Obesity

Overview

Obesity in children is on the rise. In the United States, almost nine million children and adolescents age six to 19 are overweight, according to the Centers for Disease Control and Prevention (CDC). The percentage of overweight children age six to 11 more than doubled from seven percent in 1980 to more than 15 percent today, while the percentage of overweight adolescents age 12 to 19 tripled in the same period, from five percent to 15 percent. The problem is particularly prevalent among minority groups and those with lower family incomes.

Being overweight isn't simply a result of eating too much — biochemical and genetic factors can also play a role. That said, many children don't meet recommended guidelines for healthy eating. It's estimated that almost 80 percent of young people don't eat the recommended daily servings of fruits and vegetables. Children often don't eat enough fiber, which may help with weight control. And many consume considerably more sugar, fat and calories than they need. Sugary beverages, such as soda and juice, add considerable calories and are partly to blame. In addition, many children don't get enough exercise.

Obesity increases a child's risk for a number of diseases and conditions, as well as the risk that the child will be overweight as an adult. Moreover, unhealthy diet and physical activity patterns are known risk factors for the three leading causes of death in adults: cancer, stroke and cardiovascular disease.

Prevention is the key to combating the childhood obesity epidemic.

Causes

The causes of obesity are complex, and can include genetic, biological, behavioral, nutritional and cultural factors. The root causes are excess consumption of food, a lack of physical activity or both. Obesity occurs when a person eats more calories than his or her body burns up.

A child with one obese parent has a 50 percent chance of being obese. When both parents are obese, their children have an 80 percent chance of obesity.

Many genetic and environmental factors contribute to the number of calories people eat and burn up, which is why weight loss and gain varies for different people.

Related Conditions

Obesity increases the risk of many serious health problems, and is linked to more than 30 medical conditions. Scientific evidence has established a strong relationship with at least 15 of those conditions, some of which include:

• Asthma
• Diabetes
• Gallstones
• Heart disease
• High blood pressure
• Cholesterol and triglyceride problems
• Liver problems
• Menstrual problems
• Trouble sleeping

Diagnosis

Your child's primary care pediatrician evaluates your child's weight during regular check-ups and office visits. Weight issues rarely sprout rapidly but rather develop over time. If you think your child has a weight problem, make an appointment with his or her pediatrician or primary care doctor.

There are two main tools doctors use to assess a child's weight:

Growth Charts

These charts are used throughout a child's development to assess growth in both height and weight, as compared to other children the same age, and to watch how a child's body changes over time. Almost every doctor uses the same growth charts from the Centers for Disease Control and Prevention (CDC), which is based on the measurements of thousands of children.

Body Mass Index (BMI) for Age Charts

This index uses height, weight, gender and age to assess a child's weight. A child's BMI is calculated with this formula:

BMI = weight in kilograms / (height in meters)²

The number is plotted on a growth chart. Greater than the 95th percentile is considered overweight or obese. A child who falls between the 85 percentile and 95 percentile is considered at risk for becoming overweight.

Note that this is higher than the cutoffs for adults. An adult with a BMI between 25 and 30 is considered overweight, while an adult with a BMI over 30 is considered obese.

If you have questions about your child's weight, ask to see his or her growth chart. It can be helpful to look at your child's measurements over time. Children may also like to see their chart.

If your child is overweight or at risk of becoming overweight, your doctor or a nutritionist may do a 24-hour food recall with you and your child. This is a tool for gathering information about meal patterns, snack routines and the consumption of sugary beverages. You and your child may be asked about your child's level of physical activity.

Children determined to be overweight or at risk should be referred by their pediatrician to a registered dietitian and possibly a comprehensive obesity program, such as the UCSF Weight Assessment for Teen and Child Health (WATCH) Clinic.

Treatment

With some children, especially if they are still growing taller, it's more important to stabilize weight and allow them to grow into their weight — they don't necessarily need to lose weight. In all cases, however, the earlier a child is identified as being overweight or at risk, the easier it is to treat. Because it's hard to permanently change dietary and exercise habits, it's essential to do something sooner rather than later.

Obese children need a thorough medical evaluation by a pediatrician or family doctor to assess their family history as well as their diet and exercise routines. First, the doctor will check for genetic and biochemical disorders related to obesity, such as Prader-Willi Syndrome and other genetic disorders, and hypothyroidism and other hormonal disorders.

Treatment Options

The main way to treat obesity in children is to help them eat a healthy diet and be physically active. In some instances, medication and even surgery may be considered depending on how overweight the child is and how much it's impacting his or her health. UCSF Benioff Children's Hospital has begun to evaluate the use of bariatric surgery to treat teens with severe weight problems.

Since losing weight is so difficult, it's very important that parents support their child through lifestyle changes. Lasting weight loss only occurs when the whole family participates.