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Childhood Obesity: Prevalence, Treatment and Prevention

Become an advocate for kids by taking a leadership role in the war on obesity.

Fitness professionals know that the
number of overweight or obese children in the United States and other developed
countries is increasing at an alarming rate. However, it is difficult to track
the prevalence of this obesity epidemic, since there is such variability in how experts define which
children are overweight or obese.
Additionally, while we know that physical activity patterns and
diet are contributing factors to this increase in overweight youth, our
understanding of all contributing factors is presently incomplete. This article
will examine the known negative consequences of childhood obesity and the
recommended prevention and treatment options that fitness professionals can
employ when dealing with youth.
Measuring Childhood Obesity
When it comes to research and
epidemiological purposes, body mass index (BMI, calculated as body weight in
kilograms divided by the square of height in meters [kg/m2]) serves as the relevant reference
standard for determining the obesity and overweight status of children. Using
this terminology, being “overweight” (often called “pre-obesity”) is defined as
having a BMI of 25–29.9 kg/m2,
whereas being “obese” means having a BMI of ≥30.0 kg/m2 (Janssen et al. 2005).
In a comparison of pre-obese and obese youth (ages 10–16) from 34
countries, the highest levels of overweight or obesity were seen in Malta, an
island country located south of Italy in the Mediterranean Sea. The percentage
of youth in Malta who were pre-obese was 25.4%, while the rate of obesity among
youth was 7.9% (Janssen et al. 2005). The United States had the dubious
distinction of placing second for the number of overweight or obese kids, with
25.1% of youth considered pre-obese and 6.8% deemed to be obese (Janssen et al.
2005). Among children aged 6–19 years, the most recent National Health and
Nutrition Exam­ination Survey (NHANES)—using data collected from 1999 to
2002—found that the prevalence of overweight among American kids was three
times greater than the goals established as part of the Healthy People 2010
campaign (Hedley et al. 2004).
Consequences of Childhood Obesity
Regardless of whether a child is
considered pre-obese or obese, carrying excess weight during childhood can have
serious consequences over a lifetime. These consequences involve negative
effects on health, such as abnormal blood lipid levels and chronic inflammation,
shown to contribute to heart disease and other serious health conditions later
in life. For a look at the range of diseases obese kids face, see “Health
Conditions Associated With Childhood Obesity” sidebar.
Another aspect of childhood obesity that often gets overlooked is
the way it negatively affects kids from a psychological
perspective. Being labeled as “the fat kid” in school can severely hamper a
child’s self-esteem and self-image at a time when personality and confidence
levels are being formed for life. We all know people who were overweight as
kids and continue to suffer psychological scars, even if they have managed to
shed pounds along the way to adulthood. Being overweight or obese as a child
can lead to self-destructive behavior patterns that are hard to break and that
may include high-risk activities that contribute to further unhappiness. See “The
Psychological Effects of Childhood Obesity” sidebar for more details.
Causes of Childhood Obesity
Although there is still a lot to learn
about the causes of childhood obesity, some things are clear. Experts theorize
that kids are gaining more weight than previous generations for the following
• Physical
activity is significantly down in schools nationwide.
• Kids spend
more time in sedentary activities, such as working on home computers, watching
TV and playing video games.
• Environmental
factors, such as lack of safe playgrounds, have resulted in less physical
activity among today’s youth.
Let’s look at each of these reasons in more detail.
Lack of Physical Activity
One factor that experts theorize has
contributed to the rapid climb in childhood obesity is the change in physical
activity levels and behaviors of children. The number of middle schools and
high schools that offer formal or regular physical education (PE) programs has
greatly decreased over the past few decades. More and more schools in America
have either cut out PE entirely or are no longer providing as many hours of
physical activities as they did in the past.
On the home front, today’s kids no longer play the way they used
to play. In fact, some experts argue that the current emphasis on increasing
exercise and physical activity is less
important when reaching out to overweight kids than just encouraging them to
play more often and more intensely (Burdette & Whitaker 2005). These same
researchers say that unstructured
outdoor play
has the potential to improve all aspects of a child’s
well-being: emotional, social, cognitive and physical (Burdette & Whitaker
In addition, the parents
of many overweight kids often associate exercise and physical activity in
general with their own failed attempts at weight loss—even if those parents
have positive associations from having played as children themselves. Indeed,
research conducted by Janssen and colleagues (2005) indicates that the best way
to get kids moving is to take a multipronged approach, such as mixing informal
play time with more structured physical activities at school.
The Media’s Role
have also come to recognize the role that sedentary behaviors, such as
television watching and use of other media, contribute to the childhood obesity
epidemic. Other media use is typically described as use of video games,
computers, and audio devices such as CD and MP3 players.
As early as 1985, researchers reported on the direct relationship
between television viewing (measured by time spent watching) and childhood
obesity (Dietz & Gortmaker 1985). In the past two decades, many more media
devices have become integral to the lives of children. In 29 out of 33
countries studied, Janssen and colleagues (2005) noted a strong association
between increased use of different media and the rise in childhood obesity,
along with a corresponding decrease in physical activity.
Other researchers have shown that television watching is also
highly associated with increased rates of consumption of calorie-dense foods
(Ebbeling, Pawlak & Ludwig 2002). The study found that children in the U.S.
were spending 75% of their waking hours being inactive and were logging in only
about 12 minutes of vigorous activity per day.
Other Environmental Factors
Changes in the environment over the years
may also have played a role in the ways that kids move compared with years
past, say some experts. Examples of environmental factors that may affect
children’s physical activity levels include
• the rising
cost of participating in structured activities, such as sports;
• lack of time
on the parents’ part to facilitate interest in exercise among their children; and
• safety
concerns, such as dangerous streets and playground availability (Ebbeling,
Pawlak & Ludwig 2002).
What You Can Do to Prevent & Reduce Childhood Obesity
Physical activity and play are important
components for the prevention and treatment of childhood obesity. Most American
guidelines encourage youth—both normal-weight and obese—to get 30–60 minutes of
physical activity (that produces a sweat) on most or all days of the week.
Compare these guidelines to those recommended by other countries:
Great Britain urges its citizens to get 60 minutes of daily physical activity
at least 5 days per week, whereas Canadian officials recommend that all
adolescents gradually increase their physical activity participation to 90
minutes daily (Janssen et al. 2005).
Regardless of the length of time kids spend exercising each day,
most experts agree that it is important that all physical activities be
specifically designed or tailored for the particular child or group of
children. For instance, creating a 12,000-steps-per-day incentive program for
boys and girls will require a markedly different strategy for urban youth than
it will for suburban kids, if only in having to account for environmental
concerns, like access to safe streets or parks.
When it comes to teaching kids about the best foods for their
growing bodies or instilling healthy behaviors for a lifetime, experts also
concur on an approach to take. Parents, educators and fitness professionals
should focus on teaching children about the benefits of a varied diet composed
mostly of whole foods. In addition, kids need to learn about proper portion
size and what constitutes a well-balanced diet. From a practical perspective,
they should be taught which snacks are healthiest (read: fruits and veggies)
and which contain too many calories.
Because of their strong association with childhood obesity,
television viewing and use of other media devices should be limited. This may
be one of our biggest hurdles, since advancing technologies are so much a part
of children’s lives in the 21st century. One way to meet this challenge is to
recognize the power of giving children accurate, honest and relevant education
so they can succeed in life. As today’s young people begin to truly realize and
appreciate the health consequences of childhood obesity, they just may be
motivated to balance their lives with more play and physical activity.
As citizens of this country, we must also be advocates for
creating safe environments in our communities where kids can play. Use your
voting power to protect open spaces for kids’ recreational use and to encourage
the development of better bike paths and parks and safer playgrounds for all
people. Last, since obesity is a serious concern for adults as well as
children, perhaps now more than ever is the time to initiate activities at your
fitness facility that provide the “family unit” with opportunities for play and
other ways to share physical activity.
Here’s to Kids’ Play
As conscientious fitness professionals
and personal trainers, we can and should play a leadership role in helping to
deliver health-promoting activities and programs that will stem the tide of the
childhood obesity epidemic. Individually we can have a positive impact on this
critical public-health problem by working with schools, fitness clubs, training
studios, hospitals, public-health centers and city and state governments.
Together we can take a leading role in effecting change at the local and
national levels and ultimately bring about a resurgence of kids’ play and
physical activity.
Doyeon Kim, MS, is a doctoral student in the exercise science
program at the University of New Mexico, Albuquerque (UNMA). He earned his master’s degree in exercise
and sport science in 2005 at the University of Utah. His research expertise is
in childhood obesity, body composition, sports training adaptation and exercise
Len Kravitz, PhD, is the program coordinator of exercise science
and a researcher at UNMA where he recently won the Outstanding Teacher of the
Year award. He was honored by Can-Fit-Pro as the 1999 International Presenter
of the Year and the 2006 Specialty Presenter of the Year. He was also chosen as
the American Council on Exercise 2006 Fitness Educator of the Year.
Burdette, H.L., & Whitaker, R.C.
2005. Resurrecting free play in young children.
Archives of Pediatric Adolescent
Medicine, 159,
Dietz, W.H., & Gortmaker, S.L.
1985. Do we fatten our children at the television set? Obesity and television
viewing in children and adolescents.
Pediatrics, 75 (5), 807–12.
Ebbeling, C.B., Pawlak, D.B., &
Ludwig, D.S. 2002. Childhood obesity: public-health crisis, common sense cure.
The Lancet,
Hedley, A.A., et al. 2004. Prevalence
of overweight and obesity among U.S children, adolescents and adults,
of the American Medical Association, 291
(23), 2847–50.
Janssen, I., et al. 2005. Comparison of
overweight and obesity prevalence in school-aged youth from 34 countries and
their relationships with physical activity and dietary patterns.
Reviews, 6,

Health Conditions Associated With Childhood Obesity

following physical conditions and diseases have been shown to be directly
related to childhood obesity:
• abnormal blood
• atherosclerosis
• chronic
• elevated
insulin levels
• endothelial
• heart disease
• hypertension
• increased
tendency for blood clotting
• kidney
• liver
• neurological
• type 2
Source: Ebbeling, C.B.,
Pawlak, D.B., & Ludwig, D.S. 2002. Childhood obesity: public-health crisis,
common sense cure. The Lancet, 360, 473–82.

The Psychological Effects of Childhood Obesity

addition to the physical toll that obesity takes on children, there are
damaging psychological effects. Here are some of them:
• adoption of
high-risk behaviors
• decline in
• loneliness
• nervousness
• sadness
• negative
Source: Ebbeling, C.B.,
Pawlak, D.B., & Ludwig, D.S. 2002. Childhood obesity: public-health crisis,
common sense cure. The Lancet, 360, 473–82.

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