Obesity - Children and Teens

Causes

Calories are consumed from food and drinks. They are needed for physical activity and all basic body functions. A healthy weight is reached by balancing the number of calories eaten and the number of calories used.

Weight gain happens when the number of calories eaten is more than the number of calories used. This can lead to obesity if it happens too much. Calorie imbalances happen most often with eating too much food and not being active enough. Less often, it may be caused by a medical condition or medicine.

Risk Factors

Children of African American, Hispanic, and Native American descent at are greater risk of obesity.

Things that may raise a child's risk of obesity include:

• Sleep problems, such as poor sleeping habits or lack of sleep
• Large birth weight
• Lack of exercise
• Doing a lot activities like watching TV, playing on the computer, or playing video games that do not involve moving around
• Eating a lot of fast food or sugar-sweetened drinks like soda
• Overeating or binging—short periods when very large amounts of food are eaten
• Stressful life events, family and peer problems, or life changes
• Low self-esteem
• Depression and other emotional problems
• Family history and genetic factors
• Taking some medicines or having some illnesses or conditions

Symptoms

The main symptom of obesity is increased weight. The midsection is the most common area to increase in thickness. There will also be areas of fat deposits that can be seen all over the body.

Obese Body

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Problems with Untreated Obesity

Excess weight raises the chance of a child having:

• High blood pressure or high cholesterol
• Type 2 diabetes
• Bone and joint problems
• Asthma
• Sleep problems such as sleep apnea
• Vitamin and mineral deficiencies
• Problems with anesthesia during surgery
• Liver and gallbladder disease
• Depression
• Unhealthy eating habits, including eating disorders
• Substance abuse problems
• Problems during adulthood—more likely to develop severe obesity, stroke, and heart disease as adults, early death in adulthood

Diagnosis

The doctor will ask about symptoms and health history. A physical exam will be done.

The doctor may use the body mass index (BMI). This is a tool to see if a person's weight is ideal or outside of the desired range. BMI is based on height and weight. Normal values are based on a child's sex and age. In children, the BMI results are compared to the results of other children and teens in the same age range. This will account for growth and body changes as a child ages. BMI levels for anyone under age 20 are as follows:

• Underweight —BMI at or below the 5th percentile for the age group
• Preferred weight—BMI between the 5th and 84th percentiles for the age group
• Overweight —BMI between the 85th and 94th percentiles for the age group
• Obese—BMI at or above the 95th percentile for the age group

Fat may need to be measured. This can be done with:

• Tape measurements of the waist, hip, and belly—these are used to estimate the amount of fat deposited in the skin and inside the belly
• Skinfold caliper—a small tool that measures the fat just beneath the skin
• Electrical measurements—a small electrical pulse that helps measure the amount of fat tissue and non-fat tissue in the body

Blood tests may be done to look for other conditions that may increase body weight.

Other tests may be done to check for problems that obesity can cause. These may include checking the child's blood pressure, glucose, and cholesterol levels.

Treatment

Personal habits, lifestyle, and family culture can all affect obesity. This means that a mix of treatments is best. Encouraging healthy behaviors in children and the family can help a child manage their weight.

The doctor may advise:

Diet

A dietitian can meet with the child and caregivers to help make an eating plan for them. The plan may include a daily calorie goal, healthy food options, and tips to change the child’s diet.

Have children follow basic healthy eating habits, such as:

• Eat a diet low in saturated fat. Check food labels. Saturated fats are common in processed snacks and fried foods.
• Avoid trans fats. These are also common in snack foods like cookies, crackers, cakes, and donuts.
• Limit sugar-sweetened beverages. This includes sodas, sport drinks, and juices. Encourage children to drink water.
• Switch to low- or non-fat dairy products.
• Limit refined carbohydrates. This includes sugars, white rice, and white bread.
• Eat a high-fiber diet. This includes plenty of fruits, vegetables, and whole grains.
• Eat a diet that is low in salt.
• Eat breakfast every day.

Children rarely make their own foods. It is key that a parent also have healthier eating habits. For example:

• Pay attention to how food is prepared. Using high amounts of fat to cook or season foods can quickly add calories.
• Limit fast food, take-out, and dining out.
• Make healthy lunches and snacks for children to take to school. This may keep children from buying unhealthy things at school.
• Do not use sweets as a reward for good behavior or test scores. Think of other, more active rewards.
• Set a good example. Make healthy meals at home. Children are strongly influenced by what their parents do. Eat together as a family.
• When grocery shopping, choose healthy foods. Focus on unprocessed foods. Teach children how to make good choices in the grocery store.
• Teach children about proper portion sizes. They may be able to keep eating their favorite foods, just in smaller portion sizes. Also, cook less food at mealtime and do not bring it all to the table.
• Focus on healthy foods kids can eat. Do not get rid of all sweets and treats. Overdoing this may make a child want them more. Give occasional treats in proper amounts.

If the obesity or its problems are more severe a child may have to follow a meal plan.

Physical Activity

Encourage children to join in physical activity. Sign older children up for sports or activities. Create some family-based activities that everyone can enjoy.

General guidelines for children include:

• Get at least 1 hour of physical activity every day.
• Limit time in front of a TV, game, or computer screen to 1 to 2 hours per day. Avoid screen time for children under 2 years old.

The doctor may give a specific activity plan if the obesity or its problems are more severe.

Counseling and Support

Children may struggle with weight loss or obesity. Some support options or actions include:

• Referring the child to a therapist. This type of support may give children insight into losing weight. Therapy that includes the whole family may also be helpful.
• Asking friends and family members for their support. Time and motivation will keep kids on track.
• Making sure a healthy lifestyle is promoted at school or other groups the children are in. Help kids feel confident in making healthy choices even when the other children are not.

Other Treatment

Some children who are obese may already have serious problems due to weight. This may include problems with the heart, lungs, bones, joints, or diabetes. These issues may need their own treatment.

Other children may have a hard time losing weight even when they follow the guidelines. For these children, there may be other options such as:

• Medicine may help weight loss when added to lifestyle changes. Kids need to be closely watched for side effects.
  • Note: Over-the-counter and herbal products that are sold as weight loss drugs may not work. Some may be harmful. Talk to the doctor before giving any of these to children.
• Bariatric surgery may be an option for some teens who are obese. This surgery changes the size of the stomach. This option is generally only considered if all other options have failed.

Prevention

To help reduce a child’s chance of being overweight or obese:

• Encourage children to eat a healthy diet rich in fruits, vegetables, and whole grains.
• Serve children lean meats, poultry, and fish.
• Serve reasonable portion sizes. Eat healthy meals together as a family.
• Limit sugar-sweetened drinks, even fruit juices. Encourage kids to drink water.
• Encourage kids to get at least 60 minutes of activity most days of the week. The activity should be moderate to vigorous intensity. Ask the doctor about activity levels for kids who are under 2 years old.
• Limit screen time to 2 hours a day.
• Make sure children get enough sleep.
• Set a good example for children. Choose healthy food options and be physically active.