The Kids are “Growing” Too Fast: The Growing Problem of Childhood Obesity
Andrew PERRETT, Family Medicine Physician
As the Spring Festival holiday approaches, families will be looking forward to spending some quality time together—watching TV, cooking, and lounging on the couch. Unfortunately, even well-meaning parents and grandparents can negatively affect children’s health by inadvertently encouraging unhealthy habits, which can lead to childhood obesity. It is important to know what childhood obesity is and what parents can do to help their kids stay healthy for life.
Beyond “fat,” defining overweight and obese
Technically, obesity means an excess of body fat. Yet, in many cultures, describing someone as obese is not a nice thing to do. I prefer to use the term overweight, even though it may not sound much better, since we usually measure weight rather than body fat. In fact, the words “overweight” and “obese” are also clinically defined terms for describing people according to a measurement called body mass index (BMI).
BMI is an easy-to-measure rule of thumb for adults of average height. It is also the standard measurement tool for children over two years old. However, the normal BMI range varies for children of different ages, so it has to be used with a growth chart showing these normal ranges. A growing consensus in the United States for BMI percentile is:
- 5th – 85th percentile: normal
- 85th – 95th percentile: overweight
- ≥95th percentile: obese
A child whose BMI is below the 5th percentile is considered underweight. This is a separate topic, but an important one. In the context of adequate nutrition being available, psychological causes should be considered.
Why does body weight matter?
It can be difficult to discuss this sensitive topic, but it is important. Being overweight is a risk factor for diseases normally rare in children, including sleep apnea, type 2 diabetes, orthopedic problems, skin conditions, hypertension, high cholesterol, gall bladder disease, fatty liver, intracranial hypertension and psychological illness, including low self-esteem. Overweight children are more likely to become sick as adults: boys are at increased risk of heart disease, and girls are more likely to die from breast cancer later on in life.
Children are more likely to remain overweight as adults if they remain overweight in later adolescence, especially if they are more severely overweight and if they have one or more overweight parents.
Being overweight is also increasingly prevalent. One of every three adolescents in the United States is now overweight (BMI >85th percentile). In China, the prevalence of overweight children is about one third of that in the US, but pre-school children are more often affected.
Why do children and young people become overweight?
Children do come in a range of healthy sizes! Genetic factors exist, but less than 1% have specific genetic reasons for being overweight. Environmental and nutritional influences during pregnancy may have long-term effects. Medications for other conditions sometimes cause weight gain; infections, toxins and normal gut bacteria may play a minor role. However, most children (and adults) become overweight because they are consuming much more energy than they are using, and this is often the result of parents simply feeding their kids too much and encouraging them to exercise too little. In short, childhood obesity is preventable.
Low physical activity may result from:
- Limited access to safe spaces or sports facilities
- Increased screen time (computer, television, game console)
- Avoidance of exposure to other perceived risks (child abduction, air pollution)
- Lack of safe pedestrian / cycle routes
- Increased use of motor vehicles for short journeys
Increased energy intake may result from:
- Sugar-containing beverages (including fruit juice)
- Large portion sizes
- Increased meals out at restaurants (rather than at home)
- Fast foods and processed foods
- Relative costs (fruits and nuts increasingly expensive, junk food is cheaper)
- Ready availability of a huge range of food choices
If my child’s weight is fine, no worries, right?
Probably, but not necessarily. If your child’s doctor says your child’s weight is within the normal range, it is still worth taking a look at lifestyle habits, both individually and for the whole family.
One thing to know is that children grow in bursts, going from slightly slimmer to slightly plumper and back again over time. This is normal.
Childhood is the best time to establish good habits that will last a lifetime. Most of us have an idea about which foods are ‘healthy,’ but it is also important to enjoy treats and to remember that older children need to consume more energy than most adults. Useful questions include:
- Do I (does my child) drink water, not a sugary drink, when thirsty? Is water available at a temperature I like? A slice of lemon is ok.
- Do I (does my child) spend at least 30 minutes every day doing some kind of moderate or more intense exercise? If exercise is impossible right now, what needs to change?
- Do I (does my child) eat fruit and nuts as snacks rather than cookies, chips and candy?
- Do I (does my child) eat breakfast?
- Do I (does my child) eat at least one ‘family meal’ most days?
My child needs to lose weight. Where should I start?
Start by talking with your family doctor or pediatrician. Special situations do exist in which some of the usual strategies listed below are inappropriate. For some children, more intensive management with the advice of a nutritionist may be important. However, a combination of simple behavioral strategies is usually effective:
- Figure out what you and your child really eat, and how much you both exercise during a normal day – if you write it down, it may surprise you.
- Make it easier – don’t keep cookies in the house, but do have healthy snacks available; don’t have a television in the bedroom, but do have sports equipment available. Some of this needs to be agreed on by the whole household. Other things, like limited access to computers, can be tailored to individual needs.
- If you set goals, make them “SMART” (specific, measurable, attainable, realistic and time-defined). An example would be to lose 5% of current weight over 3 months. It can be useful to know how you are doing every 2 to 4 weeks, but measuring weight every day is unhelpful.
- Rewards can be helpful when linked to achieving “SMART” goals. Beware: rewards that seem impossible are discouraging. Rewards should be discussed and agreed in advance, and they should be fun!
- Positive reinforcement is very important. Children tune out if they get too much negative feedback. Try to notice and affirm specific things they are doing right – not just to do with food or weight, but appreciate them for behavior you want to see replicated, whether it be kind acts, chores or appropriate self-control.
- Model healthy behaviors yourself. Children pay more attention to what we do ourselves than what we say.
Too weighed down?
Good health is not all about weight. Don’t make that the focus of every mealtime or conversation, but don’t ignore it either. Your nutritionist or primary care physician can help – sometimes it is easier, especially for teenagers and their parents, to have these conversations with someone else.