How does childhood obesity work?

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According to the Centers for Disease Control, approximately 30.3 percent of children ages six to 11 and 30.4 percent of adolescents ages 12 to 19 are either overweight or obese. That's almost one out of every three kids in America.

The CDC uses the scientific Body Mass Index formula to measure obesity (they never actually use the word "obese" in their reports). A combination of your height and weight, a BMI score of 25 or higher indicates that you are overweight, while a BMI score of 30 or more indicates obesity. For more information on Body Mass Index, as well as a calculator you can use to easily find your own BMI score, check out How Body Mass Index Works.

Childhood Obesity (a BMI score of 30 or more) is a serious health risk. It can lead to all sorts of problems, from heart disease and bone trouble to social and psychological trauma. And the problem is growing. Today, twice as many children ages six to 11, and three times as many adolescents ages 12 to19, are obese than they were just 20 years ago.

Graphic showing obesity trend for kids ages 6 to 19

Thank YouThanks to Scott Bernstein, M.D., for his assistance with this article.

So what's the deal? Why is this happening? Is it really a bad thing, and what can we do about it? In this article, we'll take a closer look at childhood obesity. We’ll find out who’s at risk of being obese, what the consequences are and what's being done to combat this national health epidemic.

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition, and is solely for informational purposes. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 or your local equivalent for all medical emergencies.

Are You At Risk?

If you’re gaining weight, it doesn’t necessarily mean that you're becoming obese. Children and adolescents need extra nutrients and calories to grow and develop, so you’ll naturally gain weight over time. However, if you consume more than you need and you begin to put on extra weight, it can lead to obesity and all sorts of health issues.

Worried that you might be at risk of becoming overweight or obese? Here are some signs to look out for:

Obesity in your family
Are your parents or grandparents obese? If so, you have a greater chance of becoming obese yourself.

Family history of early cardiovascular disease, type 2 diabetes, high blood pressure or high cholesterol
These are some common health risks associated with obesity. If they can be found within your family, you’re at risk.

Early warning risk factors for cardiac disease or type 2 diabetes
These can include higher blood pressure, quickened heart rate, glucose intolerance, and higher insulin levels that average. Signs of any of these risk factors are an indication of possible obesity.

Bone trouble
Weight stress in your lower limbs, bowed legs, and a particular hip disorder known as slipped capital femoral epiphysis -- which can occur during an early adolescent growth spurt -- can all be early warning signs for obesity.

Social issues
Low self-esteem, depression and poor self-image have all been linked with obesity.

Being tall
More often than not, children with obesity are taller than their peers. This doesn’t mean that if you're tall, you’ll be obese, but it's something to keep in mind.

Graphic showing more than 37% of high school students watch more than 3 hours of TV a day

Sitting around and not doing anything
This is a simple way of saying that you watch too much TV, spend too much time on the computer and you don't get enough exercise. Couch potatoes are definitely at risk of becoming obese.

These symptoms are warning signs. If you see yourself in any of them, don't panic. Just be aware.

What Causes Childhood Obesity?

So how does someone actually wind up obese? Well, the simplest explanation is that if you take in more energy (eat food) than you expend (physical activity), you will gain weight. But there are a number of different factors that can contribute negatively to the formula. For a select few, it truly is a matter of genetics. Your genes can affect things like your metabolic rate, your fat-storage hormones and your blood-glucose metabolism. In a nutshell, your genes determine how your body stores food as well as how it turns food into energy. We are all genetically programmed to gain weight when food is plentiful. It's instinctual. Our bodies are built to store energy in fat cells for times when food is scarce. But every body is different.Your genes come from your parents, so overweight parents are more likely to have overweight children than other parents. Even studies of adopted children have shown that their chances of becoming overweight have more to do with their birth parents than their adoptive parents.

However, even if you have "good" genes, you can become obese. And genetic causes of obesity cannot account for the recent surge in the epidemic. For that, we have to turn to more environmental causes.

Lack of physical activity or regular exercise

The average child today spends far less time engaged in physical activity than children 10, 15 and 20 years ago. What's changed? Computers. Television on demand. Video games. Today's youth are inundated with all sorts of reasons to sit still for hours at a time instead of getting up and doing something physical with their free time.

Also, there has been a decline in the number of children and adolescents who play after-school sports or extracurricular physical activity. More than anything else, this lack of regular exercise has created a younger generation that, for the first time in recorded history, has a shorter life expectancy than the generation before it.

Snacking, snacking, snacking

Many Americans eat the equivalent of four full meals a day, thanks to excessive snacking. And when we snack, we're not reaching for carrots and apples. Instead, it's junk food. In many ways, this is not all the kids’ fault. Schools are loaded with vending machines full of high-calorie snacks and sugary soft drinks. To make matters worse, children are practically inundated with television advertisements for unhealthy food. According to the Kaiser Family Foundation's study "Food for Thought: Television Food Advertising to Children", an average child age 2 to 7 will see more than 4,400 food ads in a year. Thirty-four percent of these ads will be for candy and snacks and another 10 percent for fast food.

The Fast-food Diet

Want an easy way to lose weight? Stop eating fast food. While many fast-food chains offer healthy alternatives, those aren't what people tend to order. Today's children and adolescents eat out a lot more than previous generations. The Kaiser Family Foundation's study found that in 1992, children ages 6 to 14 ate fast food an average of 157 million times each month. That number has only risen in the intervening years. Check out our section on Fast Food Safety and Nutrition within How Fast Food Works for more information on the realities of the fast-food diet.

Eating habits at home

All of these causes can be traced to your eating habits. Develop healthy eating habits and you'll be much more likely to remain a healthy weight. And where do we form our eating habits? At home.

If your parents are overweight or obese, you’ve probably been witnessing and mimicking their food habits your entire life. If children see their parents grab a cupcake or cookie instead of a piece of fruit, take their meals in front of the TV, eat too quickly, or engage in other unhealthy habits, they are more likely to imitate the behavior. This increases the chances that they will become overweight children, adolescents and eventually adults.

What are the Consequences?

So America's children are increasingly overweight or obese. Aside from the need for larger school desks and airline seats, is this something that we should be worrying about?

Yes. There are many consequences related to obesity in children and adolescents. While this is in no way an exhaustive list, here are a few things to look out for.

Type 2 Diabetes

Type 2 diabetes -- which can lead to blindness, heart and kidney disease, nerve damage and loss of limbs -- was once thought of as a disease that mainly affected adults. Sadly, that is no longer the case.

Before 1992, type 2 accounted for 2 to 4 percent of all childhood diabetes. By 1994, that number had risen to 16 percent. This huge increase is reported to be largely due to the rise in childhood obesity over the same time period.

Asthma

Studies have indicated that obesity can cause children with asthma to use more medicine, wheeze more, and make more visits to emergency rooms than non-obese children suffering from asthma.

High Blood Pressure

Overweight and obese children and adolescents are more likely to have high blood pressure than their peers. One study reported that persistent elevated blood pressure levels were almost nine times more frequent for obese children and adolescents than in other children.

Sleep Apnea

One of the most common complications from childhood obesity is sleep apnea. This is a disorder that causes you to have pauses in your breathing while you sleep. Left untreated, it can lead to all sorts of neurological problems, as well as heart and lung disease, bedwetting and more. Almost 17 percent of obese children and adolescents suffer from sleep apnea.

Bone Trouble

The more you weigh, the more pressure you put on your bones to support you. As a growing person, your bones are often not strong enough to bear the excess weight of an obese individual. You can end up with bowing and overgrowth of leg bones, hip pain, limited range of motion in your joints and other problems.

Mental Health Issues

Aside from all of the physical problems associated with being obese, there are a host of mental issues to be aware of as well. A very common problem is low self-esteem. This can lead to loneliness, depression, nervousness and social isolation. It can also lead to smoking or drinking alcohol regularly at a young age. Obese children, especially girls, are also at greater risk of developing an eating disorder.

Adult Obesity

Finally, overweight and obese children are at greater risk of becoming overweight and obese adolescents. In turn, overweight and obese adolescents are at greater risk of becoming overweight and obese adults.

One in five children who are overweight at age 4 will be overweight when they adults. By the time they are adolescents, their odds of becoming an overweight adult rise to upwards of 80 percent.

Adult obesity can lead to heart disease, high blood pressure, diabetes, stroke, several different types of cancer, and osteoarthritis.

Prevention and Treatment

OK, now that we've explained just why obesity is a serious health problem, what can you do about it? More than you think.

The first thing to understand is that every test that anyone's ever done has shown that the earlier you work on the problem, the better your chances. Another thing to remember is that treatment for obese children and adolescents is not usually focused on losing weight so much as creating a new nutritional lifestyle. Your body is still growing, and you're going to eventually need that weight. So you want to create healthy habits that allow your body to physically grow into your weight over time.

There are three main areas to concentrate on:

Getting physical
Managing your food intake
Changing your behavior

Getting Physical

You need to get active and increase your energy expenditure. Starting a formal exercise program, or just getting outside and being more active, is the best thing you can to do to get on the road to better health.

You can check out our article on USDA Exercise Guidelines for the full run-down, but here are a few ideas to get you started.

Start walking or bicycling regularly. Or give rollerblades a try.

Enroll in a class, such as martial arts, tennis or gymnastics.
Take up a new sport at school or in the community.
Go outside and play.

However you become active is up to you. What matters is that you start today.

Managing Your Food Intake

Resist the temptation to fast or jump on the latest trendy diet promising massive weight loss in mere days. Doing something that severe can be incredibly stressful, and it can do serious harm to your body and confuse your perception of what "normal" eating ought to be. Instead, work towards maintaining a nutritious and healthy diet. For a complete understanding of nutrition, check out our full-length article How Nutrition Works.

For the short version, some simple things to keep in mind when it comes to healthy eating include creating a balanced diet with lots of fruits, vegetables and wholesome grains, staying away from food high in calories, fat or sugar, keeping your portions manageable, and not forcing yourself to finish a meal if you're not hungry.

As you can see, there really is a lot more to a healthy diet than "eat less and exercise."

Changing Your Behavior

The most important thing to do to make sure you get healthy and stay healthy is to change the way you look at food.

Keep a record not just of what you eat, but when, where and with whom you eat. Look for patterns and situations where you find yourself eating less healthy than you want.

Don't rush yourself at mealtime. There's no prize for finishing first, and your stomach needs time to properly digest your food.

Focus on the food. These days, it's far too easy to grab a bite in front of the TV. Try to turn dinnertime into family time by having everyone sit down eat the same foods, and enjoy a meal together far away from the lure of the tube.

We probably shouldn't have to say this, but try to limit your trips to the local fast-food joints. Most of the food you'll get there is high in saturated fats and calories. Do your body a favor and try to dine in tonight.
Set realistic goals. The surest way to fail is to set the bar too high. If you visit fast-food places every other day, don't try going cold turkey. Just cut it down to once a week. Got once a week down? Try once a month. Eventually, you'll find you're not going there at all, and you'll be much, much healthier.

This can all seem daunting and overwhelming at first. Don't panic. Once you get into the rhythm, you'll soon find how much better you feel, and how much more energy you have in your system. There is no "cure" for obesity, only a gradual return to a healthier lifestyle. Put in the work and you'll get results.

Being Healthy at School

You eat a lot of food at school. Lunches, snacks, a quick soda between classes from the vending machine, and even an early-morning muffin or doughnut before your first class can add up. And it isn't healthy.

It's no secret that it's a lot easier to eat junk food at school than to eat healthy. What may be surprising is that there's a very specific reason for that. Most school food programs are self-supporting and need to make money to stay in business. According to the Institute of Medicine of the National Academies, 71.9 percent of all high schools have contracts with soft-drink companies to sell soft drinks. Of those, 91.7 percent of the schools get a cut of the money they generate through the sales. The more soft drinks you buy, the more money the school gets. And this isn't limited to high schools. More than 50 percent of middle schools and even 38.2 percent of elementary schools have similar deals with soft drink companies. Many schools also generate revenue by allowing fast food or candy companies to promote their products on campus and in publications. They can even sponsor school events.

If that wasn't enough, more and more schools are cutting physical education, or even recess, from the school day. Time and resources that used to be spent on physical education is now being taken up complying with the strict standards of the No Child Left Behind Act. This at a time when the National Association for Sports and Physical Education have increased the recommended amount of physical activity for children ages 5 to 12 from 30 minutes to at least 60 minutes per day.

Graphic showing percentage of schools that require physical education, by grade

The CDC determined that in 2003, only 55.7 percent of high school students were enrolled in a PE class, with female students and students in higher grades more likely to not be involved in the recommended amount of physical activity. To promote greater physical activity, the CDC developed Guidelines for School and Community Programs to Promote Lifelong Physical Activity among Young People, which recommended daily PE for all students in high school. However, their studies showed that only 5.8 percent of high schools require daily physical education for all students throughout the year.

But it's not all bad news. People are recognizing this problem and trying to do something about it. The USDA teamed up with a coalition of five medical associations to get the ball rolling. Titled "Prescription for Change: Ten Keys to Promote Healthy Eating in Schools" the coalition advocates the following:

Students, parents, food service staff, educators and community leaders will be involved in assessing the school's eating environment, developing a shared vision and an action plan to achieve it.
Adequate funds will be provided by local, state and federal sources to ensure that the total school environment supports the development of healthy eating patterns.
Behavior-focused nutrition education will be integrated into the curriculum from pre-K through grade 12. Staff who provide nutrition education will have appropriate training.
School meals will meet the USDA nutrition standards as well as provide sufficient choices, including new foods and foods prepared in new ways, to meet the taste preferences of diverse student populations.
All students will have designated lunch periods of sufficient length to enjoy eating healthy foods with friends. These lunch periods will be scheduled as near the middle of the school day as possible.
Schools will provide enough serving areas to ensure student access to school meals with a minimum of wait time.
Space that is adequate to accommodate all students and pleasant surroundings that reflect the value of the social aspects of eating will be provided.
Students, teachers and community volunteers who practice healthy eating will be encouraged to serve as role models in the school dining areas.
If foods are sold in addition to National School Lunch Program meals, they will be from the five major food groups of the Food Guide Pyramid. This practice will foster healthy eating patterns.
Decisions regarding the sale of foods in addition to the National School Lunch Program meals will be based on nutrition goals, not on profit making.

In April 2007, the U.S. snack industry announced its backing of new voluntary nutritional guidelines created by the Alliance for a Healthier Generation designed to improve the nutritional quality of products sold in schools. Companies including Kraft, Mars, PepsiCo, and Dannon have pledged to reformulate certain products and introduce lines of healthier snacks for kids.

These guidelines, developed with the help of experts at the American Heart Association, cover snacks, desserts, and other items sold at school through vending machines, snack carts, school stores, and so on. They ensure that products have no more than 35 percent of their calories from total fat and 10 percent of calories from saturated fat. Also, products can contain no more than 35 percent sugar by weight and can have no more than 230 milligrams of sodium. And no trans fats are allowed at all.

These new guidelines come on the heels of the Alliance for a Healthier Generation's May 2006 agreement with leaders in the beverage industry to only sell water, unsweetened juice and low-fat and non-fat milk in elementary and middle schools.

It's all a huge step in the right direction, but don't wait for your school to change its ways. You are in charge of your own nutrition. Make your own healthy choices at school, and you make healthy choices for life.

For more information on childhood obesity, check out the helpful links on the following page.

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