Undoing Childhood Obesity

It is well known that the United States faces a childhood obesity epidemic. In fact, 81% of respondents in a poll on the topic considered childhood obesity a serious concern and two-thirds believed the problem was getting worse (Hassink, Hill & Biddinger 2011). Actually, national surveys show a stabilization of childhood obesity rates and even small declines in some localities (RWJF 2012).

Despite evidence that the crisis may be easing, it is still a serious challenge. Qualified fitness professionals are ideally suited to meet this challenge by leading the charge to increase physical activity within their local schools and communities. Furthermore, the fitness industry must do more to play a meaningful role in reversing the epidemic.

A Surge in Childhood Obesity—
and Now Stabilization?

The obesity rate among children has increased from 5% in the 1960s to about 17% today. Black girls and boys (24%), Hispanic boys (23%) (Ogden et al. 2012) and children from lower-income communities with little access to healthy foods and physical activity opportunities suffer the highest rates (Halfon, Larson & Slusser 2013). After rapid increases over the past 30 years, however, the latest estimates have shown stabilization in all age groups except for teenage males, who continue to gain weight (Ogden et al. 2012).

The stabilization may be due at least in part to the increased attention and awareness surrounding obesity, including initiatives such as the Let’s Move! campaign, started by First Lady Michelle Obama; the revamping of the school lunch program; and a concerted effort to increase physical activity during the school day. While obesity rates have not yet decreased for children or adults, according to national samples (Ogden et al. 2012; Flegal et al. 2012), several promising reports in pockets of the U.S. have been released in the past year.

Children in Massachusetts, New York City, California, Mississippi, Philadelphia, Anchorage, Alaska, and El Paso, Texas, have shown small declines in childhood obesity (RWJF 2012). The communities that have experienced the greatest successes have implemented wide-scale changes. For example, Philadelphia opened grocery stores in areas that had none (“food deserts”), connected schools with local farms and ensured that farmers’ markets accepted food stamps. New York City launched a variety of initiatives—offering street carts where people could buy fresh fruits and vegetables, adding calorie information to menus, requiring physical activity in daycare centers and setting rigorous nutrition standards in schools. California and Mississippi implemented a number of requirements to improve nutrition and physical activity in schools. The efforts paid off: One 2012 study found that California students consumed 158 fewer calories per day than students in states with weaker standards (RWJF 2012).

While these changes are promising, much more needs to be done.

The Causes of Childhood Obesity
and a Population at Risk

While genes contribute to obesity risk, the increased prevalence of childhood obesity over the past generation has occurred too rapidly to be explained by a genetic shift alone. Changes in the way we live—from how we get to work and school to what we eat for snacks and meals—are responsible for the rapid and alarming widening of the American waistline from infancy to old age, with genetic factors putting some children at higher risk than others (Manco & Dallapiccola 2012).

Social and economic factors seem to play a leading role in the epidemic. Obesity rates for children in low-income families (27%) are nearly three times higher than those for children in middle-class families (10%). Children being raised by a single mother and those whose parents have a high-school education or less are also more likely to be obese (Halfon, Larson & Slusser 2013).

Children from minority backgrounds, especially black and Hispanic children, suffer from disproportionately high rates of obesity compared with white kids (24% and 23%, respectively, compared with 13%) (Halfon, Larson & Slusser 2013). These racial disparities become apparent even in preschool years.

Multiple studies show that risk for obesity starts at conception, supporting the belief that efforts to prevent and treat the problem should start early. These studies also highlight that any intervention that contributes meaningfully to the reversal of the childhood obesity epidemic must put a major focus on minority and low-income children and families. We still have a long way to go. Of the cities and states that have shown improvements in obesity rates, only Philadelphia has made progress in closing the gap in rates between whites and minority students (RWJF 2012).

Health Consequences of Childhood Obesity

What most concerns many overweight children may be how they look, but the effects of childhood obesity extend far beyond aesthetics. Childhood obesity negatively affects nearly every organ of the body, causing complications as varied as asthma and sleep apnea to gallstones, liver dysfunction, bone fractures and, in girls, infertility (Halfon, Larson & Slusser 2013). In fact, many complications of obesity that are common in adults—such as impaired fasting glucose and type 2 diabetes, high blood pressure, abnormal cholesterol and metabolic syndrome—are present in obese children (Halfon, Larson & Slusser 2013).

A study of severely obese children aged 2–18 in the Netherlands found that two-thirds (including some toddlers!) already had at least one of the following cardiovascular risk factors:

• high blood pressure
• high LDL (“bad”) cholesterol
• low HDL (“good”) cholesterol
• high total cholesterol
• high triglycerides
• high fasting blood sugar
• type 2 diabetes (van Emmerik et al. 2012)

These findings are on track with U.S. data from the National Health and Nutrition Examination Survey (NHANES) showing that about half of overweight teens and nearly two-thirds of obese teens have at least one risk factor for cardiovascular disease. For nearly 25% of the American teens surveyed, including those at a normal weight, that risk factor is increased fasting glucose or type 2 diabetes (May, Kuklina & Yoon 2012). In the past several years, the rates of type 2 diabetes among children have skyrocketed, leading the American Academy of Pediatrics to publish its first recommendations for general pediatricians on how to manage this once exceedingly rare problem in kids (Copeland et al. 2013). If current trends continue, researchers predict, the average boy born in the year 2000 will have a 33% chance of developing diabetes in his lifetime, while the average girl will have a 39% chance (Narayan et al. 2003).

With many children now suffering the same chronic diseases as their grandparents, childhood obesity experts believe that this may be the first generation with a shorter lifespan than their parents (Olshansky et al. 2005). In fact, one study of nearly 5,000 American Indian children found that those in the highest quartile for body mass index, an estimate of body fatness, had more than double the risk of dying in early adulthood compared with those in the lowest quartile. The increased risk persisted even when controlling for other factors like glucose level, cholesterol and blood pressure (Franks et al. 2010).

Social and Emotional Consequences of Obesity

Being obese in childhood is difficult, even for the most resilient and motivated child. In addition to contending with the severe health consequences of their excess weight, obese children are more likely to be teased, bullied and socially isolated than their normal-weight peers. A review of 131 research articles evaluating the association of childhood obesity with mental health and wellness found that obese children had increased rates of depression and anxiety, low self-esteem, body dissatisfaction, disordered eating, unhealthy weight-control practices, counterproductive dietary restraint and emotional distress (Russell-Mayhew et al. 2012). The authors proposed that weight-based stigmatization and teasing, along with preoccupation with weight and size, served as the major mediators in the development of these mental health concerns (Russell-Mayhew et al. 2012).

Economic Consequences of Childhood Obesity

The burden of childhood obesity extends beyond an individual child and family to affect the community and society as a whole. One way to measure this impact is through costs to the healthcare system. For 1979–1999, the Centers for Disease Control and Prevention estimated annual hospital costs related to child and adolescent obesity at about $127 million (Wang & Dietz 2002). Based on hard data, this figure was very reliable, but it likely represented only a small fraction of the total costs. Unfortunately, more recent data are not available. A 2009 study estimated that childhood obesity could be costing as much as $14.1 billion annually in additional prescription drugs, emergency room visits and outpatient care (Trasande & Chatterjee 2009). However, this estimate seems high. Economists suggest it may not be until this generation of children enters adulthood and more longitudinal data are available that we will know just how much the childhood onset of adult disease costs the healthcare system (John, Wolfenstetter & Wenig 2012).

Making Changes

While it is not “easy” to attain a healthier weight, children are frequently more successful than their adult counterparts if the right tools and support are available. Childhood obesity results from an imbalance between energy intake and energy expenditure. By improving nutrition habits and increasing physical activity levels, many children can avert the harmful consequences of obesity to achieve and maintain a healthy weight.

But the intervention must begin as soon as possible. The earlier a child is identified as overweight or obese and the sooner lifestyle changes are initiated, the more likely the child will be to achieve a healthier weight and enter adulthood without the burden of obesity (Freedman et al. 2005). One reason for the success of earlier intervention is that unlike many teenagers and adults, children are still rapidly growing in height. A 6-year-old child who is obese can achieve a healthier weight without losing a pound—simply by maintaining weight while gaining inches.

A Cochrane review highlighted several steps that may help prevent childhood obesity, especially in 6- to 12-year-olds (Waters et al. 2011). Fitness professionals are perfectly suited to helping with many of these approaches, which include the following:

• Develop or participate in a school curriculum that addresses healthy eating, physical activity and body image. This type of program is likely to have most impact if it is implemented in an underserved or low-income area.
• Offer more sessions for physical activity and the development of “fundamental movement skills” (like running, skipping, jumping and throwing) throughout the school week. These activities could take place in an outdoor after-school program or in a gym as a part of a youth fitness training program.
• Improve the nutritional quality of the food supply in schools. (Many improvements have occurred in this domain on a national scale in the past year.).
• Develop environments and cultural practices that support children in eating healthier foods and being active throughout each day.
• Lend support (for example, through professional development and capacity-building activities) to teachers and other staff to help them implement health promotion strategies and activities for children.
• Offer parent support and home activities that encourage children to be more active, eat more nutritious foods and spend less time in screen-based activities. (Parent training workshops or even family health coaching interventions could help to accomplish this goal.)

Recommendations in Action: What Is Working and How to Get Involved

The drive to combat childhood obesity is getting help from city and state governments, schools, medical societies, health organizations and influential nonprofits such as the Robert Wood Johnson Foundation, which has invested millions of dollars in reversing childhood obesity. While the private sector—restaurants, food companies and other for-profit organizations—is often blamed for obesity (and many times, rightfully so), many companies and groups have pledged to make changes to improve children’s health. An example of a powerful and growing collaborative including many of these entities is The Partnership for a Healthier America, founded in 2010 in conjunction with the Let’s Move! campaign.

A nonprofit organization, the PHA aims to connect public and private partners who have made meaningful commitments to improve the health environment for kids. In its 2012 summary report, the PHA highlighted several successes in this effort, most of which focus on enhancing the food and physical activity environment for kids.

This is a sampling of PHA partners’ physical activity commitments:

• ChildObesity180 launched a nationwide competition, ASAP (Active Schools Acceleration Project), to reward school-based programs and technological advancements designed to increase physical activity for kids during the school day. The top programs were selected, and schools can now apply for $1,000 grants to bring those programs to their classrooms. For more information on this grant opportunity, go to www.activeschoolsasap.org/acceleration-grants.
• FUNdamental Field Hockey pledged to engage 15,000 children through the introduction of 250 programs nationwide. The organization provides free equipment and a curriculum to elementary schools, YMCAs, Boys & Girls Clubs, and parks and recreation centers.
• The United States Tennis Association reached 100,000 kids in after-school and summer programs and donated $285,000 worth of tennis equipment to schools and community-based organizations.
• USA Cycling and USA BMX donated bikes and offered free races, clinics and 30-day memberships to kids across the U.S. Over 270,000 kids participated.
• USA Swimming donated swimming lessons to 75,000 underserved children.
• USA Track & Field engaged over 140,000 children in 2012. It also donated 15,000 “Track in a Box” kits to children in low-income and underserved schools.

In early 2013, in conjunction with Let’s Move! celebrating its third anniversary by launching Let’s Move! Active Schools, several organizations committed large amounts of money to fight childhood obesity through the promotion of physical activity. For example, Nike® committed $50 million over 5 years to help create active schools and physically active communities across the U.S. Kaiser Permanente® pledged $1.76 million to bring its “Fire Up Your Feet” activity program to every elementary and middle school in the country.

Notably, except for the YMCA, no major fitness industry companies or organizations were included on the PHA partners list as of April 2013, an omission the industry could correct by encouraging trainers to get involved in programs like those listed in the sidebar “How Fitness Pros Can Fight Childhood Obesity.”

Connecting Physical Activity to School

Physical activity sessions that are related to the school day (i.e., offered before, during or after school) provide the best opportunities to improve activity levels in kids. Furthermore, programs targeting low-income and minority populations are likely to achieve the most meaningful impact. Getting involved in such efforts may be a philanthropic volunteer pursuit for many fitness professionals, but there are resources and opportunities to make participation financially feasible for professionals who cannot afford to volunteer their services. For example, Shaping America’s Youth® maintains a detailed list of funding opportunities for organizations and groups committed to improving kids’ health and well-being (www.shapingamericas
youth.org/Page.aspx?nid=52). As more money gets funneled into raising physical activity levels in kids, more opportunities will arise for fitness professionals.

As the most visible group of advocates for physical activity, fitness professionals are well suited to take the lead in efforts to reverse childhood obesity, along with all its negative health, social, emotional and economic consequences. The fitness industry can play a major role in this campaign, but we must first look outside the four walls of the gym and engage in the community-wide effort to inspire America’s kids to fitness.