Since 1980, global obesity has more than doubled. Sixty-five percent of the world’s people now live in countries where overweight and obesity cause more deaths than underweight. In 2010, nearly 43 million children below the age of 5 were overweight (WHO 2011). In spite of global awareness and isolated attempts to face this crisis head-on, the fact remains that our kids are fat and getting fatter.
Obesity is preventable. If we don’t help our children find their way out of the downward spiral of obesity, what will their world be like when they grow up?
In the United States, according to the Centers for Disease Control and Prevention (CDC), 18% of adolescents aged 12–19, 20% of children aged 6–11 and 10% of children aged 2–5 are obese (CDC 2010). In the United Kingdom, experts predict, 10.1% of boys (8% of teenaged boys) and 8.9% of girls (9.7% of teenaged girls) will be obese by 2015 (Stamatakis et al. 2010). Without intervention, the physical, emotional and financial consequences will be enormous when these children grow up. This article looks at the potential doomsday effect this wave could have if we don’t do something to change it now.
A Serious Problem
According to an article by Julie DeJean Marks, MEd, LCES, for the Obesity Action Coalition, “Adults who have been obese since childhood and developed low self-esteem are more likely to face discrimination in educational settings and the workplace, thus achieving lower educational status. They are also less likely to marry. [Among this population,] a greater decrease in activity, including walking, shopping, attending movies and parties, and increased feelings of sadness and hopelessness are found in adults between the ages of 51 to 69.”
Paul Stricker, MD, FAAP, youth sports medicine specialist at Scripps Clinic in San Diego, shares some sobering points: “This is a perilous generation where [obese] children have multiple risk factors for heart disease and arterial problems similar to [those seen in] middle-aged adults. The longer a child stays overweight into late adolescence, the greater likelihood he or she will stay overweight as an adult. That urges us to intervene early and get to some of the younger kids and make a difference that could literally save their lives.”
Children who are not helped with lifestyle changes could end up medicated or undergoing surgery. At present, the U.S. Food and Drug Administration has approved only one drug for youth—orlistat, for extremely obese children (BMI >2 units above 95th percentile) older than 12; sibutramine was pulled from the U.S. market in 2010 (Rogovik & Goldman 2011). Bariatric surgery is being used more often, but in addition to its high cost ($9,000–$25,000), there are risks of complications and adverse reactions, and long-term effects are not fully known (NHLBI 2007). Would you want your child to undergo either of these treatments?
In a March 2011 speech, First Lady Michelle Obama mentioned the economic implications of childhood obesity, citing evidence that “in the 10 cities with the nation’s highest obesity rates, the direct costs . . . are roughly $50 million per 100,000 residents” (National League of Cities 2011).
In an analysis by Wang et al. (2008), an estimate of the progression and cost of the U.S. obesity epidemic showed an increase in childhood obesity rates of 46%–49% between the 1970s and 2004. If that rate persists, more than 80% of today’s children will be overweight or obese adults by 2030 (100% by 2048), costing $861 billion–$957 billion. This would account for 16%–18% of total U.S. healthcare costs.
A 2009 study by the CDC and the nonprofit RTI International put the direct and indirect costs of obesity (adults and children) as high as $147 billion annually between 1998 and 2006 (RTI International 2009). Another study (Finkelstein et al. 2009) concluded that hospitalization costs related to childhood obesity climbed from $126 million in 2001 to $238 million in 2005. At the time, this accounted for 9.1% of all annual medical spending, compared with 6.5% in 1998! These staggering increases in expenditures and percent of medical spending fall in line with projections made by Wang and colleagues.
Medical expenses aside, the indirect costs of obesity are also discouraging. A 2010 Lifestyles Statistics study compiled by the NHS [National Health Service] Information Centre in the U.K. notes that only 1 in 5 children aged 5–15 consumed the recommended “5-a-day” servings of fruit and vegetables in 2008. This corresponded to a drop in produce purchases. For example, between 2007 and 2008, fresh-fruit purchases fell by 7.7% and green-vegetable purchases by 9.6% (NHS Information Centre 2010). Although this might be good financial news for processed-food manufacturers, it does not bode well for farmers and their suppliers and customers.
Prediction: By 2035 the U.S. economy will be literally weighed down with healthcare costs for a generation that should be healthy, vibrant and productive.
Metabolic syndrome—elevated blood pressure and insulin levels, excess body fat around the waist and abnormal cholesterol levels occurring together—has become a common term in recent years. This cluster of conditions increases the risk of heart disease, stroke and diabetes (Mayo Clinic 2009) and is strongly correlated with obesity. The syndrome was formerly associated with adults, but pediatric metabolic syndrome is now routinely diagnosed, although with less specific criteria (Jessup & Harrell 2005).
“Diabetes is a complication of obesity, and was basically unheard of in children years ago,” says Stricker. “It used to be called ‘adult-onset’ diabetes, a name that had to be changed to ‘type 2’ diabetes because now it is showing up frequently in overweight children.”
The risk of cancer also increases, while mobility and the ability to perform activities of daily living decrease (DeJean Marks 2011). Obstructive sleep apnea also occurs in children and adolescents who are severely obese (BMI >99th percentile) (NHLBI 2007).
Nonalcoholic fatty liver disease—“accumulation of fat in the liver of people who drink little or no alcohol” (Mayo Clinic 2011)—is another concern. At its most severe, it can progress to liver failure. In a 2008 study, Dâmaso et al. determined that visceral adiposity is the major risk factor for pediatric nonalcoholic fatty liver disease. This study of 181 obese adolescents found that 45.3% had the disease. In plain words, more children are going to die from more obesity as a result of more obesity-related diseases!
Brett Klika, director of athletics at Fitness Quest 10 in San Diego, specializes in working with children. “From a biomechanical standpoint, as trainers we see many chronic-pain maladies due to inactivity. After 8th grade, about 70%–80% of kids drop out of sports altogether. That leaves quite a few kids doing nearly nothing starting at age 14 and earlier. When these kids become adults, they may be so far below [the threshold of physical competency,] that we may need to reteach them skills like walking. Physical education has been nearly abandoned in our current education system because technology, not physical skill, drives American industry. Unfortunately, we are falling behind on physical competency because of this reprioritization of resources. If the body is not well, the brain cannot do its job.”
Prediction: In 10–20 years, more young adults will be unable to perform basic tasks and skills owing to extremely poor health and function.
In 2007, the National Heart, Lung, and Blood Institute (2007) released a report identifying priorities for future research on childhood obesity prevention and treatment. The panel of experts behind the report emphasized that the emotional consequences of obesity are different for children and adults. “Differences in the treatment of obesity in youth compared to adults pertain to special circumstances in physiological factors, psychosocial factors and environmental influences,” according to the authors. They identified these psychosocial factors affecting children:
- cognitive development
- motivating factors
- body image
- short-term attention span
- risk-taking behaviors
- lack of concern about health
All of these have frightening implications. Impaired children who feel bad can’t function properly and don’t take care of themselves.
Although there is a lot of literature on low self-esteem, anxiety, isolation and depression, these states are not triggered entirely by self-perception or internal beliefs; external factors—such as bullying in the form of teasing, name-calling and even physical harm—have damaging effects. Also, obese youth are often the subject of rumors, lies and rejection, with drastic results such as eating disorders or suicidal thoughts (DeJean Marks 2011).
The epidemic of suicide due to bullying even has its own term, bullycide, and overweight children are at particular risk. In a 2010 survey of overweight sixth graders, 34% (per teacher report), 45% (per mother report) and 25% (per self-report) of children experienced daily teasing, bullying or rejection specifically related to their size (Lumeng et al. 2010).
Less invasive, but with the same insidious results, are parental attitudes. According to the National Institute of Medicine (2011), “Many parents do not understand the consequences of excess weight in infants and young children or are not concerned about early excess weight or obesity.” If parents don’t consider their children’s obesity an important issue, how can the kids themselves be expected to place any value on a healthy weight?
Klika believes in educating parents. “We need to communicate the importance of individual accountability in the home. It is dangerous to blame the problem on some institution. If we want active kids, parents need to set an example.”
Prediction: If nothing is done to address the emotional consequences of childhood obesity, by 2040 there could be a surge in depression, social isolation and rejection, suicide, personality disorders and other mental illnesses.
The Times They Are Changing?
Whatever we, as fitness professionals, are doing now, it isn’t working. Of course, if we’re helping kids become active, we need to keep doing that. But we must either do something more or do something different if we are to turn this burning zeppelin around.
1. Reach Children by Educating Parents. Kids themselves don’t have much power, so we need to work via adults. The 2010 Lifestyles Statistics study states, “Among boys aged 2–10, more met the physical activity recommendations for children if their parents did so for adults. Among girls, the activity levels of parents made relatively little difference to the proportion meeting recommendations, but those who had parents with low activity levels were considerably more likely to be in the low activity category themselves” (NHS Information Centre 2010).
Stricker believes that “it’s a family thing; and having both parents overweight increases the risk a child is overweight much more than if just one parent is overweight. Approaching the family to attack the issue together can be a much more supportive environment for change.”
2. Work Systemically. Noted in the NSW [New South Wales, Australia] Government Plan for Preventing Overweight and Obesity in Children, Young People & Their Families 2009–2011 is the need for working systemically: “Decisions regarding where to invest time and resources in seeking to address overweight and obesity can be challenging. Children have limited direct control over the environment in which they live, and decisions concerning food availability and opportunities for activity are mostly controlled by parents and caregivers. A family- or settings-based (e.g., childcare, school) focus for interventions is an appropriate avenue for influencing [behavior] and improving outcomes” (NSW Department of Health 2009).
Turning this information into action may mean offering a whole range of family-friendly classes or sessions, marketing creatively (i.e., working with schools and businesses to offer prizes to families that exercise together) and perhaps working with employers to offer incentives and lunches during weekend on-campus “fitness days.” Once the financial advantages of hiring fitness professionals become clear, employers who want to save money on healthcare costs and absenteeism should feel motivated to pay for the services of these professionals.
3. Change Beliefs About Exercise. In addition to becoming more systemic, we need to change beliefs about the “punitive” nature of exercise. The best place to start is probably with language, rather than using the one-by-one experiential approach that is common now. A simple example of language that can be changed is the word workout. If anything, it should be a playout or simply play.
Eleni Kehagiaras, owner of Get Fit Training in Portland, Oregon, is particular about wording and strives to create a culture that embraces good health: “Parents need to keep it short and simple; for example, [they should tell their children] that strong foods make strong bodies and weak foods make weak bodies.” Kids want strong bodies, and they’ll ask for more
information if they’d like to have it. Save the lecture about fats, proteins and carbohydrates for parents or much older children.
Kehagiaras also suggests asking parents to do their food and exercise decision-making out loud so that children clearly
understand how choices are made. Besides helping kids see how their caregiver adults make choices, this demonstrates that delayed gratification has its benefits. Another benefit? Adults may improve their own habits and behaviors once they’re articulated and recognized.
Kids Need Our Help
The obesity action plan developed in New South Wales suggests steps to reverse the childhood obesity trend. With predictions based on historical trends, the plan projects that by 2016—unless action is taken—35% of boys and 31.7% of girls in New South Wales will be overweight or obese. To reverse this “excess energy balance” lifestyle, the plan prioritizes action on five fronts:
- community information
- healthy food
- active lifestyles
- sport and recreation infrastructure
- prevention and early intervention services
The action plan recommends increasing fruit and vegetable consumption and moderate to vigorous physical activity (includes walking and incidental activity) and decreasing consumption of energy-dense, nutrient-poor foods; sugar-sweetened beverages; and “sedentary small-screen behaviors.”
Fitness professionals are uniquely positioned to impact almost all, if not all, of the five action priorities, especially given the links that fitness pros have to parents, children, the medical community, schools and food specialists. For example, fitness professionals who work with pregnant women can share literature showing that babies of mothers who breastfed are at lower risk for obesity—and that mothers who maintain a healthy diet and weight gain during pregnancy are also at lower risk. Another example could be providing age-appropriate ideas to parents for activities they could do instead of sitting (at the table, video monitor, television).
In other words, while staying within scope of practice, it has become incumbent on the fitness industry to provide clients far more than “just” exercise; we must provide holistic help that considers all factors related to obesity.
Younger parents (and even more so, their kids) no longer know how to play. Structured, organized sports are ubiquitous, but free play is gradually disappearing. Who remembers pickle, kick-the-can, street hockey, red rover and so on? More important, who still sees anyone playing these types of games?
Recognizing that kids like to play, and that play is exercise, Carrie Ekins, MA, of Kutzenhausen, Germany, is the creator and founder of Kids Beats and Academic Beats, a fitness and academic program that uses stability balls, drumsticks and other props to get kids moving and learning. Besides creating fun ways to move, Ekins appeals to children by allowing them to contribute ideas and choose music. She also uses garbage cans, plastic buckets and all manner of unusual and noisy items that children enjoy.
Get Our Children Moving!
More than ever, when it comes to kids’ health, it is time to think creatively, holistically, systemically and globally. Be involved in helping children live active, well-nourished lives—and help turn the tide of obesity.
CDC (Centers for Disease Control and Prevention). 2010. Fast Stats: Obesity and Overweight. www.cdc.gov/nchs/fastats/overwt.htm; retrieved July 22, 2011.
Chaput, J.P., et al. 2011. Video game playing increases food intake in adolescents: A randomized crossover study. The American Journal of Clinical Nutrition, 93 (6), 1196–1203.
Dâmaso, A.R., et al. 2008. Relationship between nonalcoholic fatty liver disease prevalence and visceral fat in obese adolescents. Digestive and Liver Disease, 40 (2), 132–39.
DeJean Marks, J. 2011. Obesity and age. Obesity Action Coalition. www.obesityaction.org/magazine/ywm22/obesityandage.php; retrieved July 25, 2011.
Finkelstein, E.A., et al. 2009. Annual medical spending attributable to obesity: Payer-and service-specific estimates. Health Affairs, 28 (5), w822–31.
Jessup, A., & Harrell, J.S. 2005. The metabolic syndrome: Look for it in children and adolescents, too! Clinical Diabetes, 23 (1), 26–32.
Lumeng, J.C., et al. 2010. Weight status as a predictor of being bullied in third through sixth grades. Pediatrics, 125 (6), 1301–1307.
Mayo Clinic. 2009. Metabolic syndrome. www.mayoclinic.com/health/metabolic%20syndrome/DS00522; retrieved Aug. 8, 2011.
Mayo Clinic. 2011. Nonalcoholic fatty liver disease.www.mayoclinic.com/health/nonalcoholic-fatty-liver-disease/DS00577; retrieved July 23, 2011.www.nhlbi.nih.gov/meetings/workshops/child-obesity/index.htm; retrieved Aug. 9, 2011.
National Institute of Medicine. 2011. Early childhood obesity prevention policies. www.iom.edu/Reports/2011/Early-Childhood-Prevention-Policies/Report-Brief.aspx; retrieved Aug. 25, 2011.
National League of Cities. 2011. Michelle Obama stresses impact of childhood obesity. www.nlc.org/news-center/nations-cities-weekly/articles/2011/march/michelle-obama-stresses-economic-impact-of-childhood-obesity; retrieved Aug. 25, 2011.
NHLBI (National Heart, Lung, and Blood Institute). 2007. Working group report on future research directions in childhood obesity prevention and treatment.
NHS Information Centre. 2010. Statistics on obesity, physical activity and diet: England, 2010. www.ic.nhs.uk/pubs/opad10; retrieved Aug. 25, 2011.
NSW Department of Health. 2009. NSW Government Plan for Preventing Overweight and Obesity in Children, Young People & Their Families 2009-2011. www.health.nsw.gov.au/pubs/2009/pdf/obesity_action_plan.pdf; retrieved July 22, 2011.
Rogovik, A.L., & Goldman, R.D. 2011. Pharmacologic treatment of pediatric obesity. Canadian Family Physician, 57 (2), 195–97.
RTI International. 2009. Obesity costs U.S. about $147 billion annually, study finds. Press release, July 27. www.rti.org/news.cfm?objectid=329246AF-5056-B172B829FC032B70D8DE; retrieved Aug. 24, 2011.
Stamatakis, E., et al. 2010. Time trends in childhood and adolescent obesity in England from 1995 to 2007 and projections of prevalence to 2015.Journal of Epidemiology & Community Health, 64, 167–74.
Wang, Y., et al. 2008. Will all Americans become overweight or obese? Estimating the Progression and cost of the US obesity epidemic. Obesity, 16 (10), 2323–30.
WHO (World Health Organization). 2011. Obesity and overweight. www.who.int/mediacentre/factsheets/fs311/en/index.html; retrieved Aug. 9, 2011.