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The Overweight Child

by Tiffany Hernandez, MD  |  South Tampa Office
 

Overview

In the past 30 years, the prevalence of overweight and obese American children has tripled.  Approximately 17% of children and adolescents are now obese.   Unfortunately most overweight children and teens do not outgrow their weight problem. Obese children are more likely to become obese adults and when children are overweight their obesity in adulthood is likely to be more severe.

Definition
"Overweight” and “obese" are the preferred terms to refer to children and adolescents whose excess body weight could pose medical risks. Using the 2000 CDC growth charts, overweight for ages 2 to 20 years is defined as a Body Mass Index (BMI)-for-age between the 85th and the 95th percentiles. Obesity in children is defined as a BMI-for-age at or above the 95th percentile on the charts.

The Body Mass Index
Body mass index is an equation, BMI=kg/m2, that takes into account both height, in meters squared (m2), and weight, in kilograms (kg). In children the “normal” BMI changes overtime, therefore physicians use percentiles to define overweight and obesity.

By knowing a child's BMI, parents and doctors can now recognize children who are overweight or obese.  Parents can calculate their child's BMI by going to the kidshealth.org website.

 

Medical and Psychological Consequences Facing the Overweight Child

Overweight children and adolescents are at an increased risk for serious chronic diseases in life.  Medical consequences of obesity include:

  • Cardiovascular risk- Nearly 60 percent of overweight children have at least one cardiovascular risk factor (high cholesterol levels, high blood pressure, or abnormal glucose tolerance) and 25 percent of overweight children have two or more risk factors.
  • Type 2 diabetes-The incidence of type 2 diabetes among adolescents is increasing at an alarming rate and its rise parallels the rise in teens being overweight.
  • Breathing problems-Overweight children and adolescents can suffer from sleep apnea and asthma.
  • Skin infections-These occur due to moisture from sweat being trapped in the skin folds.
  • Pseudotumor cerebri-The rare disorder is characterized by increased pressure in the skull and causes significant headaches.
  • Joint and musculoskeletal complications-These complications affect the feet, legs, and hips.  Two disorders include Blount disease (a disorder of the tibia (shin bone) that causes the lower leg to angle inward, resembling a bowleg) and slipped capital femoral epiphysis (a disorder where the top of the femur (thigh bone) slips out of place).
  • Gastrointestinal complications-These include hepatic steatosis (or fatty liver disease), gallstones, and gastroesophageal reflux (i.e., heartburn).

 

Obese children and adolescents have a greater risk of social and psychological problems.  These may include:

  • social discrimination
  • poorer development of social skills
  • a negative self-image and poor self-esteem that often persist into adulthood
  • behavior and/or learning problems as a result of the psychological difficulties related to being overweight
  • increased likelihood of being teased and bullied
  • increased likelihood to bully others
  • increased risk for depression

 

Evaluation of Overweight Children and Adolescents

A child whose BMI is greater than the 85th percentile should have a medical evaluation by the child's health care provider. An evaluation may include the following:

  • Medical History to identify any underlying causes or complications of being overweight.
  • Family History to identify risks such as type 2 diabetes, heart disease, high blood pressure, and high cholesterol.
  • Dietary Assessment to evaluate eating practices including the quantity, quality, and timing of food intake. The parents may be asked to complete a 24-hour food record to identify foods and patterns of eating.
  • Physical Activity Assessment that will reveal the child's daily activity levels, as well as time spent on sedentary behaviors such as television viewing, videogame playing, and computer usage.
  • Physical Examination will provide information about the degree of overweight or obesity and the presence of any complications such as high blood pressure or signs of impaired glucose tolerance (pre-diabetes).
  • Laboratory Tests may be obtained including a baseline cholesterol level, diabetes screening, and tests for abnormal thyroid function.

 

Causes

The basic cause of overweight or obesity is eating too many calories and not getting enough physical activity. There are many factors that produce this imbalance:

  • Lack of physical activity
  • Increased sedentary behaviors - High frequency of television viewing, computer usage, and similar behaviors that take up time that can be used for physical activity. 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. Fewer than half of children in the United States have a parent who engages in regular physical exercise and only one third of children in the United States have daily physical education at school.
  • Poor eating habits - The shift away from healthy foods (such as fruits, vegetables, and whole grains) and a greater reliance on high calorie foods such as fast food, processed snack foods, and sugary drinks are other contributing factors that account for the rise in overweight children. Some eating patterns that have been associated with this behavior are eating when not hungry, eating while watching TV, or snacking when doing homework.
  • Unhealthy Environment- Overexposure to the advertising of high calorie foods and lack of physical exercise as a family or in school contribute to a child being overweight.

 

What YOU Can Do

If your overweight child needs to lose weight they either have to decrease their caloric intake, increase activity to burn more calories, or even better, do a combination of both. Losing weight is not easy; if it was, then there would be no overweight children (or adults) in the world. Therefore, parents may need to get extra help for their overweight child. This will likely include:

  • your child's pediatrician or health care provider who will monitor weight loss (or gain) every few months
  • a registered dietician who can help plan a more healthy diet for the entire family

Promote proper nutrition

  • Limit sugar-sweetened beverages such as juice and soda.
  • Encourage your family to drink lots of water.
  • Choose low-fat or skim/non-fat dairy products for those over 2 years old.
  • Avoid fast food.
  • Keep portions small and let your child know that they can always have more.
  • Avoid allowing your children to eat while watching TV.  Instead, limit meals to the dinner table.
  • Offer a healthy diet with 3 healthy meals (don't skip meals, especially breakfast) and healthy snacks with occasional treats.
  • Know what your child is eating and where his or her calories are coming from.  Packing school lunches at home can aid with this.
  • Avoid rushing to finish meals. Eating too quickly does not allow enough time to digest and to feel a sense of fullness.
  • Have snack foods available that are low-calorie and nutritious. Fruits, vegetables, and yogurt are some examples.
  • Provide plenty of vegetables, fruits, and whole grain products.
  • Choose lean meats, poultry, fish, lentils, and beans for protein.

Create an active environment

  • Limit inactivity by setting strict limits on “screen time” (watching television, computer time, playing video games, etc.) to no more than 2 hours per day.  The American Academy of Pediatrics (AAP) does not recommend television viewing for children age 2 or younger.
  • 2008 Physical Activity Guidelines for Americans recommends at least 60 minutes of aerobic physical activity each day.
  • Make time for the entire family to participate in regular physical activities that everyone enjoys.  Try walking, bicycling, or rollerblading.
  • Plan special active family outings such as a hiking or ski trip.
  • Start an active neighborhood program. Join together with other families for group activities like touch football, basketball, tag, or hide-and-seek.
  • Enroll your child in a structured activity that he or she enjoys such as tennis, gymnastics, martial arts, etc.
  • Instill an interest in your child to try a new sport by joining a team at school or in your community.

Make it a family affair!

  • Implement the same healthy lifestyle for your entire family, not just the overweight individuals.
  • Set an example for your child by becoming more active and making healthy food choices yourself.

 

Helpful resources and references:

ChooseMyPlate.gov

CDC.gov


The information contained in this article is for educational purposes only. It should not be used as a substitute for medical care and advice of your physician.