September 20, 2019
A few months ago, I found myself in front of a patient who was four years old and weighed 140 pounds. I was dumbfounded. “What happened? How did we end up in this situation?” I wondered. More than sixty years ago, childhood obesity in the US had been unheard of. However, it has become increasingly prevalent over the past three decades. Since the 1976-1980 National Health and Nutrition Examination Survey (NHANES), pediatric obesity rates have tripled (1,2).
In the most recent NHANES data, 18.5% of children ages 2 to 19 and 39.6% of adults had obesity in 2015-2016. The proportion of obese 2 to 5 year-olds increased from 5% to 13.9%, the 6% to 11-year-olds from 6.5% to 18.4%, and the 12 to 19 year-olds from 5% to 20.6%. Data on the different subgroups showed obesity rates to be higher among the Latino children (25.8%) and Black children (22%) compared to White children (14.1%) and Asian children (11%). With regards to gender, boys are more likely to have obesity than girls (19.1% vs 17.8%). And as shown above, the prevalence of obesity increases with age(1,2).
The socioeconomic status is another contributory factor affecting obesity. The Centers for Disease Control (CDC) analyzed the 2011-2014 NHANES data by household income (£130%, >130% to £350%, and >350% of the poverty level) as well as head of household education level (high school graduate or less, some college, and college graduate). It found obesity to be lower in the highest income group (10.9%) than in the other groups (19.9% and 18.9%) and also lower in the highest education group (9.6%) than in the other groups (18.3% and 21.6%)(3,4,5,6).
Children who have obesity are at greater risk for certain diseases like type 2 diabetes and high blood pressure(7,8,9). Research also shows that children with obesity perform worse in school and have higher risk of bullying and depression(10). Those who are overweight or obese are more likely to be obese adults as well(11).
Our fight against the obesity epidemic starts at addressing childhood obesity. Afterall, if current trends continue, more than half of today’s children will have obesity by age 35 (12).It is encouraging to see some of the benefits of programs and policies aimed at this problem at the individual, community, and state levels(13). An intensive multi-sector program as shown in Texas can be successful at weight reduction among children in low-income communities(14,15). Another project (Healthy Communities Study) demonstrated that children living in localities that did more to encourage physical activity and healthy nutrition had lower body mass index and waist circumference measures(16). Likewise, the rates of obesity and severe obesity have decreased (from 15.9% in 2010 to 14.5% in 2014) among the 2 to 4 year-olds enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). This decrease was seen in 31 states and three U.S territories including some communities(17,18,19).
The obesity rates and the associated numbers can be quite daunting. However, we can all contribute and help prevent and treat childhood obesity. We can eradicate this disease. We should. We owe it to ourselves, our children, and to the future generations yet to come.
- Fryar CD, Carroll MD, and Ogden CL. “Prevalence of Overweight and Obesity Among Children and Adolescents: United States, 1963–1965 Through 2011–2012.” National Center for Health Statistics, September 2014. https://www.cdc.gov/nchs/data/hestat/obesity_child_11_12/obesity_child_11_12.pdf.
- Hales CM, Carroll MD, Fryar CD, et al. “Prevalence of obesity among adults and youth: United States, 2015–2016.” National Center for Health Statistics, Data Brief 288, 2017. https:// www.cdc.gov/nchs/products/databriefs/ db288.htm (accessed May 1, 2018).
- Wang Y, Zhang Q. Are American children and adolescents of low socioeconomic status at increased risk of obesity? Changes in the association between overweight and family income between 1971 and 2002. Am J Clin Nutr 2006;84:707–16. PubMed
- Singh GK, Kogan MD, Van Dyck PC, Siahpush M. Racial/ethnic, socioeconomic, and behavioral determinants of childhood and adolescent obesity in the United States: analyzing independent and joint associations. Ann Epidemiol 2008;18:682–95. CrossRef PubMed
- Ogden CL, Fakhouri TH, Carroll MD, et al. Prevalence of obesity among adults, by household income and education—United States, 2011–2014. MMWR Morb Mortal Wkly Rep 2017;66:1369–73. CrossRef PubMed
- Ogden CL, Lamb MM, Carroll MD, Flegal KM. Obesity and socioeconomic status in children and adolescents: United States, 2005–2008. NCHS Data Brief 2010;51:1–8. PubMed
- Pulgaron E, Delamater A. “Obesity and Type 2 Diabetes in Children: Epidemiology and Treatment.” Current Diabetes Reports, 14(8): 508, 2014. http://doi.org/10.1007/s11892- 014-0508-y
- Shrivastava S., Shrivastava P, Ramasamy J. “Childhood Obesity: A Determinant of Adolescent and Adult Hypertension.” International Journal of Preventive Medicine, 5(Suppl 1): S71–S72, 2014. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3990923/ (ac- cessed July 18, 2018).
- Llewellyn A, Simmonds M, Owen CG, Woolacott N. “Childhood obesity as a predictor of morbidity in adulthood: a systematic review and meta-analysis.” Obes Rev, 17: 56–67, 2016. doi: 10.1111/obr.12316.
- Carey FR, Singh GK, Brown HS, et al. “Educational outcomes associated with childhood obesity in the United States: cross-sectional results from the 2011–2012 National Survey of Children’s Health.” International Journal
- Frieden T, Dietz W, Collins S. “Reducing Childhood Obesity Through Policy Change: Acting Now To Prevent Obesity.” Health Affairs, 29(3), 2010. https://doi.org/10.1377/ hlthaff.2010.0039
- Ward Z, Long M, Resch S, et al. “Simulation of growth trajectories of childhood obesity into adulthood.” New England Journal of Medicine, 377(22): 2145–2153, 2017.
- Butte NF, Hoelscher DM, Barlow SE, Pont S, et al. “Efficacy of a Community– Versus Primary Care–Centered Program for Childhood Obesity: Texas CORD RCT”. Obesity, 25(9): 1584-1593, 2017. https://doi.org/10.1002/oby.21929
- Economos CD, Hammond RA. “Designing effective and sustainable multifaceted interventions for obesity prevention and healthy communities.” Obesity, 25(7): 1155–1156, 2017. https://doi.org/10.1002/oby.21893
- Frongillo EA, Fawcett SB, Ritchie LD, et al. “Community Policies and Programs to Prevent Obesity and Child Adiposity.” American Journal of Preventive Medicine, 53(5): 576-583, 2017.
- Pan L, Freedman DS, Sharma AJ, et al. “Trends in Obesity Among Participants
Aged 2–4 Years in the Special Supplemental Nutrition Program for Women, Infants, and Children—United States, 2000–2014.” Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report, 65: 1256–1260, 2016. https://www.cdc.gov/mmwr/volumes/65/ wr/mm6545a2.htm (accessed July 14, 2018).
- Pan L, Park S, Slayton R, et al. “Trends in Severe Obesity Among Children Aged 2 to 4 Years Enrolled in Special Supplemental Nutrition Program for Women, Infants, and Children From 2000 to 2014.” JAMA Pediatrics, 172(3): 232–238, 2018. https://www.ncbi.nlm.nih.gov/ pubmed/29309485 (accessed June 14, 2018).
- “Documented Declines in Childhood Obesity Rates.” Robert Wood Johnson Foundation, May 2018. https://stateofobesity.org/files/signs-of- progress-2017.pdf (accessed July 17, 2018).