Every parent wants their children to grow up healthy and safe. In many ways, we are better able to protect the health of our children than ever before. At the same time, there are threats to children’s health that were not as prevalent a few decades ago – childhood obesity is one of those threats.
According to the U.S. Centers for Disease Control and Prevention (CDC), obesity affects nearly 1 in 5 children and young adults ages 6-19. The numbers are slightly higher in Texas, where 20.7% of youth ages 10-17 have obesity, according to data from the Robert Wood Johnson Foundation.
The childhood obesity trendline is worsening, not improving. Despite advances in medicine and better information about how to keep children healthy, the childhood obesity rate is getting worse, not better. In fact, the percentage of children and adolescents who are considered obese has tripled since the 1970s.
“Fighting back against increasing childhood obesity rates is one of the most important things we can do to protect the health of children,” says Dr. Daniel Nale, a Dallas pediatrician. “Obesity can lead to significant health problems, including type 2 diabetes, elevated cholesterol, hypertension and bone and joint problems. For kids and teenagers, obesity can also contribute to low self-esteem and an increased risk of being bullied.”
How is Obesity in Children Defined?
The American Academy of Pediatrics recommends children be screened for obesity and overweightness utilizing the Body Mass Index (BMI). The BMI is a simple equation – a person’s weight divided by their height, squared: weight ÷ (height x height). For adults aged 20 and over, the BMI score indicates if someone is underweight, normal weight, overweight or obese.
For children, teens and young adults, the BMI calculation is more nuanced. The age and gender of the child is factored in to help determine the BMI, and then the result is evaluated in the context of BMI results across the entire population of children the same age and gender.
There are a variety of BMI calculators for both adults and children online, but for children, it’s best to let the pediatrician calculate the BMI and interpret the results. There are a number of variables that help determine what range the child falls in. Even if a BMI score appears high for a child’s age and gender, it does not necessarily indicate obesity or overweightness. A pediatrician may perform additional evaluation and consider other physical and environmental factors, such as diet and physical activity. Generally, if a child has a BMI in the 95th percentile or higher, that is indicative of obesity.
Biology Influences Weight
“It’s quite typical for young people who are overweight to suffer from low self-esteem and to blame themselves for their weight,” observes Dr. Anthony Scott, a pediatrician in Grapevine. “I have also known a lot of parents to be hard on themselves – they assume it is their fault that their child is overweight. The truth is, it’s usually more complicated than that.”
There are several biological factors that may contribute to obesity in childhood. First, obesity can be hereditary.
Second, people’s metabolic rates vary. Our metabolisms determine how quickly we burn calories. This is one of the biggest factors that affects if someone is normal weight or overweight. In fact, metabolic tempo can vary as much as 20% in people. That means two kids could eat the same amount of food and then get the same amount of exercise and one could burn a few hundred calories less than the other.
Another biological factor that can cause obesity is insulin resistance, which some children are born with. Insulin resistance leads to the body storing extra sugar, instead of burning it – this leads to weight gain.
Finally, low leptin levels are another common contributing factor. Our cells produce leptin to signal the brain when we are full; a leptin deficiency can lead to overeating.
“All of these conditions are beyond the control of children and their parents,” explains Dr. Camille Folkard, an endocrinologist with offices in Dallas and Plano. “But the good news is that we can diagnose these conditions and develop a strategy to treat or manage them.”
There are numerous environmental factors that contribute to children being overweight, as well.
For example, many families live in a “food desert” – an area where there is not a grocery store nearby. In addition, people may not have access to transportation to get to a grocery store. If it’s easier to buy a bag of chips and soda at a convenience store down the street than fruits and vegetables at a grocery store several miles away, this can have a big impact on a child’s diet and ultimately, their weight.
Busy schedules and lack of time are additional challenges facing many parents, regardless of where they live.
“Between our work obligations and getting kids to and from school and extra-curricular activities, it can be difficult to find time to prepare dinner at home every night,” says Dr. Isha Mannering, a Frisco pediatrician and mother of two young children. “Sometimes the convenience of driving through a fast-food restaurant or ordering pizza is hard to resist. But as parents, we have to force ourselves to develop meal plans that ensure those fast-food days are an exception, not the norm – for the benefit of our kids’ health, as well as our own.”
Of course, diet is only half the equation when it comes to weight management; burning calories through exercise and physical activity is also necessary. Just as some families may have difficulty accessing a grocery store conveniently, some live in areas where they don’t want their kids to play outside for safety reasons. Some communities lack playgrounds, parks, sidewalks and trails, which can make it challenging for people of any age to exercise outdoors.
Treating Childhood Obesity
For children who are overweight or obese, the best thing a parent can do is to work with their child’s pediatrician to develop a plan to gradually lose weight. Treatments may include nutrition support, behavioral therapy, prescription medications and in some circumstances, bariatric surgery. For children diagnosed with an underlying health condition that may be contributing to an unhealthy weight, the physician will develop a treatment plan.
Any obesity treatment plan will also include a healthy diet, focused on eating healthier foods, avoiding unhealthy foods and not overeating.
“Just as with adults, we don’t ever want to see a child start an unhealthy fad or ‘crash’ diet,” says Dr. Julie Tomberlin, a Mansfield pediatrician. “Instead, we want to look at what and how much the child is eating, what kind of exercise she or he is getting and make adjustments so that we begin to see gradual weight loss.”
Tips for Healthy Eating
Preparing meals for your kids is not an exact science – kids can be very picky eaters! It won’t do any good to serve spinach if your child refuses to eat it. All parents have to experiment to some degree to figure out what their children will eat and what they won’t. Once you know the answer to that question, here are some general guidelines for your trips to the grocery store.
Good for your kids:
- Fresh fruits and vegetables
- Frozen vegetables
- Lean meats and fish
- Breakfast cereals that are lower in sugar and higher in fiber
- Granola bars, if they are not high in sugar
- Popcorn, if it’s light on butter and salt
- 2% fat or less milk
- Whole wheat bread
Only OK every now and then:
- Deserts like cookies, ice cream, candy
- Frozen pizzas
Foods to avoid altogether:
- Sugary drinks, such as sodas, fruit punch and chocolate milk: they are loaded with sugar, which causes weight gain and cavities.
- Fruit juices: even though they have some beneficial vitamins, they are also high in sugar and should be avoided.
- Anything containing trans fats; often found in processed baked goods.
- Canned fruits and vegetables, which have little nutritional value and are usually loaded with salt and sugar.
With these guidelines in mind, here are a few ideas that will help keep your family on a healthier eating program:
- Pre-make as many meals as possible on Sunday, before the hectic school and work week gets underway. For example, grill or roast chicken and keep it in the fridge so it can be used for quick, healthy meals later in the week.
- Double or triple a recipe over the weekend that can be used as leftovers throughout the week or put in the freezer for future meals.
- Stock up on frozen vegetables, which are relatively inexpensive, don’t go bad and can be cooked in a matter of minutes on the stove or in the microwave.
- For snacks, grab enough fresh fruit that will keep for several days – apples, unripe bananas and oranges are good choices.
- Maybe you find out your child hates cooked carrots but likes them raw. Experiment with serving healthy foods different ways – you may be surprised what your child embraces.
- Be mindful of portion sizes. Use measuring cups and kitchen scales to measure food in proper quantities.
- Reserve desserts for special occasions. They should not be an everyday expectation.
- Lead by example: children mimic their parents. If your child sees you eating – and enjoying – healthy foods, they will learn from your example and imitate your behavior over time.
More Physical Activity & Less Screen Time
One of the biggest barriers to children getting enough exercise is too much screen time. Television, video games, tablets, phones – they can all become addictive. If your child is staring at a screen for hours on end, chances are he or she is not moving. That type of sedentary lifestyle can contribute to obesity.
The goal is to get at least one hour of physical activity per day and to limit screen time to no more than two hours per day. One way to ensure your children get enough exercise is to build in regular family activities – this could be a hike, a bike ride, swimming, etc. In addition, children who join an organized activity such as a sports team or scouts are sure to get more time moving around.
“The most important thing parents can do for their children is to be supportive,” says Dr. Janet Webb, a pediatrician. “Every child is special and as parents, we must remind them of that. We have to tell our kids we love them, no matter what. We’re there to help them be safe and healthy, and that means we will help them lose weight if they need to – but we’ll also protect them from a world that can be cruel at times.”
Bullying is a real issue for many kids, and those who are overweight often experience bullying disproportionately. It’s important to talk with your children about how to handle bullies – and for them to know that they should tell you if they experience bullying.
Healthy Childhood Leads to Healthy Adulthood
Given the increased risk an obese child faces for developing a variety of health problems such as type 2 diabetes, high cholesterol and high blood pressure, working to achieve and maintain a healthy weight in childhood will pay off throughout life.
“Chronic health conditions associated with obesity are some of the most common problems facing many adults today,” explains Dr. William Robert, III a Grapevine pediatrician. “By laying the groundwork in childhood to reduce the risk of those conditions, we’ll improve quality of life in adulthood and life expectancy.”
For children who are overweight, losing weight will do a lot to help their self-esteem and confidence. These positive effects will spill over into academic and extra-curricular activities, as well as help with friendships and relationships with others.
A panel of Privia Medical Group North Texas physicians has reviewed and approved this article.
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