Tipping the Scales on Childhood Obesity: Part 1

GOOD NEWS: In a recent report, the obesity rates in children 2 to 5 years old have decreased significantly over the past decade!!!

While there were no significant changes in obesity rates for most ages between 2003-2004 and 2011-2012, researchers saw a 43% decline in the 2-5 year group's rates -- from 13.9% to 8.4% (JAMA).

This is exciting news when we consider that the incidence of obesity between the ages of 5 and 14 years was more likely to have occurred at younger ages, primarily among children who had entered kindergarten overweight. 

BUT…We still have a long way to go.  (And in honor of National Walking Day on April 2, 2014…)  Let’s talk about childhood obesity – the facts, the causes and effects, what parents can do, how therapists can support, and even some fun activities to do. 

Childhood Obesity Facts^1,2,3

•    Childhood obesity has more than doubled in children and quadrupled in adolescents in the past 30 years.

•    The percentage of children aged 6–11 years in the United States who were obese increased from 7% in 1980 to nearly 18% in 2012. Similarly, the percentage of adolescents aged 12–19 years who were obese increased from 5% to nearly 21% over the same period.

•    In 2012, more than one third of children and adolescents were overweight or obese.

•    Overweight and obesity are the result of “caloric imbalance”—too few calories expended for the amount of calories consumed—and are affected by various genetic, behavioral, and environmental factors.

What is considered overweight, obese?

Among American children ages 2–19*, the following are overweight or obese, using the 95^th percentile or higher of body mass index (BMI) values on the CDC growth chart:

•    For non-Hispanic whites, 30.1% of males and 25.6% of females.

•    For non-Hispanic blacks, 36.9% of males and 41.3% of females. 

•    For Mexican Americans, 40.5% of males and 38.2% of females.  

Percentile Ranking	Weight Status
Less than 5th percentile	Underweight
5th to less than 85th percentile	Healthy Weight
85th to less than 95th percentile	Overweight
Equal to or greater than 95th percentile	Obese

*for children younger than 2 years, a different scale is used to chart height and weight percentiles; consult your primary care physician for more information

Please Note: BMI is not a perfect measure of body fat and can be misleading in some situations. For example, a muscular person may have a high BMI without being overweight (extra muscle adds to body weight — but not fatness). Also, BMI might be difficult to interpret during puberty when kids are experiencing periods of rapid growth. It's important to remember that BMI is usually a good indicator — but is not a direct measurement — of body fat.

What are the Risk Factors and Causes of Obesity in Children?

There is no one reason children become overweight.  Like so many other things in life, obesity is a multi-factorial issue.

Most common causes:

•             genetic factors
•            lack of physical activity
•           unhealthy eating patterns, eating too much (calorie imbalance)
•            a combination of these factors
•            in rare cases is being overweight caused by a medical condition such as a hormonal proble
•             A physical exam and some blood tests can rule out the possibility of a medical condition as the cause for obesity.

Many factors contribute to this growing imbalance between calories in and calories out:

•       Busy families are cooking less and eating out more.

•       Easy access to cheap, high-calorie fast food and junk food.

•       Food portions are bigger than they used to be, both in restaurants and at home.

•    Kids spend less time actively playing outside, and more time watching TV, playing video games, and sitting at the computer.

In the case of obesity, it is hard to separate “causes” and “risk factors.”  There will be much repetition and many common threads running throughout this discussion. 

Risk factors⁴:

•    Diet. Regularly eating high-calorie foods — such as fast foods, baked goods and vending machine snacks — can easily cause your child to gain weight. Soft drinks containing sugar are a risk factor. Candy and desserts also can cause weight gain. Foods and beverages like these are high in sugar, fat and calories.

•    Lack of exercise. Children who don't exercise much are more likely to gain weight because they don't burn calories through physical activity. Inactive leisure activities, such as watching television or playing video games, contribute to the problem.  Fact: on average, a child spend 4 hours a day watching television – precious time that could have been spent moving around and having fun!

•    Family history. If your child comes from a family of overweight people, he or she may be more likely to put on excess weight, especially in an environment where high-calorie food is always available and physical activity isn't encouraged. Please not that weight problems run in families, but not all children with a family history of obesity will be overweight. Children whose parents or brothers or sisters are overweight may be at an increased risk of becoming overweight themselves, but this can be linked to shared family behaviors.

•    Psychological factors. Some children overeat to cope with problems or to deal with emotions, such as stress, or to fight boredom. Their parents may have similar tendencies.

•    Family factors. If many of the groceries you buy are convenience foods — such as cookies, chips and other high-calorie items — this can contribute to your child's weight gain. If you can control your child's access to high-calorie foods, you may be able to help your child lose weight.

•    Socio-economic factors. Foods that won't spoil quickly — such as frozen meals, crackers and cookies — often contain a lot of salt and fats. These foods are often less expensive or an easier option than fresher, healthier foods. In addition, people that live in a lower income neighborhood may not have access to a recreation facility or other safe places to exercise.

What Diseases/Effects Are Obese Children at Risk For?^4-11

Obese children are at risk for a number of conditions, including:

•    High cholesterol:  In a population-based sample of 5- to 17-year-olds, 70% of obese youth had at least one risk factor for cardiovascular disease.⁷

•    High blood pressure

•    Early heart disease

•    Type 2 Diabetes

•    Bone and joint problems

•    Asthma

•    Restless or disordered sleep patterns (sleep apnea)

•    Depression and low self-esteem**

•    Early puberty or menstruation

•    Skin conditions such as heat rash, fungal infections, and acne

•   Many types of cancer, including cancer of the breast, colon, endometrium, esophagus, kidney, pancreas, gall bladder, thyroid, ovary, cervix, and prostate, as well as multiple myeloma and Hodgkin’s lymphoma

•   Behavior and learning problems:    Overweight children tend to have more anxiety and poorer social skills - may lead overweight children to act out and disrupt their classrooms or, on the other extreme, to withdraw socially.

**The psychological effects of overweight and obesity are many time overlooked, but are of critical importance.  Kids who are unhappy with their weight may also be more likely to develop eating disorders and substance abuse problems. Diagnosing and treating weight problems and obesity in children as early as possible may reduce the risk of developing these and other serious medical conditions as they get older. Children's feelings about themselves often are based on you as the parent (or grown-up, role model, therapist, any person the child looks up to) feelings about them, and if you accept your children at any weight, they will be more likely to feel good about themselves. Whatever your children’s weight, though, let them know that you love them and that all you want to do is help them be healthy and happy.

Prevention/How can I help my child¹²

•    Talk to your children. Ask them about the school day, every day. Ask how they feel, not just if they had a good day – what made them happy that day, what made them sad, etc.  Listen to their concerns and take action if there is something they need.

•    Be in touch with teachers. Speak to your child’s teachers, especially P.E. instructors, either in person or on the phone.  Ask how your child is keeping up with his peers.  Are there any concerns?  *If there are concerns, this is a great opportunity to seek help from a professional – a PT!

•    Defy busy schedules. This may be the toughest lifestyle change to make, due to busy schedules, but it can be done. If you need to, treat getting involved like another appointment or meeting in your day.

•    Spend time with your children. You don’t have to spend all your time having heart-to-hearts. Playing, reading, cooking, or any other activity, when done together, can supply your child with the self-esteem boost he or she may need to make positive changes.

•    Try to adapt healthy lifestyle habits, including healthy eating and physical activity, can lower the risk of becoming obese and developing related diseases.6

Why is exercise or physical activity important for my child?¹²

The big ones…

•       Increased physical activity has been associated with an increased life expectancy and       decreased risk of cardiovascular disease. 
•       Physical activity produces overall physical, psychological and social benefits.
•       Inactive children are likely to become inactive adults. 

More specifically, physical activity is important for:

•    Controlling weight

•    Reducing blood pressure

•    Raising HDL ("good") cholesterol

•    Reducing the risk of diabetes and some kinds of cancer

•    Improving psychological well-being, including gaining more self-confidence and higher self-esteem 

•    Manage stress

•    Building strong bones

•    Sleeping better

•    Improving the quality of life

How do I promote physical activity in my child?

The basics…

•    Physical activity should be increased by reducing sedentary time (e.g., watching television, playing computer video games or talking on the phone).

•    Physical activity should be fun for children and adolescents.

•    Parents should try to be role models for active lifestyles and provide children with opportunities for increased physical activity.

•    Be patient with your kids as they explore activities they enjoy.

•    Be willing to try several sports or activities to help them develop lifelong healthy habits.

•     Remember: Activity means any activity that gets your heart rate up! Walking is a great exercise that the whole family can do together – after dinner, on the weekend, etc. 

What if my child is uncoordinated or overweight?

All children, even less-coordinated ones, need to be physically active.  But, as the lure of the playground starts to fade and kids get older, it can be hard to get 1 hour of physical activity in every day.  Team sports are good, but not for everyone.  There are many other types of activities and sports available

Tips to help get your “non-athlete” child moving and enjoying physical activity:¹²

•    Don’t make exercise a punishment. Forcing your child to go out and play, or to play a sport he or she doesn’t like, may increase resentment and resistance. Work on creative ways to encourage physical activity. For example, let your child ride his or her bike for 30 minutes after school but before homework. Your child may beg for 20 more minutes outside just to put it off!
 

•    Find an age-appropriate activity they love. Try running, swimming, martial arts, dancing, cycling, skateboarding, yoga, soccer, ice skating, jumping rope or tennis, etc. Encourage your child to explore multiple activities to find one that clicks.

•    Build confidence. Some kids are embarrassed to participate in sports because they don’t think they’re good enough. Find time to practice together and boost their confidence. Support whatever activity they choose as long as long as it’s safe and they’re getting exercise.
 

•    Be a role model. Kids with active parents tend to be more active than kids with parents who aren’t. Do your best to get moving and keep moving!
 

•    Don’t overdo it. Keeping your kids active is the goal, so don’t overdo exercise to the point of pain or frustration. It’s hard for anyone to stick with something that causes their muscles to feel pain.
 

•    Find a friend or be a friend. See if any of your child’s friends are interested in trying a new sport or activity with your child. If you can’t, step in and be a friend yourself. It’s a perfect opportunity to spend time with together and get active too.

The American Heart Association recommends:

•    All children age 2 and older should participate in at least 60 minutes of enjoyable, moderate-intensity physical activities every day that are developmentally appropriate and varied.

•    If your child or children don't have a full 60-minute activity break each day, try to provide at least two 30-minute periods or four 15-minute periods in which they can engage in vigorous activities appropriate to their age, gender and stage of physical and emotional development.

****** More to come on childhood obesity:  tips on healthy eating and easy lifestyle changes, activities for you and your child, how to speak with your primary care physician about obesity and your concerns, AND  physical therapy's role in prevention and management****************

References:

1.  CDC "Obesity."   http://www.cdc.gov/healthyyouth/obesity/facts.htm

2.  Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of childhood and adult obesity in the United States, 2011-2012. Journal of the American Medical Association 2014;311(8):806-814.

3.   National Center for Health Statistics. Health, United States, 2011: With Special Features on Socioeconomic Status and Health. Hyattsville, MD; U.S. Department of Health and Human Services; 2012.

4. webMD “Obesity in Children”  http://www.webmd.com/children/guide/obesity-children

5. Mayo Clinic. “Childhood Obesity”  http://www.mayoclinic.org/diseases-conditions/childhood-obesity/basics/risk-factors/con-20027428

6.  Solveig A. Cunningham, Ph.D., Michael R. Kramer, Ph.D., and K.M. Venkat Narayan, M.D. "Incidence of Childhood Obesity in the United States." N Engl J Med 2014; 370:403-411January 30, 2014DOI: 10.1056/NEJMoa1309753

7. Freedman DS, Zuguo M, Srinivasan SR, Berenson GS, Dietz WH. Cardiovascular risk factors and excess adiposity among overweight children and adolescents: the Bogalusa Heart Study. Journal of Pediatrics 2007;150(1):12–17.

8. Daniels SR, Arnett DK, Eckel RH, et al. Overweight in children and adolescents: pathophysiology, consequences, prevention, and treatment. Circulation 2005;111;1999–2002.

9.  Office of the Surgeon General. The Surgeon General's Vision for a Healthy and Fit Nation.  Rockville, MD, U.S. Department of Health and Human Services; 2010.

10. Dietz WH. Overweight in childhood and adolescence. New England Journal of Medicine 2004;350:855-857.

11. Kushi LH, Byers T, Doyle C, Bandera EV, McCullough M, Gansler T, et al. American Cancer Society guidelines on nutrition and physical activity for cancer prevention: reducing the risk of cancer with healthy food choices and physical activity. CA: A Cancer Journal for Clinicians 2006;56:254–281.

12. American Heart Association  “Preventing Childhood Obesity: Tips for Parents and Caretakers”  https://www.heart.org/HEARTORG/GettingHealthy/HealthierKids/ChildhoodObesity/Preventing-Childhood-Obesity-Tips-for-Parents-and-Caretakers_UCM_456118_Article.jsp