Obesity in children is one of the most serious global public health challenges of the 21st century, affecting every country in the world.
According to World Health Organisation (WHO), in just 40 years the number of school-age children and adolescents with obesity has risen more than 10 times, from 11 million to 124 million (2016 estimates).
The condition also affects younger children, with over 38 million children aged below 5 living with overweight or obesity in 2017.
From 1975 to 2016, the prevalence of overweight or obese children and adolescents aged 5–19 years increased more than four times from 4% to 18% globally.
What is in this article?
- What causes childhood obesity?
- Health issue of obesity in children
- Prevention of childhood obesity
- Frequently Asked Questions
What causes childhood obesity?
Overweight and obesity in childhood have significant impact on both physical and psychological health.
The mechanism of obesity development is not fully understood and it is believed to be a disorder with multiple causes. Environmental factors, lifestyle preferences, and cultural environment play pivotal roles in the rising prevalence of obesity worldwide.
In general, overweight and obesity results in the increase in caloric and fat intake.
On the other hand, there are supporting evidence that excessive sugar intake by soft drink, increased portion size, and steady decline in physical activity plays major roles in the rising rates of obesity all around the world.
Consequently, both over-consumption of calories and reduced physical activity cause obesity in children.
Health issue of obesity in children
Comorbidities associated with overweight and obesity in children are similar as in the adult population. Elevated blood pressure, dyslipidaemia, and a higher prevalence of factors associated with insulin resistance and type 2 diabetes appear as frequent comorbidities in the overweight and obese paediatric population.
In some populations, type 2 diabetes is now the dominant form of diabetes in children and adolescents. Disturbingly, obesity in childhood, particularly in adolescence, is a key predictor for obesity in adulthood.
Moreover, morbidity and mortality in the adult population is increased in individuals who were overweight in adolescence, even if they lose the extra weight during adulthood.
Prevention of Childhood Obesity
Prevention is the key to success for obesity control as many, but not all obese children will eventually become obese adults. The likelihood of persistence of childhood obesity into adulthood is related to the age. The management of obesity in adults is a difficult and often unsuccessful feat.
Prevention of childhood obesity on the other hand can be more rewarding, providing better chances for reducing long-term complications. You can prevent it through a variety of interventions targeting built environment, physical activity, and diet.
- Serve low Energy Density foods
- Limit Portion Size
- Serve variety of foods
- Limit sugar-sweetened beverages
Serve low Energy Density foods
Several studies have demonstrated that children can decrease their energy intake by reducing the Energy Density (ED) of their diet.
Energy Density (ED): Energy density is the amount of energy or calories in a particular weight of food. It is generally the number of calories in a gram (kcal/g). Foods with a lower energy density provide fewer calories per gram than foods with a higher energy density.
In one study, when the ED of foods and beverages (as part of breakfast, lunch, and afternoon snacks) served to 3- to 5-year old children over 2 consecutive days was reduced by a mean of 27%, energy intake decreased by nearly 400 kcal.
Lower ED diets are associated with better dietary quality in children and adults. You should provide children with foods lower in ED to decrease their energy intake and improve dietary quality.
ED can be reduced by altering a food’s macronutrients and water content. Fat is the most energy-dense macronutrient at 9 kcal/g, followed by protein and carbohydrates, which each have 4 kcal/g.
Water influences ED because it adds weight without adding energy. Adding water or water-rich ingredients such as vegetables and fruits is the most effective way of reducing a food’s ED.
Another approach is to lower the fat or sugar content. Very low-ED foods include vegetables, fruits, and broth-based soups; low-ED foods include cooked grains and low-fat meats; medium-ED foods include meats and cheeses; and high-ED foods include chips, crackers, cookies, chocolate, butter, and oil.
Vegetables help reduce ED of meal for children. Increasing the amount of water-rich ingredients such as vegetables in foods or meals can reduce ED. This lead to decreased energy intake and increased vegetable intake.
Limit Portion Size
Portion size has robust effects on the amount eaten, and you can use this effect to increase intake of healthy foods. When you serve people larger portions, they eat more, and this effect persists over time.
High-ED foods contain a lot of calories in a small amount; therefore, you should limit the portion sizes of high-ED foods.
For example, a 100-calorie snack could be a small handful of jelly beans (ED = 3.7) or nearly 3 cups of strawberries (ED = 0.2). Serving substantial portions of low-ED vegetables is a simple strategy to increase vegetable intake and reduce energy intake, especially when implemented at the start of a meal.
Serve variety of foods
Serving a variety of foods is another factor that can be used strategically to encourage consumption of lower-ED, healthy foods. In one study, when a variety of low-ED foods including various fruits, carrots, and yogurt was served, children increased their intake of these foods compared with when only 1 of these foods was offered.
You should offer your children a wide variety of low-ED fruits and vegetables and limit the variety of high-ED foods.
Limit sugar-sweetened beverages
Sugar-sweetened beverages are the largest contributor to empty calories in children’s diets, providing 22% of empty calories. Consumption of sugary drinks causes excess weight gain and lowers the consumption of healthy foods in children.
You should prefer water as the primary means of hydration for children and adults. Children should minimize consumption of soda and fruit drinks. They should limit 100% fruit juice to 1 serving per day, and drink low-fat milk instead of whole milk.
Involve in aerobic activities and games
Encourage children and teenagers to enjoy physical activities that burn calories and use different muscle groups. These include games which involve running, swimming, skating, or riding a bicycle. Encourage them to give emphasis on sports and other outdoor activities.
Limit screen time
Excess screen time (sedentary activity) makes maintenance of energy balance difficult. Having a television in bedroom associates with the increased screen time for children.
In addition, it associates with less sleep and physical activity and a higher prevalence of overweight status in children.
Recommendations are that parents should limit children’s total media time to less than 2 hours a day and not to have a television in the bedroom where children sleep.
Prevent obesity from Infant stage
Preventing obesity in a child’s earliest years (and even before birth, by healthy habits during pregnancy) confers a lifetime of health benefits. And it’s the most promising path for turning around the global epidemic.
You should focus on the consideration of prevention of obesity in women of child-bearing age, excessive weight gain during pregnancy, and the role of breast-feeding in reducing later obesity in children and adults.
Obesity prevention cannot begin too early. Factors such as a mother’s pre-pregnancy Body Mass Index (BMI) and mother’s food choices during pregnancy can affect the risk for childhood obesity and may influence a child’s food preferences later in life.
Breastfeeding has been shown to have a protective effect against childhood obesity.
According to the studies, mothers should breastfeed their babies exclusively for 4-6 months and then partial breastfeeding should continue for at least another 6 months. During this time it is also important to learn non-food related soothing strategies such as swaddling to calm distressed infants.
Childhood obesity is a burden in developed and developing countries. Numerous social and environmental factors also cause overweight and obesity that influence people’s food habit and physical activity.
Obesity in childhood is causative for many chronic diseases, including type 2 diabetes, cardiovascular disease, hypertension, sleep apnea, osteoarthritis and growth abnormalities.
It also has psycho-social consequences and may contribute to a delay in academic and social functioning as well as poor self-esteem and depression.
The interventions for preventing and controlling obesity are mainly aimed at limiting the intake of sugar and high calorie snacks with higher consumption of vegetable- and fruit-based diet.
This includes eating calcium rich, high fiber diet with balanced micro-nutrients, daily healthy breakfasts and home cooked family meals, smaller portion size, and limiting fast foods and sugar-sweetened drinks.
Last but not least, decreasing the duration of screen time, especially television and increasing the level of physical activity are vital for preventing obesity in children.
Breastfeeding infants can help prevent obesity in early stages of life. So, mothers should focus on the preventive measures and action plans for the reduction of risk of obesity at all life stages.
Frequently Asked Questions
As per guidelines of the Centers for Disease Control and Prevention (CDC), the state of obesity can be determined on the base of Body Mass Index (BMI). If your child’s BMI is greater than 85 percent for their age and gender, your child is overweight. If BMI is greater than 95 percent, then your child is obese.
BMI is calculated mainly by considering weight and height as main factors. You can view CDC’s BMI Calculator to check the obesity status of your child.
No. Childhood obesity need not to be a lifelong problem. It all depends upon healthy diet and becoming more active. Improvement in other social and environmental factors also helps in reducing obesity in children.