Obesity rates are on the rise

September is National Awareness Month. Over the past three decades, obesity rates in children in the U.S. have tripled. In the 1970s, 5% of U.S. children ages 2-19 were obese. According to the CDC’s latest statistics, nearly 20% (14.7 million) of children and adolescents aged 2-19 have a body mass index (BMI) in the obesity range. Obesity rates are higher in some races and ethnicities than others, but rates have risen for children of all ethnicities in the past few decades.

Obesity is defined by BMI, or body mass index. BMI is a measure of a person’s weight compared to their height, and in children, BMI is compared to other children of the same age and gender. A BMI between the 85th and 95th percentile for a child’s gender and age is in the overweight category, and a BMI greater than the 95th percentile is in the obesity range. BMI has been criticized for being an imperfect tool – for example, an athlete with a muscular build and low-fat mass can have an elevated BMI. However, BMI is an inexpensive and easy tool to utilize, and studies show that it does correlate well with overall body fat and future health risks.

Obesity is a major risk factor for the following health conditions:

• High blood pressure and high cholesterol, which are risk factors for heart disease

• Pre-diabetes and Type 2 diabetes

• Gallstones and gallbladder disease

• Obstructive sleep apnea

• Bone and joint problems

• Low self-esteem

• Anxiety and depression

• Bullying and being bullied In addition, adults with obesity have a higher risk of developing cancer, stroke and premature death, and children with obesity are highly likely to become adults with obesity. Children do not always lose their “baby fat.” According to the National Institutes of Health, 55% of children with obesity will continue to have obesity as adolescents, and 80% of adolescents with obesity will go on to have obesity as adults.

Lifestyle changes are the initial treatment for children with obesity. Dietary recommendations include:

• Increasing fresh or frozen fruits and vegetables to at least five servings daily.

• Making half of the daily grain intake whole grains.

• Limiting sugary beverages and foods.

• Choosing more low-fat options over higher-fat items.

A fun way to increase the variety of fruits and vegetables in a child’s diet is to aim for “eating the rainbow,” which encourages families to incorporate fruits and vegetables from many different color groups.

In addition to the changes mentioned, limiting highly processed foods can help families improve their nutrition. A diet high in highly processed foods can lead to unhealthy weight gain, and studies show that people will eat more calories when offered highly processed foods compared to minimally processed foods. Hallmarks of highly processed foods include a lack of fiber, high amounts of added sugar and long ingredient lists of hard-to-pronounce ingredients.

Limiting highly processed foods (common in fast food restaurants and the center grocery aisles) and switching to more whole foods can help a child achieve a healthier weight and nutritional balance. Whole foods include fresh fruits and vegetables, whole grains, lean cuts of meat and fish, nuts, beans or eggs. Including the entire family in these dietary changes makes it less likely that a child will feel singled out and will help ensure that everyone in the family is eating a healthy, well-balanced diet.

Physical activity is an essential part of a child’s health and helps to maintain a healthy weight. The CDC recommends that children participate in at least 60 minutes of moderate to vigorous daily activity. Most of that activity should be aerobic activities, such as running, walking, biking or swimming. They also recommend that children and adolescents include muscle-strengthening exercises at least three days per week. Examples of muscle-strengthening exercise include tug of war, rope or tree climbing, playground equipment, yoga or exercises with resistance bands or weights. Exercise should be age-appropriate to avoid injury.

Sleep is often overlooked as a major factor in obesity, but adequate sleep helps to balance the hormones that regulate appetite. People who don’t get sufficient sleep tend to feel more hungry and are less likely to want to engage in physical activity. The American Academy of Pediatrics endorses the following sleep recommendations (including naps for younger children):

Less than 12 months: 12-16 hours Ages 1-2 years: 11-14 hours Ages 3-5 years: 10-13 hours Ages 6-12 years: 9-12 hours Ages 13-18 years: 8-10 hours Schools can be a great resource to families in helping to battle childhood obesity by providing consistent, quality physical education and recess time and nutritious offerings at lunch, limiting access to unhealthy snacks and stocking vending machines with water and healthy snacks. Schools can also support adequate sleep by delaying start times for adolescents, as the American Academy of Pediatrics and the American Academy of Sleep Medicine recommended.

By working together, families, schools and communities can fight childhood obesity and provide healthier environments for our children.

Jennifer Seidenberg, MD, is a clinical assistant professor of pediatrics at LSU Health Shreveport specializing in eating disorders and weight management.