Childhood Obesity Facts

Childhood obesity is a serious problem in the United States. The CDC reports nearly 20% of American children and adolescents have obesity. This is a huge jump compared to just 30 years ago, making obesity in children a major health challenge. Shilpi Relan, MD, UnityPoint Health, dives into the factors behind childhood obesity, its impact on a child’s health and 10 alarming facts about this rising health condition.

What is Childhood Obesity BMI?

Body mass index (BMI) helps providers understand a person's weight category. It's calculated by dividing weight by height squared. For adults, this can help determine if someone is underweight, normal weight, overweight or obese.

In children, BMI changes as they grow. Childhood obesity is classified into three categories based on a child's body mass index compared to other children of the same age and sex.

• Obesity: BMI at or above the 95th percentile
• Severe obesity: BMI above 120% of the 95th percentile
• Class 2 obesity: BMI between 120% and 140% of the 95th percentile
• Class 3 obesity: BMI above 140% of the 95th percentile

While BMI provides a general overview of weight, it’s important to remember that other factors contribute to a person’s overall health. Your healthcare provider can help evaluate your child's health risks related to their BMI and body fat.

What Causes Childhood Obesity?

Obesity can happen when someone eats too many calories, low nutrient foods and has limited physical activity. However, while these contributors are a big part of it, there's more to the story. Obesity is a complex issue with many additional factors, including:

• Genetics: Some people are more likely to gain weight due to their family history. For example, children of parents with obesity are at increased risk of obesity.
• Lifestyle: Factors like stress, insufficient sleep and even the environment we live in play a role.
• Psychological: Stress, emotional eating and body image issues all contribute to weight gain and make it harder to maintain a healthy weight.
• Socioeconomics: Lower incomes, education levels and lack of awareness about healthy eating habits and the importance of physical activity can contribute to obesity.

These are some more specific culprits, too, such as:

• Adverse childhood experiences (ACEs): Trauma, neglect or abuse can significantly impact a child's development, disrupt healthy eating and exercise habits and increase their risk of obesity.
• Gestational diabetes: It can increase a child's obesity risk by influencing a baby's development in the womb.
• Birth weight: Research shows higher birth weight is significantly associated with an increased risk of childhood obesity.
• Excessive screen time: Too much screen time is linked to an increased risk of obesity development in children.
• Hormonal imbalances: Although rare, hormone imbalances can cause obesity, often accompanied by reduced growth in height.
• Medication: Steroids, antidepressants, antipsychotics, etc. can stimulate appetite and lead to weight gain, increasing the risk of obesity. 
• Monogenic obesity: In rare instances, severe obesity results from a mutation in a single gene. This condition usually shows up in early childhood and is often marked by extreme hunger that’s hard to satisfy.
• Rapid weight gain in babies: Studies suggest rapid weight gain in infancy can increase the risk of obesity later in life.
• Sugary drinks: Consuming high amounts of sugary drinks, particularly during childhood, significantly increases the risk of developing obesity.

Tackling childhood obesity requires understanding the causes. Supporting children and families in making healthier choices plays crucial role in preventing obesity.

What are the Physical Consequences of Childhood Obesity?

Childhood obesity has a significant impact on a child's physical and mental well-being, affecting everything from their breathing to their joints. Children with obesity are at risk of developing more than 200 health problems, including:

• Asthma
• Certain cancers
• Delayed puberty (in boys)
• Early cardiovascular disease
• Early puberty (in girls)
• High blood pressure (hypertension)
• High cholesterol (too much fat in the blood stream)
• Joint pain (especially hip/knee pain)
• Liver dysfunction from increased fat accumulation and inflammation
• Mental health concerns (low self-esteem, depression, anxiety)
• Obstructive sleep apnea (trouble breathing and sleeping, which can cause daytime sleepiness)
• Type 2 diabetes (too much sugar in the blood)
• Vitamin D deficiency

10 Facts About Childhood Obesity

1. Only two percent of kids in the U.S. get enough vegetables. Based on diet recommendations from the United States Department of Agriculture, only two percent of children of children in the U.S. get enough vegetables. According to diet recommendations from the U.S. Department of Agriculture, 7.1 percent of children meet fruit intake recommendations 
2. Childhood obesity reduces life expectancy. Unless a significant change occurs, experts warn the effects of childhood obesity could reduce average life expectancy by five years or more over the next several decades.
3. Lack of exercise is a major factor for obesity in children. The U.S. Department of Health and Human Services recommends school-aged children and adolescents get at least 60 minutes of exercise every day. However, only one in every five adolescents in the United States meets these physical activity guidelines.
4. What children watch (and how much) influences obesity. Studies show children and adolescents, ages 8-16, who watch excessive amounts of television tend to have higher body fat percentages and BMIs. In fact, the odds of being overweight are 4.6 times higher in youth who watch more than five hours of television per day compared with those who watch less than an hour per day.
5. Unnecessary snacking leads to weight gain. Children’s snacking habits have significantly changed over the past few decades — taking in a more notable number of calories. A research study found states with strong nutritional policies have fewer unhealthy foods and beverages in schools, which is linked to lower student BMI levels.
6. School performance is impacted in children with obesity. Children with obesity, or who are overweight, may face increased challenges at school. Studies show they’re more likely to experience higher rates of school absenteeism, with an analysis indicating a 54% increased risk of absence compared to their normal-weight peers. This may be linked to various factors, including increased risk of chronic health conditions like diabetes and asthma, which can impact attendance. Additionally, children with obesity may experience social and emotional challenges, such as fear of bullying or embarrassment about participating in physical activities, potentially affecting their overall school experience.
7. The risk for heart disease jumps for children with obesity. Seventy percent of youth with obesity have at least one risk factor for cardiovascular disease, such as high cholesterol or high blood pressure. Researchers predict that, if current adolescent obesity rates continue, there will be more than 100,000 additional cases of coronary heart disease attributable to obesity by the year 2035.
8. Childhood obesity is linked to asthma. Children and teens who have obesity, or are overweight, have about a 50% higher chance of developing asthma compared to those at a healthy weight.
9. Healthcare costs are higher for children with obesity. Healthcare costs for children with obesity are significantly higher than for children with healthy weight, costing an additional $116 per child per year. This increases to $310 per year for children with severe obesity.
10. Half of type 2 diabetes cases in kids are caused by obesity. Nearly half (45%) of children diagnosed with diabetes have Type 2 due to being overweight or having obesity.

Ways to Reduce Childhood Obesity

Researchers continue to explore new ways to treat obesity. However, these prevention strategies seem to be the best approach at this point:

• Encourage regular physical activity: Aim for at least 60 minutes of moderate-to-vigorous physical activity most days of the week. This can be walking, biking, swimming, dancing or any type of movement your child enjoys. Exercising without changing eating habits rarely leads to much weight loss.
• Promote healthy eating habits: Emphasize fruits, vegetables, whole grains and lean protein while limiting sugary beverages, carbohydrate intake and eating out.
• Limit screen time: Try not to allow your child to snack or eat meals during screen time.
• Promote healthy sleep habits: Aim for 9-11 hours of sleep per night, to support your child’s overall well-being.

Weight Loss Medication for Children and Adolescents

Diet and exercise are beneficial for weight loss, but some children and teenagers may struggle to lose significant weight through lifestyle changes alone. In these individuals, medications can be considered in partnership with lifestyle modifications.

Currently, the following medications are FDA approved for use in children 12 and older:

• Orlistat (Xenical, Alli)
• liraglutide (Saxenda)
• Phentermine/topiramate (Qsymia)
• Semaglutide (Wegovy)
• Setmelanotide (IMCIVREE) is approved for children ages six years and older who have rare genetic disorders causing obesity

These medications need to be used in conjunction with lifestyle interventions to be effective. If a patient taking obesity medications fails to achieve significant weight loss within 12 weeks, the medication is usually discontinued.

Common side effects of these weight loss medications include:

• Constipation
• Diarrhea
• Indigestion
• Nausea
• Vomiting

These symptoms are more common with newer injectable medications, like semaglutide and liraglutide. Side effects are usually mild to moderate, are more common with higher doses and most often improve if you continue to take the medication. If effective, weight loss medications can provide numerous benefits beyond weight loss for an individual, including:

• Enhance mental health
• Improve glycemic control in patients with Type 2 diabetes
• Improve lipid profile
• Lower blood pressure
• Reduce risk of obesity-related complications such as sleep apnea, osteoarthritis and certain types of cancer
• Reduce risk of Type 2 diabetes

Childhood obesity can often be prevented by modeling positive lifestyle habits in your home, such as healthy eating and physical activity. If you're concerned about your child or are looking for medical support, talk to your child's doctor.

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