Obesity is long-lasting and has persistent and negative health effects, attributable morbidity and mortality, and social and economic consequences that can impact a child’s quality of life. Because obesity is a chronic disease with escalating effects over time, a life course approach to identification and treatment should begin as early as possible and continue longitudinally through childhood, adolescence, and young adulthood, with transition into adult care.
Here is an appeal to common sense regarding obesity in children. Both doctors and parents are reluctant about raising the issue of childhood obesity. Over the past 30 years, the rate of childhood obesity has more than doubled in children and quadrupled in adolescents. The developing world is vulnerable to obesity in children.
This blog post on Avoiding Obesity may also be useful.
Causes of obesity in children and adolescents
From EndocrineWeb:
If your child has been diagnosed with obesity or is overweight, adopting some or all of these measures can help your child reach and maintain a healthy weight. If your child is not currently overweight, the same steps can help prevent obesity over a lifetime. Another benefit: Embracing healthy lifestyle measures as a family will improve not just your child’s health but that of everyone in the household.
- Make sure your child gets adequate exercise. In addition to burning calories, physical activity strengthens children’s bones and muscles, helps them fall asleep and get good quality rest, and can boost their mood and energy. Experts recommend that children get between 150 and 300 minutes per week of moderately intense physical activity. This can take many forms, from going outside for a hike or game of tag to sliding around the house in your socks to having a dance party in your living room. Some other popular ideas: playing at a playground, playing hide-and-seek, jump-rope, having races on foot or bike, dance or martial arts classes, roller skating/rollerblading, swimming, and biking.
- Serve healthy foods. Focus on serving your child whole foods like fruits, vegetables, whole grains, seeds, nuts, and lean proteins. Emphasize fresh fruits and vegetables in particular. Cut back on processed and convenience foods like cookies, crackers, fast food, and prepared meals, all of which can be high in sugar, fat, and calories. “Put healthy snack and meal choices in the kitchen or pantry at eye level,” suggests Michelle Sands, ND, a licensed Naturopathic Physician specializing in hormones, metabolism, and epigenetics. “Put anything you want them to eat on a stick – such as fruits, vegetables, kabobs – and accompany them with healthy dips. Get your kids involved in cooking healthy meals and making them feel like they’re part of it.”
- Limit sweetened beverages. Fruit juice and sodas can be high in calories, low in nutrients, and can fill your child up, making it hard for them to eat the food that will keep them healthy and satisfied between meals. Serve water, seltzer, milk, or diluted fruit juice instead.
- Limit take out and eating out. Restaurant meals are often high in sodium and fat, which can contribute to obesity and high blood pressure. They are also often served in quantities much bigger than a child needs.
- Eat together, sitting down, for family meals. Try to avoid the TV, computer, or video games at mealtimes, which can encourage overeating and distract kids from their satiety signals. Model healthful, mindful eating where you focus on and enjoy your food. And try to have everyone in the household eat the same thing. “Don’t give one kid a special [healthy] meal and everyone else has pizza,” Dr. Sands says. “Kids follow their parents’ lead — if they see you on the couch eating ice cream they’ll want to do it too.”
- Don’t make your child clean their plate. Allow them to eat until full, and then don’t force them to “clean their plate,” which teaches children to override fullness cues. You can save leftovers to serve at a future meal. Remember, children don’t need as much food as adults do. Their portion sizes should be smaller, and if they say they’re full, allow them to stop eating.
- Make sure your child gets enough good quality sleep. Not getting enough sleep can lead to weight gain by increasing levels of ghrelin, the hormone responsible for appetite. Too little sleep can also rob your child of the energy to exercise during the day and encourage cravings for sugary foods for quick energy, Dr. Sands points out. To help your child get a good night’s sleep, serve their last meal at least two hours before bedtime, limit screen time in the evening, dim the lights, and have a consistent nighttime routine.” Consult your child’s health care provider to find out how many hours of sleep per night their age group needs.
- Teach stress-relieving practices. Stress can cause weight gain by weakening self-control, leading kids (and adults) to soothe themselves through food, and by causing hormonal changes that increase weight gain. Children’s yoga, breathing exercises, meditation, or quiet art projects can help to calm mind and body. Exercise is anti-stress.
- Be consistent (but leave room for exceptions). Consistency is key! Daily healthy eating and exercise habits are important for long-term success. However, that doesn’t mean your child can’t enjoy a treat for special occasions or take a few days off from exercise if they’re tired or not feeling well. What you do most of the time is what matters.
- Limit screen time. Being sedentary with video and computer games, watching TV, texting, and scrolling social media can make it hard to keep weight in check. The WHO recommends that children older than two get no more than two hours of screen time a day, and that children younger than two shouldn’t have any.
- Practice positive messaging. “As parents, we want to be really careful about what we communicate about weight to children,” Puhl says. “Shift the conversation away from the number on the scale and focus on health, healthy behaviors, and on ways that you as a family can promote a healthy lifestyle.” Avoid being critical of your body in front of your children, which may lead them to develop the same stigma around their body.
Family-based behavioral treatments for pediatric obesity have been around for more than three decades. These programs work, and researchers are finding new ways to make them even more effective.
Obesity may be contagious among teens.
Infant antibiotic exposures are consistently associated with increased body mass. Early antibiotic use can cause obesity via an altered microbiome.
ADD stimulant drugs can cause “rebound” weight gain later on.
Artificial sweeteners are not eliminated as quickly in children. This is important because early life exposure to artificial sweeteners may influence a child’s future taste preferences, diet and metabolic fate. Since it is known that children generally prefer more sweetness than adults, they are especially vulnerable to the intense sweetness provided by artificial sweeteners.
Minimize exposure to bisphenol A:
Shown by a study of 1,326 students in grades 4–12 from three schools in Shanghai.
Shown by a study of 766 kids aged 12 to 19.
Shown by the National Health and Nutrition Examination Survey (2003–2008).
Bisphenol S and bisphenol F may be even worse. Those who had greater levels of BPS and BPF in their urine were more likely to be obese compared to children with lower levels.
Food
As is the case with adults, eating a substantial, quality breakfast can help prevent obesity.
There is an urgent need to spread awareness among children and young adults about these adverse effects of junk food.
High consumption of added sugars increased the probability for overweight/obesity among youth, irrespectively of other dietary or macronutrient intakes.
Consumption of drinks containing added sugars, fructose in particular, continues to increase and can play an important role in the onset of obesity and cardiovascular disease (CVD).
The CDC explains: drinking sugar-sweetened beverages is associated with weight gain, obesity, type 2 diabetes.
This video from Johns Hopkins All Children’s Hospital explains the problem with hidden sugars in food.
In addition to the effects on health, too much sugar early in life had an effect on how well the children did in school and how much money they made as adults. Adults born after rationing ended were 18.5% less likely to go to college and 16.6% less likely to have a job that required a high level of skill than adults born into sugar rationing.
Comfort eating → obesity.
The Mayo Clinic: Regularly eating high-calorie foods, such as fast foods, baked goods and vending machine snacks, can cause your child to gain weight. Candy and desserts also can cause weight gain, and more and more evidence points to sugary drinks, including fruit juices and sports drinks, as culprits in obesity in some people.
From EndocrineWeb:
- Eating high-calorie, low-nutrient foods and beverages like fast-food, snack foods, candy, and soda
- Eating too much food
- Spending too much time sitting down watching TV or using a computer, tablet, or phone. Watching television excessively in early childhood, may eventually compromise muscular fitness and waist circumference in children as they approach pubertal age. One hour of TV is too much for 5-yr olds.
- Not getting enough exercise. The Physical Activity Guidelines for Americans recommend that children between the ages of 6 and 17 years get at least an hour of moderate to vigorous exercise every day. Children ages 5 and younger should be physically active throughout most of the day.
Puberty is when kids need to stop pigging out.
Limit soda consumption – or any other sugary drink, including sports drinks.
Sugary drinks are the worst offenders in the fight against child/youth obesity. It’s now clear that many children and adults are at risk for gaining weight if they consume too much of sugary drinks.
Deakin health researchers examined the data from a study of more than 4000 children aged 4—10 years and found a direct link between each time a child ate unhealthy foods and consumed sugary drinks and an increase in their weight.
This study of 168 2 to 5 yr old children showed that consumption of >12 fl oz/day of fruit juice by young children was associated with short stature and with obesity.
Sugar, due to it fructose fraction, is obesogenic. It hides in many children’s foods.
Exercise
The Mayo Clinic: Children who don’t exercise much are more likely to gain weight because they don’t burn as many calories. Too much time spent in sedentary activities, such as watching television or playing video games, also contributes to the problem. TV shows also often feature ads for unhealthy foods. Some video games can promote unhealthy diets full of sugar, salt, and fat.
The CDC: The Physical Activity Guidelines for Americansexternal icon recommends that children aged 3 through 5 years should be physically active throughout the day. Children aged 6 – 17 years need at least 60 minutes of moderate to vigorous physical activity every day.
Exercise may not be effective when a high fat (fast food) diet is consumed.
The importance of adequate sleep
The risk of being obese by age 21 was 20 percent higher among 16-year-olds who got less than six hours of sleep a night, compared with their peers who slumbered more than eight hours. This was found by analyzing health information from more than 10,000 American teens and young adults. This was also shown in a study that observed over 1,000 Philadelphia-area high school students from their freshmen through senior high school years.
Sleep-related breathing problems and chronic lack of sleep may each double the risk of a child becoming obese by age 15. This was shown by following nearly 2,000 children for 15 years.
The value of sleep was shown by a meta-analysis of 30,002 children and 604,509 adults.
42 population studies of infants, children and adolescents aged 0 to 18 years which included a total of 75,499 participants also showed the link between sleep and obesity.
Regular bedtimes and adequate sleep during childhood may contribute toward a healthy weight in the teen years, a new study of 2,200 kids in 20 U.S. cities finds.
Sleeping less than 8 hours a night may be linked to weight gain in teens. Furthermore, obesity was linked to short sleep duration in teen males, with the fewest hours slept linked to the highest BMI levels.
Data obtained from 1994-2009 of 3342 adolescents in The National Longitudinal Study of Adolescent Health was used to analyze and assess their bedtimes and BMI. The results of the analyses are:
- Later average bedtime during the workweek resulted in an increase in BMI over time.
- A sleep deficit of 1 hour as a consequence of late bedtimes resulted in a gain of 2.1 points on the BMI scale, over a period of approximately five years.
- This increase in BMI remained significant after adjusting for baseline BMI and demographic traits.
- Exercise or the number of hours an individual slept did not reduce the increase in BMI owing to late bedtime.
- Fast food contributed to the weight gain owing to late bedtimes.
Children whose mothers worked full time got fewer hours of sleep than peers whose mothers worked less than 20 hours per week. The children of women who worked full time also tended to have higher BMIs.
Citrus help for cardiovascular risk in obese children.
Resistance training combined with aerobic conditioning is best for teen obesity.
Endothelial (blood vessel) dysfunction is the first, although reversible, sign of atherosclerosis and is present in obese adolescents. Start an exercise routine in childhood for better health, less obesity as an adult.
This systematic review and meta analysis of 22 studies and 8 articles found that obesity in children is correlated with high blood pressure and high arterial stiffness.
The risk of morbidity from coronary heart disease and atherosclerosis was increased among men and women who had been overweight in adolescence. The risk of colorectal cancer and gout was increased among men and the risk of arthritis was increased among women who had been overweight in adolescence.
Frequent interruptions in sedentary time are associated with a favorable cardiometabolic risk profile and highlight the deleterious relationship between screen time and cardiometabolic risk among children with a family history of obesity.
Children who regularly walk or cycle to school are less likely to be overweight or obese than those who travel by car or public transport.
Vitamin D supplements may promote weight loss and reduce risk factors for future heart and metabolic disease in overweight and obese children.
Endocrine disrupting chemicals are bad news. Household dust is one source.
Those with genetic risk for obesity respond more strongly to advertising for obesogenic junk foods.
Childhood asthma → obesity risk
Excessive fruit juice consumption is associated with increased risk for childhood obesity. Liquid calories are especially problematic. Liquid calories are causative of visceral fat (the most dangerous) in adolescents. Substitute juice with whole fruit, which reduces inflammation.
Parent weight change is a key contributor to child weight change. Parents who believed their own weight was a health problem were less likely to be ready to make changes to their child’s dietary behaviors. For daughters who were being encouraged to lose weight by their mothers, outcomes were worse if their mothers were not also discussing their own weight concerns. The daughters who were being encouraged to lose weight but whose moms were not also discussing their own weight concerns were more at risk for development of disordered eating.
Passive smoke and air pollution drive childhood obesity. Exposure to second-hand smoke is associated with a larger waist and poorer cognition in children.
Physicians using body mass index (BMI) to diagnose children as obese may be missing 25 percent of kids who have excess body fat despite a normal BMI, which can be a serious concern for long-term health.
Self or parental opinions may not recognize teenage obesity – it is best to consult medical charts.
Seeing your kid as obese requires removing the rose-colored glasses. Even health professionals struggle with this.
The Consequences of Child and Adolescent Obesity
Childhood obesity can lead to→ adult obesity, and lots of adult health problems such as:
- asthma
- anxiety and depression
- emotional and behavior problems
- poor sleep
- poorer adult cardiovascular health
- future colon cancer
- future diabetes: 4X the chance of developing type 2 diabetes in their 30s and 40s.
- poorer midlife cognitive function
Childhood it the best time to intervene to prevent future health problems. The sooner that children start eating right, the better, according to Dr. Pooja Tandon, a pediatrician at Seattle Children’s Hospital. “Healthy behaviors start from a very young age”.
From EndocrineWeb: In addition to excessive body weight, typical signs and symptoms of childhood obesity include:
- Shortness of breath
- Fatigue
- Increased sweating
- Sleep apnea and snoring
- Joint pain
- Dislocated hips
- Flat feet and knock knees
- Skin rashes and irritation
- Stretch marks on hips, abdomen, and back (though these can occur in non-obese children as well)
- Acanthosis nigricans, which is dark, velvety skin around the neck and in other areas
- Fat tissue in the breast area (which can be particularly challenging for boys)
- Constipation
- Gastroesophageal reflux (also called acid reflux)
- Early puberty in girls
- Delayed puberty in boys
Childhood obesity can lead to immediate health problems as well as put your child at greater risk of developing medical issues in the future. These are some of the weight-related complications that children with obesity are at increased risk of:
- Asthma
- Type 2 diabetes
- High cholesterol
- Heart disease
- High blood pressure
- Gall stones, fatty liver disease, or kidney disease
- Arthritis
- Reproductive problems like irregular menstruation and hormonal imbalances
- Heartburn, reflux, and other digestive problems
- Sleep disorders like sleep apnea
Additionally, children who are obese have an increased risk of being overweight or obese as adults.
Obesity can have a significant negative effect on a child’s mental health, contributing to problems including:
- Anxiety
- Depression
- Low self-esteem
- Being bullied or socially isolated from peers
- Prejudice from adults in their lives like relatives, teachers, and health care provider
Managing weight, blood pressure and cholesterol in children may help protect brain function in later life.
Obese kids are prone to asthma, adult hypertension, smoking, and stupidity.
Obesity can cause early puberty in boys.
Resolving child obesity can prevent a (disastrous) prediabetic diagnosis and even premature death. This study of 229 of pubertal obese children from Mexico City showed that magnesium-deficient diets are determinants of inflammation, while high intake of refined carbohydrates is a risk factor for insulin resistance, independently of central adiposity.
Kids who become overweight during their teenage years may be more likely to develop a stroke decades later.
Parents of children as young 12 who are overweight or obese should be offered options including weight-loss drugs, and surgery should be considered for teens, according to new guidelines from the American Academy of Pediatrics. But doctors are uneasy about this recommendation.
Bariatric surgery (a last resort) may minimize heart health risk.
Fixing Child and Adolescent Obesity
A plant-based diet is weight-loss friendly, but may be difficult to implement.
Children who eat a Mediterranean-style diet are less likely to be overweight or obese than other youngsters. A Mediterranean diet, supplying plant protein, is a healthful choice for the whole family. The fiber featured in this way of eating will also benefit the gut microbiota.
A low-carb diet appears to be an effective method for short-term weight loss in overweight adolescents.
Epidemiologic studies indicate that vegetarian diets are associated with a lower body mass index (BMI) and a lower prevalence of obesity in adults and children. Plant foods are highlighted in the Dietary Guidelines for Americans, and children do not meet the current recommendations for most plant foods.
A low-starch plant – based diet for weight loss. Plant protein intakes may play a role in preventing obesity among European adolescents. (see the preventing obesity post also)
The Cleveland Clinic: Do not place your child on a restrictive diet to lose weight. You should only place your child on a diet if their healthcare provider supervises one for medical reasons. Restrictive diets are hard to stay on and can lead to eating disorders and disordered eating patterns.
From the Mayo Clinic:
- Prioritize fruits and vegetables. When food shopping, cut back on convenience foods — such as cookies, crackers and prepared meals — which are often high in sugar, fat and calories.
- Limit sweetened beverages. This includes beverages that contain fruit juice. These drinks provide little nutritional value in exchange for their high calories. They can also make your child feel too full to eat healthier foods.
- Avoid fast food. Most of the menu options are high in fat and calories.
- Sit down together for family meals. Make it an event — a time to share news and tell stories. Discourage eating in front of a TV, computer or video game screen, which can lead to fast eating and lowered awareness of the amount eaten.
- Serve appropriate portion sizes. Children don’t need as much food as adults do. Start with a small portion and your child can ask for more if they’re still hungry. Allow your child to eat only until full, even if that means leaving food on the plate. And remember, when you eat out, restaurant portion sizes are often way too large.
To increase your child’s activity level:
- Limit TV time. Recreational screen time — in front of a TV, computer, tablet or smart phone — should be limited to no more than two hours a day for children older than 2. Children younger than 2 should have no screen time at all.
- Emphasize activity, not exercise. Children should be moderately to vigorously active for at least an hour a day. Your child’s activity doesn’t have to be a structured exercise program — the object is to get him or her moving. Free-play activities — such as playing hide-and-seek, tag or jump-rope — can be great for burning calories and improving fitness.
- Find activities your child likes. For instance, if your child is artistically inclined, go on a nature hike to collect leaves and rocks that your child can use to make a collage. If your child likes to climb, head for the nearest neighborhood jungle gym or climbing wall. If your child likes to read, then walk or bike to the neighborhood library for a book.
Children who are genetically predisposed to overweight by common gene variants can still lose weight by changing their diet and exercise habits.
Daily supplementation with Ω-3 capsules increases the serum Ω-3 fat concentration, improves vascular function, and lowers the degree of inflammation in obese adolescents.
