Obesity In Children: Causes, Risks, Prevention & Treatment

Obesity in children can significantly impact their physical and psychological health. The World Health Organization (WHO) defines obesity as an excess of fat buildup that poses a health concern (1). Children are said to be obese if their body mass index (BMI) is at or above the 95th percentile compared to children of the same age and gender (2).

Your child’s weight may be influenced by your family lifestyle, nutrition, and physical activity preferences. Hence, to assist children in maintaining a healthy weight, parents should lead by example. Further, childhood obesity should be addressed since it can negatively impact a child’s long-term health as an adult.

This post discusses the reasons and risks of childhood obesity and measures to prevent it.

Why Do Children Become Obese?

The fundamental reason for obesity is the energy imbalance between the intake and consumption of calories (1) (2). The present day life style favours obesity. Children tend to eat junk food containing high density fats and cholestrol. Use of computers, tablets, mobile phones, etc., lead to less physical activity and less calories are burnt. Children become obese or overweight when they eat more food (calories) than what their bodies need for growth and physical activities. The extra calories are then stored in the fat cells. If the practice continues, the number of fat cells in the body increase over time, leading to obesity.

What Do The Statistics Show?

Since the 1970s, the percentage of children and adolescents with obesity has increased more than three times in the United States. According to the 2015-16 statistics, one in five school-aged children and youth between the ages of six and 19 is obese (3). The corona pandemic has greatly increased obesity in children. Lockdowns, no in-person schools, online classes, a lack of outdoor activities — all lead to obesity.

Below are some key statistical findings from a childhood obesity survey conducted by CDC in 2015-16 (4). The survey assessed obesity in children between the ages of two and 19 years.

• Obesity affected 18.5% of children; about 13.7 million children.

• Adolescents between the ages of 12 and 19 years showed maximum prevalence at 20.6 %.

• The prevalence of obesity stood at 18.4% in children between the ages of six and 11 years.

• Obesity had shown a constant increase among children since 2005.

According to the survey, the prevalence of obesity in children would constantly increase if the same trends continue.

Causes Of Obesity In Children

The causes of obesity in children may include the following (1) (2) (5).

1. Diet and lifestyle

Eating calorie-dense, low-nutrient food and beverages is a contributing factor to obesity. Foods that are high in sugar, fat, and salts are available easily and in large portions (sizes). Intake of such foods leads to higher calorie intake than required. Burgers, pizza, broast, sandwiches, french fries, cup cakes, and biscuits, which are frequently eaten by children, contain carbohydrates and fats.

The commercials and advertisements for many of these high-calorie food items are primarily aimed at children and can influence their healthy food choices. Moreover, the practices at home and school can affect a child’s choices. For instance, parents may use food as a reward or to offer comfort, which can cause the child to develop the habit of overeating in the long run.

2. Lack of exercise and physical activity

The screen time among children has increased drastically. Children spend most of their leisure hours gaming, texting, watching television, and surfing the internet. These sedentary activities require very little physical energy. Moreover, children are spending increasingly less time on outdoor physical activities. Some experts also believe that urbanization and changes in the mode of transportation may have contributed to a sedentary lifestyle.

3. Genetic factors

Genetic conditions can also increase the risk of obesity in some children. Conditions such as hormone disorders or hypothyroidism (low thyroid levels) could increase the appetite of children. Eventually, this can increase the risk of being overweight or obese.
Obese parents need to be careful about their family’s life style.

Factors That Increase The Risk Of Obesity

Risk factors for developing obesity include the following (5) (6).

1. Babies who gain weight rapidly during infancy could be prone to being overweight or obese as they grow older.

2. High birth weight and gestational diabetes have also been associated with an increased risk of obesity and type 2 diabetes in children.

3. A family medical history of obesity, hypertension, sleep apnea, type 2 diabetes, early heart attack, and hyperlipidemia may also increase the risk of obesity and other related complications in childhood.

4. Psychological factors, such as bullying, anxiety, depression, stigma, low self-esteem, or low quality of life, have been associated with obesity in children.

5. Certain medications, such as steroids or anti-seizure medicines, may also put a child at an increased risk of obesity.

6. Socioeconomic factors, such as accessibility and affordability to healthy food choices, could also be an important risk factor.

Children who are obese are more likely to be obese in adulthood as well. Obesity in children is leading to the following health problems that were earlier observed only in adults. (2) (5).

• High blood pressure or hypertension

• High cholesterol and triglycerides (risk factors for several cardiovascular diseases)

• Impaired glucose tolerance, type 2 diabetes, and insulin resistance

• Heart attacks primarily due to coronary heart disease and congestive heart failure

• Stroke

• Bone and joint problems, such as osteoarthritis and musculoskeletal discomfort. It primarily occurs due to increased pressure on the bones due to excess weight

• Fatty liver disease, gastroesophageal reflux (heartburn), and gallstones

• Breathing problems, such as sleep apnea, may lead to sleepiness, fatigue, and poor attention

• Bullying, low self-esteem, or difficulty in making friends

Ways To Help Prevent Obesity

Consider the following tips for preventing obesity in children.

1. Don’t use food as a reward or for offering comfort. Praise the child verbally or with hugs and kisses instead of promising candy or cookies.

2. Avoid force-feeding. Encourage the child to take small portions and respect their wish when they say “stomach is full.” It will also help children learn when to stop eating when their tummies are full.

3. Be a role model to your children. Children learn from their parents. Make healthier food choices, snack mindfully, and have an active lifestyle. When families do such things together, the child doesn’t feel left out.

4. Create a healthy environment at home that prevents food temptations. Keep healthy snacks within reach and unhealthy options out of the home.

5. Ensure regular, annual health check-ups. This becomes vital in cases where the child is predisposed to obesity due to family history.

6. Encourage eight to nine hours of sleep. This helps avoid sugar cravings due to lethargy.

Signs That A Child Is Obese

Children may experience different obesity symptoms. The following are the common signs and symptoms of obesity in children (6).

• Stretch marks on abdomen, hips, and armpits. The appearance of dark and velvety skin (acanthosis nigricans) around the neck and other areas.

• Deposition of fatty tissues in breasts, stomach, back, hips, and thighs.

• Poor self-esteem due to body; either too shy or irritated

• Increased craving for food

• Eating disorder along with a constant increase in body weight

• Sleep apnea (sleep disorder in which breathing stops and starts repeatedly)

• Out of breath even after less physical activity

• Constipation due to high carb and low fiber food

• Gastroesophageal reflux

• Dislocated hip, flat feet, and knock knees

• Knee and joint pains

• Delayed puberty in boys

• Early puberty and irregular menstrual cycle in girls, pain during menstruation

When To See A Doctor?

If you see any signs and symptoms of excess weight gain or obesity, see a doctor. Children should gain weight as they grow older. However, the weight gained should be appropriate for their height. Your doctor will check the child’s weight-for-height, BMI, and other factors, such as underlying pathological condition, to determine if the child is overweight or obese.

Treatment Of Obesity In Children

Doctors usually recommend screening for obesity in children by the age of six years. Your child may also be recommended for a blood test, thyroid test, and endocrine test to determine any underlying causes.

The doctor may recommend any of the following interventions after considering the child’s medical history, family medical history, eating habits, and level of physical activity (2) (7).

• A balanced diet with the right type of foods and avoiding sugary beverages. is an important first step.

• Regular visits to the doctor to monitor height and weight. More than 90th centile should be a concern.

• The portion size of food is an important part of a healthy diet. It is dependent on the age of the child. Make sure the child eats small portions and chews well. The doctor may refer you to a pediatric dietician to formulate the appropriate portion size and meal plans after discussion with you and the child. Do not encourage eating frequent snacks.

• Although fast foods or quick snacks are cheap and readily accessible, offer healthy foods to your child. Avoid or limit fast foods. You can limit fast foods to twice or thrice a week. You can involve your children while buying food and planning meals, encouraging them to pick healthy yet enjoyable food items.

• Encourage intuitive eating, which means enabling them to make choices that honor hunger and fullness without guilt. For instance, if your child feels full and does not wish to eat more, do not force them to eat or punish them for not clearing their plate.

• Include a variety of foods from different food groups. Make sure your child eats items from each food group in all their meals in the right portions.

• Fruits and vegetables are vitamin-packed healthy snack options. You may also try healthy homemade crackers and other snacks.

• Limit the intake of high-sugar and high-calorie food, such as cookies, candies, cakes, chips, sugary beverages, and ice cream.

• Pack home-cooked meals for the school whenever possible.

• Avoid intake of sugar-rich or corn syrup-rich beverages, carbonated drinks, sodas, and flavored water. You may offer coconut water or homemade lemonade.

• Encourage moderate physical activity for 60 minutes daily.

• Motivate them to do some physical activity even if your child is not athletic. They can run, play sports, or do cycling in their free time. You can do such activities together as a family, too. Alternatively, make them part of daily chores if the child isn’t much into outdoor activities.

• Restrict their screen time to not more than two hours in a day.

• Avoid giving weight loss or herbal supplements without consulting your doctor, as they may have serious side effects.

References

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Reviewer

Dr. Mubina AgboatwallaMBBS, DCH, MCPS

   

Dr. Mubina Agboatwalla is a well-known pediatrician, practicing paediatrics since the last 20 years in Karachi Pakistan. She is the head of the department of Pediatrics in Karachi Liaquat Hospital, as well as her private practice in three specialist clinics in Pediatrics.

Read full bio of Dr. Mubina Agboatwalla