Obesity, a serious health problem that affects an alarming number of US teens and children, is complex. In 2017 and 2018, obesity rates increased more than three times, from 5% to 19%. They hovered around 5% between 1963 and 1965. Early data suggest that childhood obesity rates have increased during the pandemic. These trends will continue, and 57% of children aged 2-19 will be obese by 2050.
This means that more than half the children in America are at higher risk of developing high blood pressure, diabetes, heart disease, liver disease, or other complications associated with obesity. Obesity stigma is often associated with depression, stress, and low self-esteem. The American Academy of Pediatrics (AAP) recently updated the clinical practice guidelines to help with treating obese children and teens.
Childhood obesity is a result of a complex interplay.
Obesity is a long-held stigma. Experts once believed that if people ate less and exercised more, they wouldn’t be obese. The medical evidence is more complex than that. Genetic, physiologic, and socioeconomic factors can cause obesity in children.
- Calories, foods. Exercising too often and eating unhealthy food can lead to obesity. Many families are unable to access healthy food like fresh vegetables and fruits. Many children are limited to unhealthy food choices, such as fast and processed foods. Not all schools have healthy options. Even when their families have the resources to eat healthy food, they often feel overwhelmed.
- Get active. Many children live in areas where they cannot exercise or have the time or money to take them to activities.
- Other factors that influence obesity. Prenatal risk factors such as maternal weight gain and gestational diabetes can increase the likelihood of a child being born with diabetes. Our understanding of genetic factors is only beginning. Many can be affected by the environment. Systemic racism and deeply embedded socioeconomic factors can sometimes play a part. Obesity is complex.
Discuss your child’s health with the doctor.
According to the new guidelines, your doctor should:
- Regularly screen for obesity. It uses the body mass index (BMI). This calculation takes into account a child’s weight and height. It is not based on an adult’s age, which is calculated purely based on the number. Although it’s not perfect, it is the best that we have. Obesity is defined as a BMI more significant than the 95th percentile.
- See the whole picture if a child is losing too much weight for his age or is overweight. What is the location of your family? What is your socioeconomic standing? What information can you share about your beliefs, daily living, school, ethnic background, community connections, and other matters? Willingness to change your lifestyle. This, as well as family medical history, is important when it comes down to help create a plan.
- Describe treatment options. IHBLT is the best evidence-based treatment. Face-to-face, multidisciplinary, family-based counseling on nutrition and exercise, which is preferably located in your local community and linked to community resources, is what this involves. It should take at least 26 hours and be done throughout 3 to 12 months to make a real difference. Unfortunately, these programs are only readily available for some families.
What happens if IHBLT isn’t available?
The new guidelines suggest that pediatricians consult when a complete program is impossible.
- Regularly visit obese children. They do their best to understand all contributing factors and promote strategies that are endorsed by professional organizations, such as:
- Reduce sugar-sweetened beverages
- myplate.gov offers suggestions and recipes.
- Engage children in moderate-to-vigorous physical activity for 60 minutes per day
- They are finding ways to prevent inactivity (sedentary behavior), such as limiting screen time and encouraging active gaming.
- Take into consideration medications. Many weight-loss drugs have been approved for children. All of them have modest benefits and can’t replace lifestyle changes.
- Think about surgery. For teens and children with severe obesity (a BMI of 120th percentile or more), bariatric surgery could offer the best long-term results. Although we tend to view this as an option only for adults, there is growing evidence that it can and should be considered sooner.
