger chemicals fat tissue produces travel through the bloodstream and affect organs all over the body. When someone is overweight, they produce an excess of these powerful substances.
The list of disorders associated with child obesity is a long one:
- Emotional problems, including depression and low self-esteem, especially in adolescence
- Sleep apnea
- Bone and joint problems
- Early puberty in girls, delayed puberty in boys
- Digestive disorders, such as gastroesophageal reflux disease (GERD)
- Respiratory problems
- Fatty liver disease
If you have an obese child, your first impulse might be to put him or her on a diet. But as any dieter can tell you, diets may take fat off quickly, but it can go back on even faster. Instead, help your child to change their eating habits. Cook meals at home as much as possible, and have dinner together. Your kid is much more likely to eat meals that they have helped to choose, shop for and prepare, so include them in those activities. And don't make your child finish everything on the plate.
Limiting screen time -- sitting in front of the TV or computer -- to two hours a day is one of the best things you can do for your child. If they're not in front of a screen, they're much more likely to be socializing, playing games, helping out with chores and playing outside. It's reasonable to start with 20-30 minutes of outside activity per day and aim to work up to an hour. Alternatively, you could do a number of 5- or 10-minute "activity bursts" throughout the day.
Physical activity doesn't have to mean exercise for a kid. (Before adolescence a child's body isn't ready for adult-style exercise anyway.) Focus more on decreasing inactivity than on vigorous exercise. It helps if the whole family is involved. Go for family bike rides, walk through the zoo, fly kites, hike in the woods together. Everyone in the family will benefit, and your kid will feel supported in becoming active.
If the changes you've made at home don't help, consider a structured weight-loss program. But be sure that the program you choose aims for long-term behavioral changes, not just short-term weight loss. The program should have mental health professionals on staff, because obesity has major emotional aspects as well as physiological ones. Make sure physical activity is an important part of the program, and that it supports the whole family in making changes.
Finally, kids have one huge advantage: their parents. Kids look to their parents for guidance and encouragement, even though it might not always seem that way. When a parent is a good role model and supports a child in losing weight, he or she has a much better chance of losing weight and getting fit. The great mistake we adults make with our kids is to project our own self-judgment on to them. This is particularly tricky with weight gain since so many Americans struggle with the negative feelings associated with their body image.
Sometimes children just don't lose weight, even when you've done everything you can to help them. If this is the case, don't blame or criticize your child. Obese kids carry a huge emotional burden. Let them know you love and support them, no matter what their size. Every positive step you take at the level of awareness will be reflected in the awareness your child absorbs and adopts, often for life.