Childhood Obesity

U N D E R S TA N D I N G

An educational resource provided by

American
Treatment Association

What is Childhood Obesity?

Childhood obesity a ects more than 30 percent of children, making it the most common chronic disease of childhood. Today, more and more children are being diagnosed with diabetes, hypertension and other co-morbid conditions associated with obesity and morbid obesity. A child is de ned as obese if their body mass indexfor-age (or BMI-for-age) percentile is greater than 95 percent. A child is de ned as overweight if their BMIfor-age percentile is greater than 85 percent and less than 95 percent.

Causes of Childhood Obesity

Although the causes of childhood obesity are widespread, certain factors are targeted as major contributors to this epidemic. Causes associated with childhood obesity include: Environment Lack of physical activity Heredity and family Dietary patterns Socioeconomic status Incorrect attitudes towards food

Environment
Today s envir onment plays a major role in shaping the habits and perceptions of children and adolescents. The prevalence of television commercials promoting unhealthy foods and eating habits is a lar ge contributor. In addition, children are surrounded by environmental in uences that demote the importance of physical activity . Today, it is estimated that approximately 40 to 50 percent of every dollar that is spent on food is spent on food outside the home in r estaurants, cafeterias, sporting events, etc. In addition, as portion sizes have increased, when people eat out they tend to eat a larger quantity of food (calories) than when they eat at home. Beverages such as soda and juice boxes also greatly contribute to the childhood obesity epidemic. It is not uncommon for a 32 ounce soda to be marketed toward children, which contains approximately 400 calories. The consumption of soda by children has increased throughout the last 20 years by 300 percent. Scienti c studies have documented a 60 percent increase risk of obesity for every regular soda consumed per day. Box drinks, juice, fruit drinks and sports drinks present another signi cant problem. These beverages contain a signi cant amount of calories and it is estimated that 20 percent of children who are currently overweight are overweight due to excessive caloric intake from beverages.

Lack of Physical Activity

Children in todays society show a decrease in overall physical activity. The growing use of computers, increased time watching television and decreased physical education in schools all contribute to children and adolescents living a more sedentary lifestyle.

Another major factor contributing to the childhood obesity epidemic is the increased sedentary lifestyle of children. School-aged children spend most of their day in school where their only activity comes during recess or physical education classes. In the past, physical education was required on a daily basis. Currently, only 8 percent of elementary schools and less than 7 percent of middle schools and high schools have daily physical education requirements in the U.S.

Only 50 percent of children, 12 to 21 years of age, regularly participate in rigorous physical activity, while 25 percent of children report no physical activity. The average child spends two hours a day watching television, but 26 percent of children watch at least four hours of television per day.

Heredity and Family

Science shows that genetics play a role in obesity . It has been pr oven that children with obese parents are more likely to be obese. Estimates say that heredity contributes between 5 to 25 percent of the risk for obesity. However, genes alone do not always dictate whether a child is overweight or obese. Learned behaviors from par ents are a major contributor. Parents, especially of those whose children are at risk for obesity at a young age, should promote healthy food and lifestyle choices early in their development.

Dietary Patterns
Over the past few decades, dietary patterns have changed signi cantly. The average amount of calories consumed per day has dramatically increased, yet the quality of nutrients needed for a healthy diet has decreased. Food por tions also play an important role in the unhealthy diet patter ns that have evolved.

Socioeconomic Status
Children and adolescents that come from lower-income homes are at greater risk of being obese. This is a result of several factors that in uence behaviors and activities. Lower-income children cannot always a ord to partake in extracurricular activities, resulting in a decrease in physical activity. In addition, families who str uggle to pay bills and make a living often opt for convenience foods, which are higher in calories, fat and sugar.

Behavior and attitudes

Behavior and attitudes towards food and physical activity during childhood have a huge impact on how that child feels toward food when he is an adult. An overweigth child is 35% more likely to be obese as an adult then a normal child. The ght on obesity begins in the crib.

Measuring Obesity in Children

Obesity in children is determined by using BMI-for-age percentiles. BMI-for-age percentiles have emerged as the favored method to measure weight status in children. This method calculates your childs weight category based on age and BMI, which is a calculation of weight and height. However, it should be kept in mind that this method, among other methods, should be used as a tool, and only a physician can best determine and diagnose weight status in your child.

B M I-fo r -a g e p e r ce n tile s : B o y s , 2 to 2 0 y e a r s

Boys

Weight status category

Underweight Healthy weight Over weight Obese

Percentile range
Less than 5th percentile 5th - 85th percentile 85th - 95th percentile 95th percentile and greater

A g e (y e a r s )
5 th p e r ce n tile 1 0 th p e r ce n tile 2 5 th p e r ce n tile 5 0 th p e r ce n tile 7 5 th p e r ce n tile 8 5 th p e r ce n tile 9 0 th p e r ce n tile 9 5 th p e r ce n tile

To plot your childs BMI-for-age percentile, you must rst calculate his/her BMI. Please see page 8 for a BMI chart which includes weight and heights appropriate for children. Once you calculate his/her BMI, nd the age of your child on the bottom of the BMI-for-age percentile chart and look to the left or right A g e (y e a r s ) to locate their BMI. Plot the point on the graph using a pen or pencil. Once you have plotted the meas5 th p e r ce n tile 1 0 th p e r ce n tile 2 5 th p e r ce n tile 5 0 th p e r ce n tile 7 5 th p e r ce n tile 8 5 th p e r ce n tile 9 0 th p e r ce n tile 9 5 th p e r ce n tile urement, locate the corresponding shaded color on the bottom of the chart to determine your childs BMIfor-age percentile. You are then able to nd your childs weight status by viewing the Weight Status Category table located to the right of the chart.

B M I-fo r -a g e p e r ce n tile s : G ir ls , 2 to 2 0 y e a r s

Girls

Weight status category

Underweight Healthy weight Over weight Obese

Percentile range
Less than 5th percentile 5th - 85th percentile 85th - 95th percentile 95th percentile and greater

A g e (y e a r s )
5 th p e r ce n tile 1 0 th p e r ce n tile 2 5 th p e r ce n tile 5 0 th p e r ce n tile 7 5 th p e r ce n tile 8 5 th p e r ce n tile 9 0 th p e r ce n tile 9 5 th p e r ce n tile

Measuring Growth in Children

You may have heard your pediatrician refer to your childs weight in terms of a percentile. To measure growth in your child based on their weight, doctors most commonly use weight-for-age percentiles. Weight-for-age percentiles are used to measure your childs weight based strictly on age. It does not take into account the height of a child. This is not a method to determine obesity (or overweight) in children, but simply an indicator of growth as compared to children of the same age.

BM B

kg 10 5 10 0 95 90 85 80 75

lb 230 220 2 10 200 190 18 0

W e ig h t-fo r -a g e p e r ce n tile s : B o y s , 2 to 2 0 y e a r s

9 5 th

9 0 th

75 th
17 0 16 0

70 15 0 65 60 55 50 45 40 35 30 25 50 20 40 15 10 kg 30 20 lb 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 14 0 13 0 12 0 11 0 10 0 90 80 70 60

5 0 th

Boys

25th 10 th 5 th

Once you have found your childs weight-forage per centile, you can then determine what percentile (or per centile range) they fall into, as compared to children of the same age. For example, if your child is in the 95th percentile, this means that their weight is greater than 95 percent of children of the same age.

20

A g e (y e a r s )
5 th p e r ce n tile 1 0 th p e r ce n tile 2 5 th p e r ce n tile 5 0 th p e r ce n tile 7 5 th p e r ce n tile 9 0 th p e r ce n tile 9 5 th p e r ce n tile

5 th p e r ce n tile

1 0 th p e r c

P u b lis h e d M a y 3 0 , 2 0 0 0 . S O U R CE: De v e lo p e d b y th e N a tio n a l Ce n te r fo r H e a lth S ta tis tics in co lla b o r a tio n w ith th e N a tio n a l Ce n te r fo r Ch r o n ic Dis e a s e P r e v e n tio n a n d H e a lth P r o m o tio n (2 0 0 0 ).

CD C
SAFER HEALTHIER PEOPLE

15 10 kg

30 20 lb 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20

To plot your childs weight-for-age percentile, e and) the age of your child on the bottom of the chart and A g e (y r s look tor ce n tile left1 to plocate their pbody weight.e rOnce you locate their weight and age, tile the point on thep e r ce n tile the plot 5 th 5 th p e 0 th e r ce n tile 2 5 th e r ce n tile 5 0 th p ce n tile 7 5 th p e r ce n tile 9 0 th p e r ce n tile 9 5 th p e r ce n graph using a pen or pencil. Once you have plotted the measurement, locate the corresponding shaded color on the bottom of the chart to determine your childs weight-for-age CD C percentile.
P u b lis h e d M a y 3 0 , 2 0 0 0 . S O U R CE: De v e lo p e d b y th e N a tio n a l Ce n te r fo r H e a lth S ta tis tics in co lla b o r a tio n w ith th e N a tio n a l Ce n te r fo r Ch r o n ic Dis e a s e P r e v e n tio n a n d H e a lth P r o m o tio n (2 0 0 0 ).
SAFER HEALTHIER PEOPLE

1 0 th

kg 10 5 10 0 95 90 85 80 75

lb 230 220 2 10 200 190 18 0 17 0 16 0

W e ig h t-fo r -a g e p e r ce n tile s : G ir ls , 2 to 2 0 y e a r s
9 5 th

9 0 th

70 15 0 65 60 55 50 45 40 35 30 25 50 20 40 15 10 kg 30 20 lb 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 14 0 13 0 12 0 11 0 10 0 90 80 70 60

75 th

Girls
Once you have found your childs weight-forage per centile, you can then determine what percentile (or per centile range) they fall into, as compared to childr en of the same age. For example, if your child is in the 95th percentile, this means that their weight is greater than 95 percent of children of the same age.

5 0 th 25th 10 th 5 th

A g e (y e a r s )
5 th p e r ce n tile 1 0 th p e r ce n tile 2 5 th p e r ce n tile 5 0 th p e r ce n tile 7 5 th p e r ce n tile 9 0 th p e r ce n tile 9 5 th p e r ce n tile

P u b lis h e d M a y 3 0 , 2 0 0 0 . S O U R CE: De v e lo p e d b y th e N a tio n a l Ce n te r fo r H e a lth S ta tis tics in co lla b o r a tio n w ith th e N a tio n a l Ce n te r fo r Ch r o n ic Dis e a s e P r e v e n tio n a n d H e a lth P r o m o tio n (2 0 0 0 ).

CD C
SAFER HEALTHIER PEOPLE

About Body Mass Index (BMI)

BMI is the most common method to measure adult obesity. However, BMI is now becoming a popular tool used to measure obesity in children. BMI is a number calculated by dividing a persons weight in kilograms by his or her height in meters squared.

W eight in pound
20 2'0" 2'1" 2'2" 2'3" 2'4" 2'5" 2'6" 2'7" 2 '8" 2'9" 2 '10" 2'11" 3'0" 3'1" 3'2" 3'3" 3'4" 3'5" 3'6" 3'7" 3'8" 3'9" 3'10" 3'11" 4'0" 4'1" 4'2" 4'3" 4'4" 4'5" 4'6" 4'7" 4'8" 4'9" 4'10" 4'11" 5'0" 5'1" 5'2" 5'3" 5'4" 5'5" 5'6" 5'7" 5'8" 5'9" 5'10" 5'11" 6'0" (24 in ches) (25 in ches) (26 in ches) (27 in ches) (28 in ches) (29 in ches) (30 in ches) (31 in ches) (32 in ches) (33 in ches) (3 4 i nches) (3 5 i nches) (36 in ches) (37 in ches) (38 in ches) (39 in ches) (40 in ches) (41 in ches) (42 in ches) (43 in ches) (44 in ches) (45 in ches) (4 6 i nches) (4 7 i nches) (48 in ches) (49 in ches) (50 in ches) (51 in ches) (52 in ches) (53 in ches) (54 in ches) (55 in ches) (56 in ches) (57 in ches) (5 8 i nches) (5 9 i nches) (60 in ches) (61 in ches) (62 in ches) (63 in ches) (64 in ches) (65 in ches) (66 in ches) (67 in ches) (68 in ches) (69 in ches) (7 0 i nches) (7 1 i nches) (72 in ches) 24 22 21 19 18 17 16 15 14 13 12 11 11 10 10 30 37 34 31 29 27 25 23 22 21 19 18 17 16 15 15 14 13 13 12 11 11 10 10 10 40 48 45 42 39 36 33 31 29 27 26 24 23 22 21 19 18 18 17 16 15 15 14 13 13 12 12 11 11 10 10 10 50 56 52 48 45 42 39 37 34 32 30 29 27 26 24 23 22 21 20 19 18 17 17 16 15 15 14 14 13 13 12 12 11 11 10 10 10 60 70 80 90 100 110 120 130

s
140 150 160 170 180 190 200

58 54 50 47 44 41 39 36 34 33 31 29 28 26 25 24 23 22 21 20 19 18 18 17 16 16 15 14 14 13 13 13 12 12 11 11 11 10 10 10

59 55 51 48 45 43 40 38 36 34 32 31 29 28 27 25 24 23 22 21 20 20 19 18 18 17 16 16 15 15 14 14 13 13 12 12 12 11 11 11 10 10 10

59 55 52 49 46 43 41 39 37 35 33 32 30 29 28 27 25 24 23 22 22 21 20 19 19 18 17 17 16 16 15 15 14 14 13 13 13 12 12 11 11 11

58 55 52 49 46 44 41 40 38 36 34 33 31 30 29 27 26 25 24 23 23 22 21 20 19 19 18 18 17 16 16 15 15 15 14 14 13 13 13 12

If your childs BMI is not listed on this chart, please visit the AOTAs Web site at www .americanobesity.org to calculate your childs BMI.
57 54 51 49 46 44 42 40 38 36 35 33 32 31 29 28 27 26 25 24 23 22 22 21 20 19 18 18 17 17 16 16 15 15 14 14 14 13

56 54 51 48 46 44 42 40 38 37 35 34 32 31 30 29 28 27 26 25 24 23 22 21 20 20 19 18 18 17 17 16 16 15 15 14

58 55 53 50 48 46 44 42 40 38 37 35 34 32 31 30 29 28 27 26 25 24 23 22 22 21 20 20 19 18 18 17 17 16 16

57 54 52 49 47 45 43 41 40 38 37 35 34 33 31 30 29 28 27 26 25 24 23 23 22 21 21 20 19 19 18 18 17

59 56 53 51 49 47 45 43 38 39 38 36 35 34 33 31 30 29 28 27 26 25 24 24 23 22 22 21 20 20 19 19

57 54 52 50 48 46 44 42 41 39 38 36 35 34 32 31 30 29 28 27 26 25 25 24 23 22 22 21 21 20

58 56 53 51 49 47 45 43 42 40 39 37 36 35 33 32 31 30 29 28 27 26 25 25 24 23 23 22 21

59 56 54 52 50 48 46 44 43 41 40 38 37 36 34 33 32 31 30 29 28 27 26 25 25 24 23 23

H e ig h t

57 55 53 51 49 47 45 43 42 40 39 38 36 35 34 33 32 31 30 29 28 27 26 25 25 24

58 56 53 51 49 48 46 44 43 41 40 38 37 36 34 33 32 31 30 29 28 28 27 26 25

59 56 54 52 50 48 46 39 45 43 37 42 40 36 35 34 33 32 31 30 29 28 28 27

Treating Childhood Obesity

Treating obesity in children and adolescents di ers from treatment in adults. Involving the family in a childs weight management program is a key element to treatment. Treatment of pediatric obesity is not accomplished by just dieting. You need to address multiple aspects of the child and the familys lifestyle, nutrition and physical activity patterns. Prior to discussing any treatment plans, you rst must determine the desired goals. If your child is overweight, or at risk for becoming overweight, it is important to work with your healthcare provider to develop an individualized plan of care that includes realistic goals and action steps. As a support system, family is integral in ensuring weight management goals are met. You must rst assess the readiness of the child and the family to make changes. If the child is depressed, this needs to be addressed prior to working on the childs weight problem. If a depressed child attempts weight-loss and is unsuccessful, this may worsen their depression or lower their self-esteem.

Similarly, if there is a lot of stress in the family at that time it is not ideal to try and tackle yet another major issue. In some situations where there is signi cant depression or stress, it may be most appropriate for the child and the family to seek counseling to address these issues. In addition, if parents express little concern regarding their child being overweight, they are not ready to make the necessary changes. It is important to talk with your physician about options for treating childhood obesity. The various treatments of obesity in children and adolescents include: Dietary therapy Physical activity Behavior modi cation Natural Supplements (14-21 and in extreme cases)

Dietary Therapy

When treating an obese child or adolescent, it is often recommended that they have a consultation with a dietitian that specializes in childrens needs. Dietitians can best help children understand healthy eating habits and how to implement them in their long-term diet. Dietitians do not always recommend restricting caloric intake for children. Education on how to read food labels, cut back on portions, understand the food pyramid and eat smaller bites at a slower pace is generally the infor mation given to change a child s eating habits.

Another form of obesity treatment in children is increasing physical activity. Physical activity is an important long-term ingredient for children, as studies indicate that inactivity in childhood has been linked to a sedentary adult lifestyle. Increasing physical activity can decrease, or at least slow the increase, in fatty tissues in obese children. The U.S. Surgeon General recommends that children get at least 60 minutes of physical activity each day. Individualized programs are available and possible for those children or adolescents that are not able to meet minimum expectations.

Physical Activity

Lifestyles and behaviors are established at a young age. It is important for parents and children to remain educated and focused on making long-term healthy lifestyle choices. There are several ways that children and adolescents can modify their behavior for healthier outcomes, such as: Changing eating habits Increasing physical activity Becoming educated about the body and how to nourish it appropriately Engaging in a suppor t group or extracur ricular activity Setting realistic weight management goals

Behavior Modi cation

Things to avoid
Do not use food to reward or to bribes the child. Avoid food struggles. Parents should decide What to eat, When to eat, and Where to eat, but children (+5 yrs) should decide how much to eat or not at all.

What can you do to learn more about childhood obesity?

The America Obesity Treatment Association, a non pro t patient-based organization, o ers many valuable resources to those a ected by childhood obesity and their family members. To learn more about childhood obesity, please visit the Childhood Obesity section on the A O T A Web site at www .americanobesity.org . For more infor mation, please contact us at (334) 651-0821 or info@americanobesity.org

10

Notes:
Date Age Weight Heigh BMI
BMI-for-age Percentile

American
Treatment Association
AOTA was founded as a membership organization to bring together individuals who are a ected by obesity. By building a strong Association of members, AOTA is able to represent those a ected through its education and advocacy efforts. Consider joining the AOTA today! Yes! I would like to join the e orts of the American Obesity Treatment Association by becoming a member I would like to join as a/an: Patient/Family Member: $20 Professional Member: $50 Physician Member: $75 Surgeon Member: $150 Institutional Member: $200 (Doctors o ces, weight management centers, surgery centers, etc.)

AOTA Resources
The AOTA produces well-rounded and comprehensive education and advocacy materials. All AOTA resources are free-of-charge and may be requested by contacting us at info@americanobesity.org. You may also make a request online by visiting our Web site at www.americanobesity.org . Brochures/Guides Understanding Obesity Series - Understanding Obesity Brochure - Understanding Obesity Poster - Understanding Obesity Stigma Brochure - Understanding Childhood Obesity Brochure - Understanding Childhood Obesity Poster Advocacy Primer:Your Voice Makes a Di erence AOTA Insurance Guide: Working with Your Insurance Provider State-speci c Advocacy Guides BMI Chart

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