Childhood diets are ways of treating overweight and obesity in children ages 2–19 years by changing eating and exercise habits.
There is no doubt that American children are getting heavier. As recorded by the National Center for Health Statistics in the United States, rates of overweight and obesity have increased from approximately 15% in the early 1970s to 33% in 2013/2014. Although the problem of excessive weight is growing fastest in the United States, the trend toward heavier children is occurring in most developed countries.
SOURCE: Center for Science in the Public Interest. “Healthy School Snacks.” https://cspinet.org/protecting-our-health/nutrition/healthyschool-snacks (accessed April 23, 2018).
In 2013/2014, the percentage of children reported obese were:
The number of children who are overweight or obese differs significantly among different races and ethnic groups. Significantly more Mexican American boys are obese than non-Hispanic black or white boys. Significantly more Mexican American girls and non-Hispanic black girls are obese than white girls. Native American and Native Hawaiian children also have higher rates of obesity than whites.
Most healthcare professionals calculate overweight and obesity using the body mass index (BMI). BMI is a calculation that compares a person's weight and height to arrive at a specific number. BMI for children is calculated the same way it is for adults; however, children between the ages of 2 and 19 are assigned a percentile ranking for their age group, whereas adults are simply assigned a BMI number and weight category. The percentile ranking indicates how a child's weight compares to that of other children who are their same age and gender. For example, if a boy is in the 65th percentile for his age group, 65 of every 100 children who are his age weigh less than he does and 35 of every 100 weigh more than he does. The percentiles are based on growth charts last modified in 2000, so it is possible that, with the increase in childhood obesity, the rankings are now inaccurate or skewed.
The BMI weight categories for children are:
Less than 10% of childhood obesity is associated with a hormonal or genetic defect. The remaining 90% of cases are caused by lifestyle and dietary factors.
At its simplest, obesity is caused by taking in more calories than the body uses. This difference is called the “energy gap.” This energy gap exists for many reasons but often it is related to both increased food intake and decreased energy use. Causes related to food intake include:
Inadequate energy use reasons include:
Other factors that affect childhood obesity include an inherited tendency toward weight gain, mental illness, binge eating disorder, eating in response to stress, boredom, loneliness, poor sleeping habits, and having at least one parent who is obese.
Before putting a child on a diet, parents should always seek the advice of a pediatrician and/or dietitian. Inappropriate dieting in children can negatively affect their physical growth and cognitive development. Current medical thinking is that overweight and obesity in children are often best treated by establishing healthy eating habits and increasing physical activity. Many experts suggest children should not diet to reach a specific target weight, but rather be encouraged to change their lifestyle habits and hold their weight steady. With growing children, keeping weight steady as the child grows is often enough bring to the child into a healthy weight range. Any complications of obesity such as hypertension should be treated under the direction of a physician.
Depending on their age and health, some children who are obese should diet under medical supervision. Some children may be resistant, and if their weight is adversely affecting their health, an intervention may be necessary. When weight loss goals are set by a medical professional, they should be moderate and allow for normal growth. Goals should initially be small; one-quarter of a pound to a maximum of two pounds per week. An appropriate weight goal for all obese children is a BMI below the 85th percentile, although such a goal should be secondary to the primary goal of weight maintenance via healthy eating and increased activity.
Many studies have demonstrated that obesity runs in families. For this reason, it is important to involve the entire family when treating obesity in children. The long-term effectiveness of a weight control program is significantly improved when the intervention is directed at the parents/caregivers as well as the child. Some positive guidelines for safe weight-loss programs include:
Children who are overweight or obese often have psychological and social problems that can be helped with psychotherapy (talk therapy) in addition to nutritional counseling. Types of therapy include:
Nutrition in the early years can determine lifelong health. Children who are overweight or obese as children usually grow up to be overweight or obese as adults. This excess weight not only affects children's health, but also their future. Teaching children to eat healthily and maintain a good weight for their height gives them a good start for a healthy life and helps prevent diseases related to obesity such as cardiovascular disease, type 2 diabetes, and joint disorders.
Maintaining a healthy weight and eating well have many benefits. In addition to reducing the risk of many diseases that are connected to being overweight, a nutritious diet may improve well-being, increase emotional stability and self-esteem, alleviate depression, and lead to a longer life span.
As the problem of childhood obesity has come into focus, commercial diet companies have begun touting diets for children. Parents should be very wary of these products. Some are appropriate for certain children who meet specific criteria. The best programs require a note from a physician stating that it is safe for the child to participate. Many fad diets found on the Internet can be quite harmful when used by children. The best way to avoid negative health complications and achieve weight-loss success is to consult a healthcare professional before starting any child on a diet.
A clear association has been shown between obesity and low self-esteem in adolescents. Although a diet that helps a child maintain a healthy weight can increase self-esteem, some concerns have been noted about the psychological or emotional harm a weight-loss program may cause in a child. Eating disorders may arise, although a supportive, nonjudgmental approach to therapy and attention to the child's emotional state minimizes this risk. A child or parent's preoccupation with the child's weight may damage the child's self-esteem. If weight, diet, and activity become areas of conflict, the relationship between the parent and child may deteriorate.
Being overweight or obese carries many risks, including cardiovascular disease and type 2 diabetes. In addition to the more well-known problems, other risks include joint disorders. One orthopedic complication is slippage of the head of the thigh bone (capital femoral epiphysis) where it meets the pelvis at the hip. This can occur during the adolescent growth spurt. It is not common but occurs most frequently in children who are obese. The slippage causes a limp and/or hip, thigh, and knee pain, and can result in considerable disability.
Blount's disease (tibia vara) is a growth disorder of the tibia (shin bone). The inner part of the tibia, just below the knee, fails to develop normally. This causes the growing bone to angle inward, so that the child appears bowlegged. The cause is unknown, although it is related to the effects of excess weight on the growth plate and is associated with obesity.
Obesity is a risk factor for gallbladder disease in adults. Gallbladder disease causes abdominal pain and tenderness. Although the risk of gallbladder disease is much lower in children than in adults, children with obesity are at greater risk than those of normal weight. Children who are obese may develop gallstones because they have higher levels of cholesterol.
Noninsulin-dependent diabetes mellitus (NIDDM), commonly called type 2 diabetes, is a hormone disorder strongly related to obesity. Type 2 diabetes has become increasingly common in children, whereas a generation ago it was extremely rare. The link between obesity and insulin resistance, which causes type 2 diabetes, has been very clearly documented.
Children who are obese are at risk for hypertension (high blood pressure) and hyperlipidemias (high blood fats). These conditions increase the risk of cardiovascular disease in adulthood. Hypertension and hyperlipidemia often go undiagnosed or untreated in children because they cause no obvious symptoms.
Childhood obesity also affects the social and emotional development of children. In a society that places a high premium on thinness, children who are obese often become targets of early and systematic bullying and discrimination that can seriously hinder healthy development of body image and self-esteem.
Children who remain overweight or obese have a much greater likelihood of being overweight or obese adults with all the health problems that obesity brings. Studies have found that 26%–41% of preschoolers who are obese become adults who are obese. In school-aged children, 42%–63% of children with obesity become adults who are obese. The more overweight a child is, the higher the likelihood that the child will continue to be overweight into adulthood.
Eating habits are often established early in life. Building healthy eating and exercise habits early on can help prevent unhealthy weight gain. Strategies for building a healthy relationship to food and body image include:
See also Binge eating ; Body image ; Body mass index ; Childhood nutrition ; Childhood obesity ; Diabetes mellitus ; Eating disorders ; Obesity .
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Megan Porter, RD, LD
Revised by Anne P. Nugent, PhD RNutr