Obesity in Children Overview

Obesity means an excess amount of body fat. No general agreement exists on the definition of obesity in children as it does adults. Most professionals use published guidelines based on the body mass index(BMI), or a modified BMI for age, to measure obesity in children. Others define obesity in children as body weight at least 20% higher than a healthy weight for a child of that height, or a body fat percentage above 25% in boys or above 32% in girls. Although rare in the past, obesity is now among the most widespread medical problems affecting children and adolescents living in the United States and other developed countries. About 15% of adolescents (aged 12-19 years) and children (aged 6-11 years) are obese in the United States according to the American Obesity Association. The numbers are expected to continue increasing. Childhood obesity represents one of our greatest health challenges. Obesity has a profound effect on a child's life. Obesity increases the child's risk of numerous health problems, and it also can create emotional and social problems. Obese children are also more likely to be obese as adults, increasing their risk of serious health problems such as heart disease and stroke. If your child is overweight, further weight gain can be prevented. Parents can help their children keep their weight in the healthy range. In infancy, breastfeeding and delaying introduction of solid foods may help prevent obesity.

In early childhood, children should be given healthful, low-fat snacks and take part in vigorous physical activity every day. Their television viewing should be limited to no more than seven hours per week (which includes video games and the Internet). Older children can be taught to select healthy, nutritious foods and to develop good exercise habits. Their time spent watching television and playing with computer or video games should be limited to no more than seven hours each week. Avoid snacking or eating meals while watching TV, movies, and videos.

Obesity in Children Causes

Children who regularly consume more calories than they use will gain weight. If this is not reversed, the child will become obese over time. Consumption of just 100 calories (the equivalent of 8 ounces of a soft drink) above daily requirements will typically result in a 10-pound weight gain over one year. Many different factors contribute to this imbalance between calorie intake and consumption. o o Genetic factors Obesity tends to run in families. A child with an obese parent, brother, or sister is more likely to become obese.

o Genetics alone does not cause obesity. Obesity will occur only when a child eats more calories than he or she uses.

Dietary habits o Children's dietary habits have shifted away from healthy foods (such as fruits, vegetables, and whole grains) to a much greater reliance on fast food, processed snack foods, and sugary drinks. o These foods tend to be high in fat and/or calories and low in many other nutrients.

o Patterns associated with obesity are eating when not hungry and eating while watching TV or doing homework. Socioeconomic status o Low family incomes and having nonworking parents are associated with greater calorie intake for activity level. Physical inactivity o The popularity of television, computers, and video games translates into an increasingly sedentary (inactive) lifestyle for many children in the United States. o Children in the United States spend an average of over three hours per day watching television. Not only does this use little energy (calories), it also encourages snacking. o Fewer than half of children in the United States have a parent who engages in regular physical exercise. o Only one third of children in the United States have daily physical education at school.

o Parents' busy schedules and fears about safety prevent many children from taking part in after-school sports programs. Certain medical conditions can cause obesity, but these are very rare. They include hormone or other chemical imbalances and inherited disorders of metabolism. fat. Certain medications can cause weight gain by altering how the body processes food or stores

When to Seek Medical Care

If you or the school personnel think your child is overweight If your child has expressed concerns about his or her weight If your child has problems keeping up with peers in physical fitness or sports

Exams and Tests

Weight-to-height tables These tables give general ranges of healthy weights and overweight for a child's height. Many health care providers define obesity in a child as weighing 20% or more over the healthy range. The tables, however, do not take into account the individual characteristics of each child. The healthcare provider must consider the child's age and growth pattern when interpreting the chart. For example, some children gain weight before a growth spurt. This doesn't mean they are becoming obese. Body fat percentage The percentage of body weight that is fat is a good marker of obesity. Boys over 25% fat and girls over 32% fat are considered obese. Body fat percentage is difficult to measure accurately, however. The most accurate methods use special equipment that is not found at most medical offices. The method that measures skinfold thickness is not reliable unless it is done correctly by a trained and experienced technician. Body mass index (BMI) This measure is used to assess weight relative to height. It is the same as the body mass index used to identify adult obesity. BMI is defined as weight in kilograms divided by height in meters squared (kg/m 2). BMI also can be calculated in pounds and inches. BMI is closely related to body fat percentage but is much easier to measure. BMI is the standard for defining obesity in adults, but its use in children is not accepted universally. The Centers for Disease Control and Prevention(CDC) suggests two levels of concern for children based on the BMI-for-age charts.

1. At the 85th percentile and above, children are "at risk for overweight" and,
2. At the 95th percentile or above, they are "overweight". The American Obesity Association defines those children above the 95th percentile as "obese", which corresponds to a BMI of 30 (considered obese in adults). To calculate a child's body mass index, follow these steps: 1. Multiply the child's weight in pounds by 705 2. Then divide by the child's height in inches 3. Divide this by the height in inches again To calculate body mass index on the Internet, fill in the child's height and weight at the Web site of the Department of Health and Human Services, Obesity Education Initiative. Waist circumference (WC) This measurement in a child or adolescent correlates closely with the future risk of developing type 2 diabetes mellitus and related complications of the a href="/script/main/art.asp?

articlekey=103831">metabolic syndrome (high blood pressure, abnormal circulating cholesterol or other fat levels, heart attack, stroke, and damage to eyes, heart, and kidneys). The assessment is made with a tape measure stretched across the widest abdominal girth (usually at or just below the level of the belly button, called the umbilicus). Any value over the 90th percentile for age and gender carries the highest risk.

Obesity in Children Treatment

When the goal is to help a child reach and maintain a healthy weight, parents take the lead. Healthcare providers and nutrition consultants are there to help, but parents exert the most control over the child's activities and habits and thus are in the greatest position to make changes. The most important thing parents can do for an obese child is to be supportive. Your child's feelings about himself or herself are at least partly determined by your feelings. Let your child know that you love and accept him or her at any weight. Encourage Don't criticize Be sensitive to the child's concerns about appearance and social relationships.

Weight loss itself is rarely a goal in an obese child. Rather, the goal is to slow or stop weight gain. The idea is to allow the child to grow into his or her body weight gradually, over time. This may take a year or two, or even longer, depending on the child's age, weight, and growth pattern. Remember, an obese child does not have to become an obese adult. When weight loss is set as a goal, the safest and most practical objective is two pounds per month. For such a plan to succeed, it must involve long-term changes in the habits of the entire family. The obese child should not be singled out. Parents, brothers and sisters, and other family members living in the home all will benefit from a shift toward a healthier lifestyle. Remember that children learn best by example-set a good one.

Self-Care at Home
The cornerstones of a weight control plan are physical activity and diet management. Old habits and attitudes-yours and your children's-need to change. The sooner a plan is put in place, the better; it is much easier to change habits in children than in adults. Physical activity The single best thing you can do is restrict the amount of time your child spends watching TV, sitting at the computer, or playing video games. These activities burn few calories and encourage snacking. The U.S. Surgeon General recommends moderate physical activity for children every day for at least 60 minutes. Encourage children to enjoy physical activity that burns calories and uses different muscle groups: running games, swimming, skating, riding a bicycle. The most effective activities raise the

heart rate moderately and cause mild sweating; the child should not become exhausted, overheated, or severely short of breath. Allow each child to try different activities to find those that he or she enjoys.

The goal is to participate in continuous, moderately strenuous activity for at least 30 minutes every day. Be a role model for your children. If they see you being active and having fun, they are more likely to be active and stay active into adulthood. Plan family activities so that everyone can get some exercise and have fun. Walk, dance, or bike together. Encourage your children to get involved in sports at school or in the community. Don't force children to take part in activities they find uncomfortable or embarrassing.

Whatever activities your children become involved in should be appropriate for their ages and development. Make sure children understand basic safety rules. Make sure they have plenty of water to drink to replace fluid lost by sweating. Diet management First, educate yourself about your children's nutritional needs. Use what you learn to help your children learn a healthy attitude about eating. If you are unsure about selecting and preparing foods for a healthy diet, tell your healthcare provider. He or she can make recommendations or refer you to a nutritionist. Involve your children in food shopping and meal preparation.

Don't dictate exactly what your children eat. Children should help choose what they eat and how much. Offer your children a variety of foods, including sweets and snack foods. All foods have a place in a healthy diet, even foods high in fat and calories-as long as they are eaten occasionally and in moderation. Familiarize yourself with appropriate serving sizes. Encourage your children to eat slowly. This helps them recognize the feeling of fullness and stop eating when they are full. The family should eat together whenever possible. Make meals a pleasant time for conversation and sharing the events of the day. Don't forbid snacks. While continuous snacking contributes to weight gain, planned snacks are part of a healthy diet for children. A nutritious and tasty snack after school will give children the energy they need for homework, sports, and play until supper.

 Identify high-risk situations such as having too many high-calorie foods in the house or watching television during meal times. With the distraction of television, many people overeat. Don't deprive your child of occasional treats like chips, cake, and ice cream, especially at parties and other social events. Meal and snack suggestions Most of your diet should be whole grains, fruits, and vegetables. Serve a variety of green, red, yellow, brown, and orange vegetables, fresh fruits, and whole-grain bread, pasta, and rice. Eat two or three servings of low-fat (1% milk) or nonfat dairy products every day.

A healthy diet also includes two to three servings of foods from the meat and beans group. This includes lean meat, poultry, fish, cooked dry beans, eggs, and nuts. Limit fats to no more than 25%-30% of total calories. o foods. o o o o peanut butter bars o o Switch to low-fat (1% milk) or nonfat dairy products if you now use whole-fat dairy

Trim all fat off meat and remove skin from poultry. Choose low-fat or fat-free breads and cereals. Avoid fried foods. Choose low-fat and tasty snack foods Fruit, fresh or dried Low-fat or nonfat yogurt or cheese Nuts or sunflower or pumpkin seeds Whole-grain breads, crackers, or rice cakes spread with a fruit spread or

Frozen desserts such as frozen yogurt, fruit sorbet, popsicles, and fruit juice

Do not limit fat in children younger than two years of age. Select snacks for young children carefully to avoid choking hazards.

Obesity in Children (cont.)

IN THIS ARTICLE

Obesity in Children Overview

Obesity in Children Causes When to Seek Medical Care Exams and Tests Obesity in Children Treatment Self-Care at Home Next Steps Follow-up Outlook Support Groups and Counseling For More Information Web Links Synonyms and Keywords Authors and Editors

Next Steps Follow-up

Parents need to develop good habits of their own to help their children maintain a healthy weight. Don't make your child eat when he or she isn't hungry. Don't insist that your child finish a meal. Don't rush meal time. In general, you eat more when you eat quickly. Don't use food to comfort or reward. Don't offer dessert as a reward for finishing a meal.

Offer your child a healthy, balanced diet that includes a variety of foods. No more than 30% of calories should come from fats. The American Heart Association guidelines (see below) are appropriate for most children. Switch your child from whole milk to 2% milk at age two years. If she or he is overweight, switch to 1% milk. In early childhood, skim milk should only be substituted following a doctor's recommendation. Don't eat at fast-food restaurants more than once a week. Make sure meals outside the home, such as school lunches, are balanced. Offer your child water to quench thirst. Avoid away from soda and other sugary drinks. Limit your child's time watching television and playing computer and video games.

Encourage your child to do something active, like riding a bicycle, jumping rope, or playing ball. Better yet, bicycle or play ball with your child.

Teach your child good eating and exercise habits now.

American Heart Association Dietary Guidelines for Healthy Children and Families Achieve adequate nutrition by eating a wide variety of foods.

Eat adequate energy (calories) to support growth and development and reach a healthy body weight. o o o Recommended average daily fat intake Saturated fat - 7%-10% of total calories Total fat - Limit to 25%-30% of total calories Cholesterol - Less than 300 mg per day

These guidelines apply to adults and children older than two years of age. These measures should be applied to everyone in the family, not just children who are already overweight or obese. Parents should focus on building self-esteem and coping with emotional distress

Outlook
Some health problems are much more likely to affect obese children than non-obese children. Asthma, especially severe asthma Diabetes, type 2 High blood pressure High cholesterol Heart failure Liver problems ("fatty liver") Bone and joint problems in the lower body Growth abnormalities Emotional and social problems Breathing problems such as sleep apnea Rashes or fungal infections of the skin, acne

Obese children also are much more likely to have these and other obesity-related health problems in adulthood: Heart disease Stroke Certain types of cancer Osteoarthritis Gout Gallbladder disease

Support Groups and Counseling

American Obesity Association This group itself is not-for-profit, but it is made up of several types of sponsors, including professional groups (such as the American College of Nutrition), health insurance interests, forprofit companies (such as drug and biotechnology companies), and weight loss interests (such as Jenny Craig, Inc. and Weight Watchers, Inc.). The group's purpose is to change the way obesity is perceived and to end discrimination against obese people, as well as to find more effective strategies for preventing and "curing" obesity. It uses lobbying, advocacy, and education to achieve these goals.

For More Information Web Links

American Heart Association, Overweight in Children Institute of Medicine of the National Academies, Preventing Childhood Obesity: Health in the Balance The Hormone Foundation (http://www.hormone.org)