Childhood obesity has become the most common health problem in children today, and for the first time ever, policy makers are concerned that this generation of children may not outlive their own parents.
Childhood obesity has been identified as a nationwide epidemic that impacts children regardless of sex, age, race, and ethnic group. As children who are overweight or obese grow older, they are more likely to become obese as adults. According to the Institute of Medicine, approximately nine million U.S. children age six and above are obese, which has led policy makers to rank childhood obesity as a critical public health threat.
Overweight children may also struggle with:
- Sleep apnea
- High cholesterol
- Hepatic steatosis (fatty liver)
- High blood pressure
- Type 2 diabetes
- Joint problems
- Social discrimination
- Low self-esteem
Definitions of Overweight and Obesity
In order to comprehend the prevalence of obesity, it is important to know how obesity is defined in child populations. According to the 2007 Expert Recommendations, weight is categorized by age and gender-specific BMI. There are now four weight categories for children, which can be seen in Table 1.
Body Mass Index
When there is a concern about a child being overweight or obese, a medical provider will typically begin with a physical examination that includes finding the child’s Body Mass Index, which is based on the child’s height, weight, and sex. To calculate BMI: take weight (pounds) ÷ height (inches) ÷ height (inches) x 703. A normal adult BMI = 18.5-24.9; overweight = 25.0-29.9; obese = 30 or greater; and morbidly obese = 40 or greater. This same formula is used for children and adults; however for children, BMI must be defined using percentiles based on age and sex.
Table 1: The weight status category for the calculated BMI-for-age-percentile (U.S. DHHS, Centers for Disease Control and Prevention).
Weight Status Category
Less than the 5th percentile
5th percentile to less than the 85th percentile
85th to less than the 95th percentile
Equal to or greater than the 95th percentile
Who can help with these problems?
- Medical providers: Pediatricians, nurse practitioners, physician assistants, and other medical providers can assess and diagnose childhood overweight or obesity. In addition, they can provide counseling on general nutrition and physical activity goals. At each medical visit, a child’s Body Mass Index (BMI) should be plotted to determine what weight category they fall in. Additionally, a medical provider should follow up on sleep apnea, high cholesterol, asthma, hepatic steatosis, high blood pressure, type 2 diabetes, and joint problems.
- Nutritionists and dietitians: A licensed nutritionist or dietitian can be helpful for incorporating more healthy food choices into a child and family’s diet. Children who are described as “picky eaters” can explore more food options with a consultation from a licensed nutritionist or dietitian. Additionally, they can often find easy ways to cut unnecessary calories, such as switching from regular soda to diet
- Exercise specialists: Exercise physiologists and physical therapists can assess for joint problems and prescribe a physical activity plan specialized for a child’s individual needs. These providers are important because children at an increased weight need to learn strategies to reduce injuries while engaging in fun physical activity.
- Family therapists and other mental health providers: Family therapists and mental health providers can work with children and their families around issues such as bullying, depression, and social discrimination. Often, children are teased about their weight by peers, which may cause problems at school and home.
Encourage healthy eating habits. To help your children and family develop healthy eating habits:
- Provide plenty of vegetables, fruits, and whole-grain products
- Include low-fat or non-fat milk or dairy products
- Choose lean meats, poultry, fish, lentils, and beans for protein
- Serve reasonably-sized portions
- Encourage your family to drink lots of water
- Limit sugar-sweetened beverages
- Limit consumption of sugar and saturated fat
- No foods should be "off limits"
Encourage fun physical activity
Another part of balancing calories is to engage in an appropriate amount of physical activity and avoid too much sedentary time. In addition to being fun for children and teens, regular physical activity has many health benefits, including:
- Strengthening bones
- Decreasing blood pressure
- Reducing stress and anxiety
- Increasing self-esteem
- Helping with weight management
Children and teens should participate in at least 60 minutes of moderate intensity physical activity most days of the week, preferably daily. Remember that children imitate adults. Start adding physical activity to your own daily routine and encourage your child to join you. Caregivers and children can even use a pedometer to calculate how many steps children are taking each day. Girls need 13,000 and boys need 10,000 steps per day for weight loss.
Some examples of moderate intensity physical activity include:
- Brisk walking
- Playing tag
- Jumping rope
- Playing soccer
Reduce sedentary time
In addition to encouraging physical activity and healthy food choices, children need to reduce their sedentary time or “screen time.” Screen time can be time spent sitting down either watching television, playing video games, or using a computer. Although quiet time for reading and homework is fine, limit the time your children watch television, play video games, or surf the Web to no more than two hours per day. Additionally, the American Academy of Pediatrics does not recommend television viewing for children age 2 or younger. Instead, encourage your children to find fun activities to do with family members, caregivers, friends, or on their own that simply involve more activity.
This text was written by Keeley Pratt, MS, and Angela Lamson, PhD, courtesy of the East Carolina University’s Medical Family Therapy Doctoral Program.
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