The number of U.S. youth who are overweight or obese has risen dramatically over the past three decades. Although percentages vary among different ethnic groups, currently the State of Obesity reports about 18.5% of children are obese. Obesity in children and adolescents leads to a variety of diseases. For example, before the epidemic of obesity, diabetes in adolescents was almost always type 1 (requiring insulin) but now type 2 diabetes (usually associated with older adults) accounts for 30% of newly diagnosed cases of diabetes in teenagers. Also associated with obesity are sleep apnea (temporary interruptions of breathing during sleep), high blood pressure,high cholesterol, bone and joint problems, and depression.
This patient guide is based on clinical guidelines written by an expert panel of doctors from the Endocrine Society to help physicians who are evaluating and treating children and adolescents who are obese.
Defining childhood overweight and obesity is difficult. Most definitions of obesity use the body mass index (BMI) to measure body fat. BMI is calculated as weight in kilograms divided by height2 in meters. In adults, a BMI of 25 to 30 is overweight and over 30 is obese. However, BMI varies with age and gender in children, so the BMI is plotted on a curve of normal children to determine overweight or obesity. A BMI-for-age higher than that of 85% of children of similar age indicates overweight; a BMI-for-age higher than that of 95% indicates obesity.
Why is obesity a concern?
Both overweight and obesity can make it more likely that you will develop serious complications. These problems include diabetes, high blood pressure, heart disease, stroke, gallstones, high cholesterol, gout, and many types of cancer. Obesity can even raise the risk of early death. Obesity can also make many other medical problems harder to treat.
What causes obesity?
Obesity is very complex and not just a simple problem of willpower or self-control. In general, it results from a combination of eating too much, getting too little physical activity, and genetics. Overweight or obesity occurs when, over time, the body takes in more calories than it burns. However, some people do gain weight more easily than others.
Some medications may cause weight gain, such as those used to treat diabetes, psychiatric illnesses, neurologic disorders, or inflammatory conditions. Your doctor may be able to suggest a different medication that has less effect on weight gain.
Out understanding of obesity is growing rapidly. For instance, we now know that fat cells, the gastrointestinal tract, and the brain produce many hormones that play an important role in how much you eat, how much energy (calories) you spend, and how much you weigh.
Childhood obesity is a serious matter. Having excess fat should not be dismissed as a condition the child will grow out of, something “in the genes,” or a merely cosmetic concern. Obese children become obese adults, with increased chance for early death. Your recognition of the problem and support in tackling it are essential to your child’s life and health.
The panel recommended that clinicians prescribe and support lifestyle (diet and activity) changes for the patient, in an age-appropriate manner, and for the entire family.
Healthy eating habits include:
Energy intake (calories) is only half of the equation governing weight gain; the other half is energy output (physical activity). The panel recommended that children engage daily in 60 minutes of vigorous physical activity, and that they spend no more than 1 to 2 hours daily watching television, playing video games, talking or texting on cell phones, or using the computer for fun.
Parents should promote healthy habits related to diet and activity. For example, it is important for parent to be an example of these healthy lifestyles, avoid overly strict dieting, avoid use of food as a reward or punishment, and try to build children's self-esteem. A positive approach works best. Parents should encourage healthy eating and regular exercise without developing a fear of food. This is the first step in establishing the behaviors essential to long-term success.
The panel suggested that clinicians consider using medication (in combination with changes in diet and exercise) only if a formal program of intensive lifestyle change has failed to limit weight gain or has failed to improve co-existing medical conditions in obese children (those with a BMI-for-age higher than that of 95% of children). Overweight children (those with a BMI-for-age higher than 85% but lower than 95%) should not be treated with obesity medication unless significant, severe co-existing medical conditions continue despite intensive lifestyle modification. In these children, a strong family history of type 2 diabetes or the presence of risk factors for cardiovascular disease (e.g., high blood pressure, high levels of “bad” cholesterol, low levels of “good” cholesterol) may support the use of obesity medication.
Obesity medications should be prescribed for children only by doctors who are experienced in their use and are aware of the potential for adverse, possibly dangerous reactions to these drugs. There is no sure-fire, risk-free medication for pediatric obesity and the benefits of any drug used to treat childhood obesity should clearly outweigh its risks. In fact, there are several concerns about using medication:
Obesity surgery either reduces the size of the stomach, bypasses the small intestine, or both. Surgery can be effective in selected cases, but serious short- and long-term complications can result—including death. The panel recommended against surgery for pre-adolescents, adolescents who have not attained their final height, for pregnant or breast-feeding adolescents, or for those planning to become pregnant within 2 years of surgery. It recommended that surgery never be performed in adolescents with an unresolved eating disorder, untreated psychiatric disorder, or Prader-Willi syndrome.
The panel also suggested that surgery was appropriate only in a few circumstances where all the following situations apply:
Many aspects of American life promote obesity: advertising aimed at children that promotes high-calorie, non-nutritious food and drinks; the popularity of “fast food”; large portions served by restaurants; meal patterns of eating on the run and frequent snacking; and sedentary lifestyle.
The cornerstone of obesity treatment is lifestyle modification. Although sticking to changes in diet and exercise can be successful, the rate of long-term success is disappointing. Therefore, prevention is even more important in controlling the current obesity epidemic. The panel suggested the following actions for parents and clinicians:
The panel recommended some specific actions that parents can take to prevent obesity. The panel recommended a minimum of 6 months of breast-feeding. Infants exclusively breast-fed for 3 to 5 months are 35% less likely to be obese when they enter school. Babies should be fed when hungry but should not be forced to finish.
Between the ages of 2 and 6 years, children often develop irregular eating patterns. They may want to eat the same foods repeatedly and refuse to try new foods. What is important is that the quality and the overall quantity of the food be appropriate and consist of healthy choices. If young children are allowed to decide when to eat and when to stop without outside interference, they will eat as much as they need.
The Hormone Health Network is the public education affiliate of the Endocrine Society dedicated to helping both patients and doctors find information on the prevention, treatment and cure of hormone-related conditions.
All Network materials, including the content on this site, are reviewed by experts in the field of endocrinology to ensure the most balanced, accurate, and relevant information available. The information on this site and Network publications do not replace the advice of a trained healthcare provider.
Paid advertisements appear on the Hormone Health Network. Advertising participation does not influence editorial decisions or content.