Health implications of childhood obesity

Introduction

Childhood obesity is one of the most serious public health challenges of the 21st century. The problem is global and is steadily affecting many low- and middle-income countries, particularly in urban settings. The prevalence has increased at an alarming rate. Globally, in 2010 the number of overweight children under the age of five is estimated to be over 42 million. Close to 35 million of these are living in developing countries (Kopelman, 2005).

According to Anderson and Butcher (2006), childhood obesity is a serious medical condition that affects children and adolescents. It occurs when a child is well above the normal weight for his or her age and height.

Childhood obesity is particularly troubling because the extra pounds often start children on the path to health problems that were once confined to adults, such as diabetes, high blood pressure and high cholesterol. Childhood obesity can also lead to poor self-esteem and depression.

Causes of childhood obesity

Although there are some genetic or hormonal causes of childhood obesity, in most cases excess weight is due to overeating and under-exercising. Children require extra calories to fuel their growth and development; if they taken in the appropriate amount of calories, they should add pounds in proportion to their growth. But if they consume more calories than they’re burning off, the result will be unnecessary weight gain. Childhood obesity is almost always a result of a number of factors working together to increase risk.  These include:

  • Diet: Unhealthy lunch options and regular consumption of high-calorie foods, like fast food, cookies and other baked goods, soda, candy, chips and vending machine snacks contribute to weight gain. Snacking is another major culprit: new research shows that American children are snacking more than ever before — sometimes almost continuously throughout the day — accounting for up to 27% of their daily caloric intake. Between 1977 and 2006, children increased their caloric intake from snacks by an average of 168 calories/day, up to a total of 586 calories. The largest increase was found in children aged 2 to 6, who consumed an extra 181 snack calories per day compared to two decades earlier.
  • Lack of physical activity: Computers, television, and video games conspire to keep kids inside and sedentary, which means they burn fewer calories and are more likely to gain weight. Concerns about the safety of outside play and a reliance on cars instead of walking – even to the corner store – don’t help matters. By preschool age, many kids are already lacking enough activity, which often translates into poor exercise habits later in life.
  • Environment: If a child opens up the refrigerator or kitchen cabinets and is greeted by bags of chips, candy bars and microwave pizza, then that’s likely what they will eat. Similarly, if you keep your fridge stocked instead with tasty cut-up fruits and veggies (berries, baby carrots, red pepper strips) with low-fat ranch dip, low-fat yogurt and higher-fibre granola bars, then they will go for the healthier fare (rather than eat nothing at all). Don’t feel like you need to deny children all treats, but strive for a healthy balance.
  • Psychological factors: Like adults, some kids may turn to food as a coping mechanism for dealing with problems or negative emotions like stress, anxiety, or boredom.  Children struggling to cope with a divorce or death in the family may eat more as a result.
  • Genetics: If your child was born into a family of overweight people, he/she may be genetically predisposed to the condition, especially if high-calorie food is readily available and physical activity is not encouraged.
  • Socioeconomic factors: Children from low-income backgrounds are at increased risk for childhood obesity since low-income parents may lack the time and resources necessary to purchase and prepare healthy foods (versus fast food, which is cheaper and more readily available in low-income communities), join a gym or otherwise encourage physical activity. Because safety is a big issue in poorer communities, playing outdoors may not be a viable option.
  • Medical conditions: Though not common, there are certain genetic diseases and hormonal disorders that can predispose a child to obesity, such as hypothyroidism, (when the thyroid gland, located in the neck just below the voice box, is underactive and does not release enough of the hormones that control metabolism), Prader-Willi syndrome (a genetic disorder affecting the part of the brain that controls feelings of hunger)  and Cushing’s syndrome (a disorder in which your body is exposed too much of the hormone cortisol from overproduction in the adrenal glands or use of medications such as those for asthma) (Ogden, Carroll, Curtin, McDowell, Tabak & Flegal, 2006).

Symptoms of childhood obesity

Many parents do not recognize that their child has a problem until they are already overweight. In one survey, 49 percent of parents believed their kids were of average size, but those same kids were actually classified as overweight. They might also be unsure of how to broach this sensitive topic, so they procrastinate when it comes to talking about it. It might take the intervention of a paediatrician for parents to face the problem and get help.

At your child’s annual visit to the paediatrician, the doctor will track his/her growth via height and weight; The Centres for Disease Control and Prevention currently recommends that children age two and up have their body mass index (BMI) calculated and plotted on a growth chart, to see how he/she compares with other children of the same sex and age. For example, if you are told your child’s BMI is in the 80th percentile, that means that, compared with other children of the same sex and age, 80 percent have a lower BMI. These numbers provide the paediatrician with a snapshot of your child’s growth trajectory and can alert him or her to potential weight problems. A BMI of 85th to under 95th percentile for age and sex indicate your child may have a weight problem. 95th percentile and up indicates obesity.

By the time a child is already overweight or obese, he/she may be suffering from weight-related conditions like type 2 diabetes, sleep apnea and knee or hip pain. High cholesterol, abnormal liver enzymes, asthma, skin conditions and headache are other possible symptoms.  Research also shows that overweight children have lower self-esteem than their thinner peers, and may face teasing and discrimination at school. Ideally, a weight problem can be caught before the condition progresses to this point, which is why early detection is essential (Family Health Guide, 2008).

Effects of childhood obesity

Childhood obesity is associated with;

  • Health (medical) effects and
  • Psychological effects.

Health (medical) effects of childhood obesity

Childhood obesity has both immediate and long-term effects on health and well-being.

Immediate health effects:

  • Obese youth are more likely to have risk factors for cardiovascular disease, such as high cholesterol or high blood pressure. In a population-based sample of 5- to 17-year-olds, 70% of obese youth had at least one risk factor for cardiovascular disease.
  • Obese adolescents are more likely to have pre-diabetes, a condition in which blood glucose levels indicate a high risk for development of diabetes.
  • Children and adolescents who are obese are at greater risk for bone and joint problems, sleep apnea, and social and psychological problems such as stigmatization and poor self-esteem.

Long-term health effects:

  • Children and adolescents who are obese are likely to be obese as adults and are therefore more at risk for adult health problems such as heart disease, type 2 diabetes, stroke, several types of cancer, and osteoarthritis. One study showed that children who became obese as early as age 2 were more likely to be obese as adults.
  • Overweight and obesity are associated with increased risk for many types of cancer, including cancer of the breast, colon, endometrium, esophagus, kidney, pancreas, gall bladder, thyroid, ovary, cervix, and prostate, as well as multiple myeloma and Hodgkin’s lymphoma (Daniels, Arnett & Eckel, 2005).

Psychological effects of childhood obesity

According to Riccairdelli (2002), the most immediate consequence of being overweight as perceived by children themselves is social discrimination and low-self-esteem. A 2003 study asked 106 children between ages 5 to 18 to rate their quality of life based on things like their ability to walk more than one block, play sports, sleep well, get along with others and keep up in school. The study found that obese children often rated their quality of life with scores as low as those of young cancer patients on chemotherapy. The results indicated that that teasing at school, difficulties playing sports, fatigue, sleep apnea and other obesity-linked problems severely affected the children’s well-being. Interestingly, parents answered the same questionnaires, and their ratings of their children’s well-being were even lower than the children’s self-ratings.

Society, culture, and the media send children powerful messages about body weight and shape ideals. For girls, these include the “thin ideal” and an urging to diet and exercise. Messages to boys emphasize a muscular, “buff” body and pressure to body build and perhaps make use of potentially harmful dietary supplements and steroids. While gender has not been identified as a specific risk factor for obesity in children, the pressure upon girls to be thin may put them at greater risk for developing eating disordered behaviours and or related mood symptoms. Although society presents boys with a wider-range of acceptable body images, they are still at risk for developing disordered eating and body image disturbances.

Prevention/control of childhood obesity

There are steps you can take to help an overweight child achieve a healthy weight. Many of these approaches will also benefit normal-weight children:

Begin in infancy

Breastfeed if you can. Research suggests breastfeeding may lead to a reduced risk of the child becoming overweight later. Not only do compounds in breast milk help regulate appetite and body fat, but breastfed babies may also be more likely to take in only as much as they need.

If you bottle-feed, resist the urge to encourage your baby to always finish that last ounce – whether it’s formula or expressed breast milk – if he’s signalled he’s full. And don’t automatically pop a bottle in his mouth every time he cries. Your child may just want a clean diaper, or a nap, or just your attention.

When your baby moves on to solid food, try to keep in mind that solids are mostly for practice at this stage. The bulk of your baby’s nutrition will still come from breast milk or formula until her first birthday.

There’s no need to push your baby to finish off jar after jar of food at every sitting; continue to follow her cues that she’s had enough.

Some new moms worry their chubby baby may be at risk for obesity later. While some studies have found a link between heavy babies and childhood obesity, moms should not count or cut calories in the first year, and should just concentrate on helping their babies to grow.

Focus on healthful foods

From the beginning, focus on building a solid nutritional base and a palate of healthy foods. Encourage kids to eat five fruits and vegetable servings per day, focusing on whole grains, including lean meats and low-fat or fat-free dairy products. High-calorie treats should be avoided, especially in very young kids. Avoid soda and limit your kid’s juice intake, as both are essentially empty calories and may make them too full to want to eat healthier foods. A better choice would be an actual piece of fruit, which contains satiating fibre and cancer-fighting antioxidants.  Talk early and often with your kids about why healthy food is good for your body, and don’t use food as a reward or punishment.

Watch portion size

Many parents are unclear about exactly how big a serving size is. Good news: you don’t need to buy a scale — simply use your child’s hand as a guide. A kid-size portion of meat is about the size of his palm. For carbs, fruits and veggies, the serving size is equal to the size of his fist. A snack should be about a handful, and a serving of cheese is about the size of his thumb.

Cook meals at home

Cooking can be a powerful tool for weight loss and healthy weight maintenance. It allows you to choose whole ingredients and control portion sizes. Get your kids involved — they’re more likely to eat healthy foods if they’ve had a hand in creating them. Page through a cooking magazine together or sort through recipes online and ask them which dishes look interesting, then go grocery shopping together and pick out nutritious, lower-fat and calorie ingredients, like part-skim mozzarella instead of full-fat for veggie lasagna, or applesauce instead of oil for brownies. Pack school lunches together or plant a family garden — try anything that involves them and allows them to make decisions in a fun way. Research has also shown preschoolers who sit down to regular family meals have a lower risk for obesity.

Forget the clean plate club

If your kid is pushing food around their plate, that’s a sign they might be full. Dealing with a picky eater, who just doesn’t do veggies? Although it’s fine to insist that they try just one bite of everything, don’t press them to gag down foods they truly don’t like, even in the name of healthy eating. One trick that really works: put out veggies first, when kids are hungriest and most likely to eat them.

Avoid focusing on cutting calories

Children need extra nutrients to fuel their growth. Rather than obsess over calorie cutting, focus on balancing diet with physical activity, managing portion sizes, and incorporating lots of high-nutrient foods that are naturally lower in calories, like fruits, vegetables and low-fat or non-fat dairy. The exception: If your child is clinically obese, the doctor may feel the need to prescribe a stricter calorie-controlled program.

Encourage physical activity

Get your kids moving! This can start in infancy: Your baby needn’t be confined to the crib. Let her explore in a safe environment, which will aid in muscle development. Head outside with toddlers as often as possible instead of plunking down in front of the television. Most experts say that children under the age of two should have no screen time at all; human interaction and physical activity are preferred at this stage. However, we all know moms need an electronic babysitter now and then, so Parenting’s stance is not to beat yourself up if you must pop in a DVD to take a shower or wrestle up a family dinner. Just be judicious about how often you rely on it.

As they grow older, continue to monitor your children’s TV and computer time; kids over age two should be limited to two hours of TV/computer time per day and should be getting one hour or more of physical activity per day. Active children are more likely to become fit adults, so encourage them to join sports teams or play tag in the back yard. Physical activity not only burns calories but builds strong bones and muscles and helps children sleep well at night and stay alert during the day. One way to make physical activity seem more appealing is to identify activities your child truly enjoys: nature lovers can take family walks; kids who like to climb can be treated to a post-dinner trip to the neighbourhood jungle gym.

Involve the entire family

Rather than single out one child, talk to the entire family about the importance of a healthy diet for everyone. This will help prevent the overweight child from feeling guilty, chastised or embarrassed. Always avoid making disparaging comments; an intense focus on your child’s weight and eating behaviours can backfire, which can pave the way to an eating disorder where a child may either end up eating even more or drastically cutting back in an unhealthy way.

Be a role model

Set a good example by making it a point to incorporate healthy foods and exercise in your own lifestyle.

Schedule yearly well-child visits

Take your child to the doctor for annual well-child checkups so her height, weight and BMI can be tracked. Increases in your child’s BMI or in his or her percentile rank over one year, especially if your child is older than age 4, may signal that your child is at risk of becoming overweight.

Relax

Many overweight children simply grow into their extra weight as they grow taller. Even if that’s not the case with your child, remember that what’s important is that you’ve noticed the problem and are taking steps to address it (Eissa, 2004).

Treatment of childhood obesity

Many of the healthy behaviours that prevent obesity are also used as treatment. Depending on your child’s age and co-existing medical conditions, treatment for childhood obesity typically focuses on dietary changes and improvements in physical activity levels. In more advanced cases, medications or weight-loss surgery may be recommended.

For children under age 7 with no other health concerns, treatment usually focuses on weight maintenance rather than loss, which allows the child to essentially “grow into” their weight, adding inches in height but not pounds. The result: Their BMI will drop into a healthier range. For children older than age 7, weight loss may be recommended, particularly if the child has developed a weight-related health issue. As in adult weight loss, children should aim for slow, steady weight loss of anywhere from one pound a week to one pound a month. Your doctor will help you and your child set a goal.

In the case of severe obesity, some adolescents may benefit from weight loss surgery (bariatric surgery) when traditional weight loss methods have failed. Many doctors will only recommend this option if your child’s weight poses a greater threat to his or her health than the potential risks of surgery. Long-term effects of weight loss surgery on a child’s future growth and development remain largely unknown, and any type of surgery carries potential risks. It also does not guarantee weight loss. Be sure to surround yourself with a team of experts, including a paediatric bariatric surgeon, a paediatric endocrinologist, a psychologist and a nutritionist, if you are considering this option.

Conclusion

The growing issue of childhood obesity can be slowed, if society focuses on the causes. There are many components that play into childhood obesity, some being more crucial than others. The most important being the parents supervising the children at home in both food choices and exercising regularly. If parents enforce a healthier lifestyle at home, then many obesity problems could be avoided. What children learn at home about eating healthy, exercising and making the right nutritional choices will eventually spill over into other aspects of their life. This will have the biggest influence on the choices kids make when selecting foods to consume at school and fast-food restaurants and choosing to be active. Focusing on these causes may, over time, decrease childhood obesity and lead to a healthier society as a whole.

Recommendations

Parents of obese children and adolescents should be concerned for their current and future health, since obesity can result in diabetes, hypertension, and coronary artery disease. Losing weight can be very difficult for obese children, and parental support is essential for success. Because children model behaviour after their parents, obesity often affects both parents and children. Parents should strive to have healthy eating habits and exercise regularly to be effective role models for their children. Making healthy eating and exercise a family priority is better for everyone and helps reinforce positive changes in behaviour for the obese child.

Obese children and adolescents are more susceptible to eating disorders, negative self-esteem and body image, and depression due to peer influences. Counselling, peer group therapy, and family therapy may be required to support lifestyle modifications for obese children and adolescents.

References

Anderson, P. M. & Butcher, K. F. (2006). Childhood Obesity: Trends and Potential Cause. The Role of Schools in Obesity Prevention. The Future of Children, 16(1), 19-45.

Daniels, S.R., Arnett, D.K., & Eckel, R.H. (2005). Overweight in children and adolescents: pathophysiology, consequences, prevention, and treatment. Circulation 111;1999–2002.

Eissa, M. A. (2004). “Evaluation and Management of Obesity in Children and Adolescents.” Journal of Pediatric Health Care 18(4): 35–38.

Family Health Guide (2008). “Childhood Obesity Treatment”. Retrieved Feb., 25th, 2014 from http://www.parenting.com/health-guide/childhood-obesity/treatment

Family Health Guide (2008). “Symptoms of Childhood Obesity”. Retrieved Feb., 25th, 2014 from http://www.parenting.com/health-guide/childhood-obesity/symptoms

Kopelman, P.G. (2005). Clinical obesity in adults and children: In Adults and Children. Edinburgh: Blackwell Publishing.

Ogden, C. L., Carroll, M. D., Curtin, L. R., McDowell, M. A., Tabak, C. J., & Flegal, K. M. (2006). Prevalence of Overweight and Obesity in the United States, 1999-2004. The Journal of the American Medical Association, 296, 1549-1555.

Riccairdelli, L.A.(2002). Body image and body change methods in adolescent boys: Role of parents, friends and the media, Journal of Psychosomatic Research, 49 (3):189-197.

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