Obesity in children
Obese - children
Obesity in children means having a weight that is higher than what is healthy for a child’s height. Obesity is a serious, chronic disease. Over time, it can lead to other health problems, including diabetes, heart disease, and some cancers.
Studies indicate obese children overwhelmingly tend to stay overweight into adulthood.
You may have heard of the childhood obesity epidemic. But is it real? And if it is real, how important is it? And the answer is yes, it's very real. Up until about 1988, kids' weights in the United States were pretty constant over the years. But since 1988, they've been skyrocketing. And that's important for a few reasons. One of them is that what ever our weight is today, people tend to gain weight gradually over time. So if you're already overweight as a child that sets you up to be really overweight as an adult. And all the more so as a child because when kids, before puberty especially, are putting on extra weight, they tend to make new fat cells. Where as adults, when they're getting overweight, tend to have the fat cells they already have get larger. People who make more fat cells during childhood find it easier to gain even more weight as an adult and harder to lose weight. So kids are setting habits in their metabolism and even the structure of their bodies as a child. Childhood obesity is a big problem. But it's not just because of the way fat looks. It's a health problem as well. In fact a ticking time bomb. When I started in pediatrics not that long ago, it was rare to see some of the common conditions of middle age in children. Things like high blood pressure, or abnormal blood sugar, waist size over 40 inches, abnormal cholesterol. Those things were really rare in kids. But in a recent study, about two-thirds of American high schools students already had at least one of those. Two-thirds. They use to call something juvenile diabetes and there was adult onset diabetes, the kind that you get often from being overweight. Well now, what use to be adult onset diabetes, type 2 diabetes, is more common by age 9 because of the obesity epidemic. It is a ticking time bomb. The good news is that it's never easier than today to start to make a difference in a child's life.
Causes
When children eat more food than their bodies need for normal growth and activity, the extra calories are stored in fat cells for later use. If this pattern continues over time, they develop more fat cells and may develop obesity.
Normally, infants and young children respond to signals of hunger and fullness so that they do not consume more calories than their bodies need. However, changes over the last few decades in lifestyle and food choices have led to the rise of obesity among children.
Children are surrounded by many things that make it easy to overeat and harder to be active. Foods that are high in fat and sugar content often come in large portion sizes. These factors can lead children to take in more calories than they need before they feel full. TV commercials and other screen ads can lead to unhealthy food choices. Most of the time, the food in ads aimed at children is high in sugar, salt, or fats.
"Screen time" activities such as watching television, gaming, texting, and playing on the computer require very little energy. They often take the place of healthy physical exercise. Also, children tend to crave unhealthy snack foods they see in TV ads.
Other factors in the child's environment can also lead to obesity. Family, friends, and school setting help shape a child's diet and exercise choices. Food may be used as a reward or to comfort a child. These learned habits can lead to overeating. Many people have a hard time breaking these habits later in life.
Genetics, medical conditions, and emotional disorders can also increase a child's risk for obesity. Hormone disorders or low thyroid function, and certain medicines, such as steroids or anti-seizure medicines, can increase a child's appetite. Over time, this increases their risk for obesity.
An unhealthy focus on eating, weight, and body image can lead to an eating disorder. Obesity and eating disorders often occur at the same time in teenage girls and young adult women who may be unhappy with their body image.
Exams and Tests
The health care provider will perform a physical exam and ask questions about your child's medical history, eating habits, and exercise routine.
Blood tests may be done to look for thyroid or endocrine problems. These conditions could lead to weight gain.
Child health experts recommend that children be screened for obesity starting at age 6. Your child's body mass index (BMI) is calculated using height and weight. A provider uses a BMI formula designed for growing children to estimate your child's body fat. Obesity is defined as a BMI (body mass index) at or above the 95th percentile compared to other children and teens of the same age and sex.
Treatment
The first step in helping your child get to a healthy weight is to talk to the child's provider. The provider can help to set healthy goals for weight loss and help with monitoring and support.
Try to get the whole family to join in making healthy behavior changes. Weight-loss plans for children focus on healthy lifestyle habits. A healthy lifestyle is good for everyone, even if weight loss is not the main goal.
Having support from friends and family can also help your child lose weight.
CHANGING YOUR CHILD'S LIFESTYLE
Eating a balanced diet means your child consumes the right types and amounts of foods and drinks to keep their body healthy.
- Know the right portion sizes for your child's age so your child gets enough nutrition without overeating.
- Shop for healthy foods and make them available to your child.
- Choose a variety of healthy foods from each of the food groups. Eat foods from each group at every meal.
- Learn more about eating healthy and eating out.
- Choosing healthy snacks and drinks for your children is important.
- Fruits and vegetables are good choices for healthy snacks. They are full of vitamins and low in calories and fat. Some crackers and cheeses also make good snacks.
- Limit junk-food snacks like chips, candy, cake, cookies, and ice cream. The best way to keep kids from eating junk food or other unhealthy snacks is to not have these foods in your house.
- Avoid sodas, sport drinks, and flavored waters, especially ones made with sugar or corn syrup. These drinks are high in calories and can lead to weight gain. If needed, choose beverages with artificial (man-made) sweeteners.
Make sure children have a chance to engage in healthy physical activity every day.
- Experts recommend children get 60 minutes of moderate activity every day. Moderate activity means you breathe more deeply than when at rest and your heart beats faster than normal.
- If your child is not athletic, find ways to motivate your child to be more active.
- Encourage children to play, run, bike, and play sports during their free time.
- Children should not watch more than 2 hours of television a day.
WHAT ELSE TO THINK ABOUT
Talk to your provider before giving weight loss supplements or herbal remedies to your child. Many claims made by these products are not true. Some supplements can have serious side effects.
Weight loss drugs are not recommended for most children.
Wegovy (a brand name of semaglutide) as a once a week injection was approved by the FDA in January 2023 to treat obesity in children 12 years and older with an initial BMI in the 95th percentile or higher; or with overweight (a BMI in the 85th percentile or higher) and at least one weight-related coexisting condition.
Bariatric surgery is currently being performed for some children, but only after they've stopped growing.
Possible Complications
A child who is overweight or has obesity is more likely to be overweight or have obesity as an adult. Children with obesity are now developing health problems that used to be seen only in adults. When these problems begin in childhood, they often become more severe when the child becomes an adult.
Children with obesity are at risk for developing these health problems:
- High blood glucose (sugar) or diabetes.
- High blood pressure (hypertension).
- High blood cholesterol and triglycerides (dyslipidemia or high blood fats).
- Heart attacks due to coronary heart disease, congestive heart failure, and stroke later in life.
- Bone and joint problems -- more weight puts pressure on the bones and joints. This can lead to osteoarthritis, a disease that causes joint pain and stiffness.
- Stopping breathing during sleep (sleep apnea). This can cause daytime fatigue or sleepiness, poor attention, and problems at work.
Girls with obesity are more likely not to have regular menstrual periods.
Children with obesity often have low self-esteem. They are more likely to be teased or bullied, and they may have a hard time making friends.
References
Barb D, Donahoo WT, Considine RV. Obesity: risk factors and medical management. In: Robertson RP, ed. DeGroot's Endocrinology. 8th ed. Philadelphia, PA: Elsevier; 2023:chap 20.
Daniels SR, Hassink SG; Committee on Nutrition. The role of the pediatrician in primary prevention of obesity. Pediatrics. 2015;136(1):e275-e292. PMID: 26122812
Gahagan S. Overweight and obesity. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 60.
Johnson CR, Kumar S. Obesity in children. In: Kellerman RD, Rakel DP, Heidelbaugh JJ, Lee EM, eds. Conn's Current Therapy 2023. Philadelphia, PA: Elsevier; 2023:1347-1354.
US Preventive Services Task Force, Grossman DC, et al. Screening for obesity in children and adolescents: US Preventive Services Task Force recommendation statement. JAMA. 2017;317(23):2417-2426. PMID: 28632874
Weghuber D, Barrett T, Barrientos-Pérez M, et al. Once-weekly Semaglutide in adolescents with obesity. N Engl J Med. 2022;387(24):2245-2257. PMID: 36322838
Version Info
Last reviewed on: 7/1/2023
Reviewed by: Charles I. Schwartz, MD, FAAP, Clinical Assistant Professor of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, General Pediatrician at PennCare for Kids, Phoenixville, PA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
