Fighting childhood obesity

By Kelly Byczek, registered dietitian, Marquette County Health Department

We all know that obesity is on the rise. More than two-thirds (68.8 percent) of adults in the United States are overweight or obese. More than one-third (35.7 percent) of adults are considered to be obese. What does that mean for our children? Unfortunately, we are seeing the same trends for obesity in children. Nearly 1 in 3 children (ages 2 to 19) in the United States are overweight or obese, putting them at risk for serious health problems.

What defines obesity? Body Mass Index (BMI) is a measure used to determine childhood overweight and obesity. Overweight is defined as a BMI at or above the 85th percentile and below the 95th percentile for children of the same age and sex. Obesity is defined as a BMI at or above the 95th percentile for children and teens of the same age and sex. BMI is calculated by dividing a person’s weight in kilograms by the square of their height in meters.

For kids and teens, BMI is age and sex specific. Comparisons can be made and usually referred to as “BMI for age” meaning assessing the child’s “weight for height for age” and comparing that to other children of the same age and sex. BMI is plotted on the World Health Organization (WHO) or the Centers for Disease Control and Prevention (CDC) growth charts. It is important to mention that BMI does not measure body fat or muscle mass directly, but has been identified as a good indicator of true overweight/obesity.

Studies have shown that children who are overweight or obese, are more likely to be overweight as teenagers and adults. They are at greater risk for long-term health problems like type 2 diabetes, cardiovascular disease, joint problems, asthma, and certain cancers. This does not take into account the social impact such as bullying, low self-esteem, and food shaming faced by obese children.

One study, published by World Obesity, measured BMI of more than 200,000 children and tracked them into adolescence and adulthood. Results reported that obese children and adolescents were around five times more likely to be obese in adulthood than those who were not obese. Approximately 55 percent of obese children go on to be obese in adolescents, with 80 percent of obese adolescence still obese in adulthood and around 70 percent will be obese over age 30.

Who is more at risk? The State of Obesity Report of 2016 concluded that obesity rates are higher among African American children (19.5 percent) and Latino (21.9 percent) compared to White American children (14.7 percent), and Asian (8.6 percent), with obesity rates rising faster at earlier ages and with higher rates of severe obesity Among preschoolers (ages 2 to 5), Latinos and African American toddlers are almost twice as likely to be extremely obese as Caucasian toddlers. Extreme obesity is defined as a Body Mass Index of 120 percent or more. The majority of the differences in rates that arise between African American and White children occur between the third and eighth grades.

Addressing the possible causes for the differences in obesity rates helps to define additional resources needed for these populations. Obesity disproportionally affects children from low-income families. Families in minority and low-income communities have limited access to grocery stores and fresh produce. They tend to rely on pre-packaged or fast foods, which tend to be less expensive, yet less nutritious and contain more calories. Safety is also a concern. Many of these families reside in areas where it might be unsafe to bike to school or even play outside.

We need to act now. Health professionals, the media, and work places have made health and wellness a priority toward the fight against obesity. Obesity should not be the norm. The more prevalent it becomes, the more “normal” it seems. Look around. How many children in the classroom are overweight or obese? How does that compare to a school classroom 20 years ago? Look around your office. How many of your co-workers and friends are struggling to lose weight? We need to educate parents, grandparents, child caregivers, teachers and school-aged children on the benefits of making good food choices and including exercise as part of their daily routine.

Providers need to address the issue of obesity as a true condition, like hypertension or high cholesterol. It is often hard to address obesity, especially when trying to tell a parent their child is overweight. It seems to be more of a subjective topic, with providers having personal opinions on the issue and how they plan to address it. In my opinion, if the child’s BMI falls within the parameters of overweight or obese (85 percent or greater) their doctor, physician’s assistant, dietitian, nurse, etc., should be reviewing their growth chart in detail. Goals for children in this category are to “maintain weight” and then gain at a slower rate. Then, as they age, they will naturally come down on the growth curve. Their health care provider should discuss usual food intake, beverage consumption, eating out and exercise and also offer suggestions on places to make changes. They can make referrals to outside professionals such as registered dietitians, behavioral health specialists, exercise clinics, etc.

As a dietitian, I use a handout to address overweight and obesity issues with my clients. I start out the conversation asking the parents, if they (personally) have any concerns about their child’s weight, eating habits, etc. That breaks the ice so I can move forward with my concerns.

Nationally, childhood obesity rates have remained stable for the past decade, at around 17 percent for children ages 2 to 19 (National Health and Nutrition Examination Survey, 2011-2014 data). Rates are actually declining among 2-to-5-year-olds, stable among 6-to-11-year-olds, and increasing among 12-to-19-year-olds. Even though the obesity rates are stable over the past 10 years, if comparing today’s data to 1980, the childhood obesity rates for ages 2 to 19 have tripled. However, there have been some positive outcomes in the fight against obesity.

The CDC worked in conjunction with the United States Department of Agriculture (USDA) and conducted a study using data from the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). WIC is a state-funded program that promotes healthy eating, breastfeeding advice, and nutrition education to low-income infants and children up to age 5, along with women who are pregnant, postpartum, or breastfeeding. The purpose of the study was to monitor the prevalence of obesity among toddlers aged 2 to 4 from low-income families. The study collected data from 2000 to 2014. The results of the study concluded that the prevalence of childhood obesity in this population initially rose in the first 10 years of the study, but then decreased significantly from 15.9 percent in 2010 to 14.5 percent in 2014 among all five major racial/ethnic groups and among 34 of the 56 WIC state agencies.

The main factors contributing to the decline are most likely due to a combination of childhood obesity efforts at the national, state, community and family levels. Federal efforts include USDA’s revision of the WIC food package, WIC endorsing most of the feeding practices from the American Academy of Pediatrics, breastfeeding promotion, and the CDC’s Early Care and Education Childhood Obesity Program. WIC clients generally meet with a registered dietitian or registered nurse quarterly which helps to provide ongoing education, follow up and support. This reinforces that we still need ongoing research and support to assess what really helps to limit excess weight gain and keep our kids healthy for the future.

MM

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