8.8: Obesity

The current measurement for determining excess weight is the Body Mass Index (BMI) which expresses the relationship of height to weight. According to the Centers for Disease Control and Prevention (CDC), children’s whose BMI is at or above the 85th percentile for their age are considered overweight, while children who are at or above the 95th percentile are considered obese.

In general, childhood obesity is a complex health issue. It occurs when a child is well above the normal or healthy weight for his or her age and height. Childhood obesity is a serious problem in the United States putting children at risk for poor health. For children and adolescents aged 2-19 years in 2017-2020[1]:

• The prevalence of obesity was 19.7% and affected about 14.7 million children and adolescents.
• Obesity prevalence was 12.7% among 2- to 5-year-olds, 20.7% among 6- to 11-year-olds, and 22.2% among 12- to 19-year-olds. Childhood obesity is also more common among certain populations.
• Obesity prevalence was 26.2% among Hispanic children, 24.8% among non-Hispanic Black children, 16.6% among non-Hispanic White children, and 9.0% among non-Hispanic Asian children.

Where people live can affect their ability to make healthy choices. As seen in the statistics above, obesity disproportionally affects children from low-income families.

Causes of Obesity

The causes of excess weight gain in young people are similar to those in adults, including factors such as a person’s behavior and genetics. Behaviors that influence excess weight gain include:

• larger portion sizes
• limited access to nutrient-rich foods
• increased access to fast foods and vending machines
• lack of breastfeeding support
• declining physical education programs in schools
• insufficient physical activity and a sedentary lifestyle
• media messages encouraging the consumption of unhealthy foods
• sedentary activities (such as watching television or other screen devices)
• medication use
• sleep routines

The decreased participation in school physical education and youth sports is just one of many factors that has led to an increase in children being overweight or obese.

Consequences of obesity

Excess weight and obesity in children are associated with a variety of medical and cognitive conditions including high blood pressure, insulin resistance, inflammation, depression, and lower academic achievement (Lu, 2016)

Being overweight has also been linked to impaired brain functioning, which includes deficits in executive functioning, working memory, mental flexibility, and decision making (Liang et al, 2014). Children who ate more saturated fats performed worse on relational memory tasks while eating a diet high in omega-3 fatty acids promoted relational memory skills (Davidson, 2014). Using animal studies, Davidson et al. (2013) found that large amounts of processed sugars and saturated fat weakened the blood-brain barrier, especially in the hippocampus. This can make the brain more vulnerable to harmful substances that can impair its functioning. Another important executive functioning skill is controlling impulses and delaying gratification. Children who are overweight show less inhibitory control than normal- weight children, which may make it more difficult for them to avoid unhealthy foods (Lu, 2016). Overall, being overweight as a child increases the risk for cognitive decline as one ages.

Children who are overweight tend to be rejected, ridiculed, teased and bullied by others more than their peer counterparts (stopbulling.gov) This can certainly be damaging to their self-image and popularity. In addition, children who are obese run the risk of suffering orthopedic problems such as knee injuries, and they have an increased risk of heart disease and stroke in adulthood. It is hard for a child who is obese to become a non-obese adult. In addition, the number of cases of pediatric diabetes has risen dramatically in recent years.

Figure \(\PageIndex{1}\): A child watching TV instead of playing – children spend a lot more time in front of devices than running around playing.[2]

The consequences of childhood obesity are both immediate and long term. It can affect physical as well as social and emotional well-being.

• More Immediate Health Risks
  • High blood pressure and high cholesterol, which are risk factors for cardiovascular disease (CVD).
  • Increased risk of impaired glucose tolerance, insulin resistance, and type 2 diabetes.
  • Breathing problems, such as asthma and sleep apnea.
  • Joint problems and musculoskeletal discomfort.
  • Fatty liver disease, gallstones, and gastro-esophageal reflux (i.e., heartburn).
• Childhood obesity is also related to
  • Psychological problems such as anxiety and depression.
  • Low self-esteem and lower self-reported quality of life.
  • Social problems such as bullying and stigma.
• Future Health Risks
  • Children who have obesity are more likely to become adults with obesity.¹¹Adult obesity is associated with increased risk of a number of serious health conditions including heart disease, type 2 diabetes, and cancer.
  • If children have obesity, their obesity and disease risk factors in adulthood are likely to be more severe.[3]

    

    Figure \(\PageIndex{2}\): There are certainly many health risks associated with being overweight.[4]

Being Overweight Can Be a Lifelong Struggle

A growing concern is the lack of recognition from parents that children are overweight or obese. Katz (2015) referred to this as “oblivobesity”.

Black et al. (2015) found that parents in the United Kingdom (UK) only recognized their children as obese when they were above the 99.7^th percentile while the official cut-off for obesity is at the 85^th percentile. Oude Luttikhuis, Stolk, and Sauer (2010) surveyed 439 parents and found that 75% of parents of overweight children said the child had a normal weight and 50% of parents of obese children said the child had a normal weight. For these parents, overweight was considered normal and obesity was considered normal or a little heavy. Doolen, Alpert, and Miller (2009) reported on several studies from the United Kingdom, Australia, Italy, and the United States, and in all locations parents were more likely to misperceive their children’s weight. Black, Park, and Gregson (2015) concluded that as the average weight of children rises, what parents consider normal also rises. If parents cannot identify if their children are overweight they will not be able to intervene and assist their children with proper weight management.

An added concern is that the children themselves are not accurately identifying if they are overweight. In a United States sample of 8-15 year-olds, more than 80% of overweight boys and 70% of overweight girls misperceived their weight as normal (Sarafrazi, Hughes, & Borrud, 2014). Also noted was that as the socioeconomic status of the children rose, the frequency of these misconceptions decreased. It appeared that families with more resources were more conscious of what defines a healthy weight.

Interventions

Behavioral interventions, including training children to overcome impulsive behavior, are being researched to help children achieve and maintain a healthy weight (Lu, 2016). Practicing inhibition has been shown to strengthen the ability to resist unhealthy foods. Parents can help their children the best when they are warm and supportive without using shame or guilt. Parents can also act like the child’s frontal lobe until it is developed by helping them make correct food choices and praising their efforts (Liang et al, 2014). Research also shows that exercise, especially aerobic exercise, can help improve cognitive functioning in children (Lu, 2016). Parents should take caution against emphasizing diet alone to avoid the development of any obsession about dieting that can lead to eating disorders. Instead, increasing a child’s activity level is most helpful.

Dieting is not really the answer. If you diet, your basal metabolic rate tends to decrease thereby making the body burn even fewer calories in order to maintain the weight. Increased activity is much more effective in lowering the weight and improving the child’s health and psychological well-being. Exercise reduces stress and being an overweight child, subjected to the ridicule of others can certainly be stressful. Parents should take caution against emphasizing diet alone to avoid the development of any obsession about dieting that can lead to eating disorders as teens. Again, helping children to make healthy food choices and increasing physical activity will help prevent childhood obesity.[5]

Weight Management

Forming good eating habits and engaging in fitness or exercise programs will help maintain a healthy weight and develop lifelong habits. Research says that the best way to control weight is: eat less (consume fewer calories) and exercise (burn more calories). To maintain a healthy weight, restricting your diet alone is difficult and can be substantially improved when it is accompanied by increased physical activity.

The energy (calorie) requirements for preteens differ according to gender, growth, and activity level. For ages nine to thirteen, girls should consume about 1,400 to 2,200 calories per day and boys should consume 1,600 to 2,600 calories per day. Physically active preteens who regularly participate in sports or exercise need to eat a greater number of calories to account for increased energy expenditures.[7]

People who exercise regularly, and in particular those who combine exercise with dieting, are less likely to be obese (Borer, 2008).Borer, K. T. (2008). Exercise not only improves our waistline, but also improves our overall mental health by lowering stress and improving feelings of well-being. Exercise also increases cardiovascular capacity, lowers blood pressure, and helps improve diabetes, joint flexibility, and muscle strength (American Heart Association, 1998).

For long lasting change, it’s important to plan healthy meals, limit snacking, and to schedule exercise into our daily lives.[8]

Programs to address childhood obesity can include behavior modification, exercise counseling, psychological support or therapy, family counseling, and family meal-planning advice. [9]

References:

Davidson, L. (2014). Do impaired memory and body weight regulation originate in childhood with diet-induced hippocampal dysfunction? The American Journal of Clinical Nutrition, 99(5), 971-972.

Davidson, L., Hargrave, S. L., Swithers, S. E., Sample, C. H., Fu, X., Kinzig, K. P., & Zheng, W. (2013). Inter-relationships among diet, obesity, and hippocampal-dependent cognitive function. Neuroscience, 253, 110-122.

Lu, (2016). Obesity and the growing brain. Monitor on Psychology, 47(6), 40-43.

Liang, , Matheson, B., Kaye, W., & Boutelle, K. (2014). Neurocognitive correlates of obesity and obesity-related behaviors in children and adolescents. International Journal of Obesity, 38(4), 494-506

Sarafrazi, , Hughes, J. P., & Borrud, L. (2014). Perception of weight status in U.S. children and adolescents aged 8-15 years, 2005-2012. NCHS Data Brief, 158, 1-8.

(Stopbullying.gov).

Attributions

Child Growth and Development by Jennifer Paris, Antoinette Ricardo, and Dawn Rymond, 2019, is licensed under CC BY 4.0

[1] Prevalence for Childhood obesity in the US by Centers for Disease control in the public domain

[2] Image by Melissa Gutierrez is licensed under CC-BY-2.0

[3] Childhood Obesity Causes & Consequences by the CDC is in the public domain

[4] Image by Gaulsstin is licensed under CC BY 2.0

[5] Lifespan Development: A Psychological Perspective by Martha Lally and Suzanne Valentine-French is licensed under CC BY-NC-SA 3.0 (modified by Dawn Rymond); Lifespan Development - Module 6: Middle Childhood by Lumen Learning references Psyc 200 Lifespan Psychology by Laura Overstreet, licensed under CC BY 4.0 (modified by Dawn Rymond)

Parenting and Family Diversity Issues by Diana Lang, 2020, published by Iowa State University is licensed under CC BY-NC-SA 4.0

[7] Beginning Psychology - Two Fundamental Human Motivations: Eating and Mating by Charles Stangor is licensed under CC BY-NC-SA 3.0

[8] Beginning Psychology - Two Fundamental Human Motivations: Eating and Mating by Charles Stangor is licensed under CC BY-NC-SA 3.0 (modified by Dawn Rymond)

[9] An Introduction to Nutrition- Puberty and Nutrition by Maureen Zimmerman and Beth Snow is licensed under CC BY-NC-SA 3.0