Overweight Children and Adolescents -Screening and Prevention is The Best Approach

The rate of overweight and obese children and adolescents has doubled over the last 2 decades. Medical complications of obesity usually seen only in adults have now begun to appear in children and adolescents. Diabetes and cholesterol problems have reached almost epidemic proportions among children in North America. The American Academy of Pediatrics suggests the term obesity not be used, but rather they refer to children with excessive weight as overweight.

According to recent studies, 15.3% of 6-11 year olds and 15.5% of 12-19 year olds are considered to be overweight. Alarmingly, the rate is higher among poorer children and within certain minority groups. Similar rising trends have been observed in children younger than 5 years of age.

What are the complications of being overweight?

In adults it is very well known that being overweight is a risk factor for significant illness and often leads to premature death. When children become overweight at an early age, these risk factors start at a younger age. Here are some problems seen at an-ever increasing rate in overweight children and teenagers:

  • Heart related problems such as high blood pressure and high cholesterol.
  • Diabetes(Type 2 or insulin resistant)
  • Psychological effects, such as depression and low self-esteem

Other complications include respiratory problems such as asthma and sleep apnea, and certain bone or hip conditions.

The psychological effects of being an overweight child or adolescent

Overweight children are often stigmatized. Today all of the "role models" seen on TV and at the movies are thin and so body image is becoming increasingly important to the media savvy tween and teenage consumers. The psychological effects are as important as the medical complications of being overweight. Understandably, overweight children can be negatively affected by their body image. Often, this associated with the normal stresses of being an adolescent; the added pressure of being overweight just adds to their puberty related stress.

An urgent situation

Because the rate of childhood obesity is increasing at an alarming rate, experts fear that this will cause a tremendous load of illness in the future of our children. This is why preventing, identifying and treating childhood and adolescent obesity is quickly becoming an emergency medical and societal priority in North America.

Will an overweight child become an overweight adult?

The answer depends on the age of the child. It is estimated that the chance of remaining overweight as an adult is 20% at 4 years of age, but it jumps to 80% for adolescents. So for the most part, overweight teenagers will become overweight adults.

Why are people overweight?

This is no clear answer. Research at the molecular level has been progressing, but we still do not fully understand the whole picture from a medical/biological point of view. Although there is no one factor that determines whether a child will become overweight or not, combinations of several factors may potentially play a role. This is referred to as a "multi-factorial" model where an interaction between many factors is the cause. In the case of becoming overweight, these factors include:

  • Familial/genetic tendency
  • Biologic/medical problems
  • Psychological factors
  • Sociocultural influences and surroundings
  • Environmental factors

To which degree each factor contributes to obesity depends on the individual situation. It is interesting to see that only 2 of the above 5 factors are really out of our control.

The child's surrounding and environment

The environmental risk factors include family and personal dynamics. For example, a parent's food preference and eating habits will influence a child's food preference and habits. Children in lower socioeconomic areas tend to have less access to fruits and vegetables and have a higher total intake of fat. Even the absence of "family mealtime" has been associated with lower fruit and vegetable consumption as well as with a higher consumption of fried foods and soft drinks. Reflecting life in the 21st century, the current lifestyle is quick paced. This imposes increasing demands and pressures on families(including single parent families). As a result, our society is rushed and fast food has become a very important and convenient source of food for families on the go. It is well known that for the most part, "fast food" is FAT food.

Lack of physical activity among children

Lack of exercise and physical activity is another important contributing factor. The following have contributed to decreased physical activity among our children:

  • TV and video games
  • Computers, computer games and the Internet(screens)
  • Decrease of available parks and play areas
  • Decreased resources/emphasis for physical education at school

Today's children are less active and more sedentary than in previous generations. 20 % of children in a recent survey reported 2 or fewer periods of physical activity per week. Over 25% of children watch more than 4 hours of TV per day. This is a striking finding because another study showed that children who watch more than 4 hours of TV per day were more overweight than children who watched TV for less than 2 hours a day.

BMI or Body Mass Index

How does one know one is overweight? The weight of a child is important, but it must be correlated with the length as well as total body fat. For years, the Body Mass Index or BMI has been used to assess the weight status in adults. The BMI is one of the best ways to indirectly measure total body fat. Recently, experts have recommended that the BMI be calculated at every pediatric check up along with the other routine measurements.
BMI calculation:

The BMI is the weight over the square of the height and is calculated as follows:

Body Mass Index

Tables are available with pre-calculated values that can easily determine the BMI based on a child's weight and height.
Click here to download the WHO BMI tables and charts..

Using BMI in adults

In adults, the weight status based on the BMI is as follows: BMI less than 18.5 = Underweight
BMI 18.5 - 24.9 = Normal
BMI 25 - 29 = Overweight
BMI over 30 = Obese

Using BMI in children

Unlike for adults, the BMI values vary with the age and sex of the child. The BMI in children is called: BMI-for-age. The BMI value itself, is plotted on a specific BMI chart. Just like the height and weight growth charts parents are familiar with, the BMI charts also contain a series of lines, which indicate specific percentiles.

In the BMI chart below, this 10-year-old boy's BMI is 18, placing him at the 75th percentile. This means that compared to other kids his age, 75% have a lower BMI than him.

Example of a BMI chart:

Body Mass Index Chart
In children, instead of looking at the actual BMI value itself, we focus on the specific percentile of the BMI according to age and gender. BMI Percentiles indicate the following:
  • BMI-for-age less than the 5th percentile means Underweight
  • BMI-for-age 85th to 95th percentile means the child is at risk for Overweight
  • BMI-for-age greater than 95th percentile means the child is Overweight
Why is the BMI-for-age important?

Recent studies have shown that cardiac disease risk factors are associated with the BMI for age. 60% of children aged 5-10 years with a BMI-for-age greater than the 95%, had at least one obesity-related condition such as high blood pressure, high cholesterol, or high insulin levels (an indication type 2 diabetes). 20% of these children had 2 or more such abnormalities. The BMI for age is now recommended method for screening overweight and underweight in all children from 2 to 20 years of age.

Early recognition is best

As a result of this alarming increase in the number of overweight children and adolescents, physicians are now going to be looking at BMI as well as eating and physical activity habits more closely as part of the regular pediatric check up. The experience with adults shows very little success in terms of getting overweight adults to lose weight. Therefore prevention, especially in children, is the best approach. This requires the cooperation of the parents, physician, school and other societal/community members.

At the home, parents should set a good example by practising healthy eating and exercise habits. Parents should always be on the lookout for signs of excessive eating or inadequate amounts of exercise in their children. Furthermore, as part of preventing a sedentary lifestyle, they should limit the time children or teenagers watch TV daily.

The physician will focus more on questions such as:

"How much activity does your child do per week?"
"How much TV does your child watch?"
"What type of foods and how much does your child eat?"

The doctor will also be looking closely at the BMI-for-age of all children as part of the routine examination.

From the community standpoint, government policy makers and other implicated officials and decision makers should be encouraged and perhaps pressured to support healthy lifestyles in all children, and this, across all socioeconomic and racial/ethnic lines.

Specific Recommendations

As part of their regular check up, all children should have their BMI calculated and plotted yearly. In addition, the American Academy of Pediatrics recommends that Parents help promote a healthy eating and lifestyle by:
  • Offering nutritious snacks such as fruits, vegetables and low fat dairy foods
  • Encouraging their children's freedom to choose food, yet set appropriate limits
  • Promoting and fostering routine physical activity, at home, school or other child care settings
  • Limiting TV and video(screen) time to no more than 2 hours per day

Although prevention and early recognition is the best approach, overweight children and teenagers must be taken very seriously. Parents and other caretakers should be aware of the dangers of being overweight and be prepared to work with their doctor and other health professionals to help and support their children to lose weight and live and experience healthier lifestyles. Focusing on a healthy lifestyle rather than body image or habitus is key.

References:  BMI GUIDELINES AMERICAN ACADEMY OF PEDIATRICS- POLICY STATEMENTS