What is the incidence of obesity in children and adolescents in the United States?

Results from the 2011-2012 National Health and Nutrition Examination Survey (NHANES), using measured heights and weights, indicate that 8.4% of children age 2 to 5 years, 17.7% of children age 6 to 11 years, and 20.5% of children age 12 to 19 years are obese. Overall, 16.9% of children are considered obese (BMI >95th percentile on CDC growth chart) and 14.9% of children are considered overweight (BMI between 85th and 95th percentile on CDC growth chart).

This most recent data shows that the incidence of obesity in children and adolescents has tripled over the past 25 years. Children have fewer weight-related health and medical problems than adults; however, overweight children are at high risk of becoming overweight adolescents and adults, placing them at risk of developing chronic diseases such as heart disease and diabetes later in life.

What causes children to become overweight?

Children become overweight for a variety of reasons. The most common causes are genetic factors ("runs in the family"), lack of physical activity, unhealthy eating patterns, or a combination of these factors. Only in rare cases is being overweight caused by a medical condition such as an endocrine disorder. A physical exam and some blood tests will rule out the possibility of a medical condition.

Although weight problems run in families, not all children with a family history of obesity will be overweight. Children whose parents or brothers or sisters are overweight may be at an increased risk of becoming overweight themselves, but this can be attributed to shared family behaviors such as eating and activity habits. Genetic factors can increase the likelihood that a child will be overweight.

A child's total diet and activity level play an important role in determining a child's weight. Today, many children spend a lot time being inactive. For example, the average child spends approximately 24 hours each week watching television. As computers and video games grow further in popularity, this number of hours of inactivity may only increase.

How do I know if my child is overweight?

The best person to determine whether or not a child is overweight is the child's doctor. If you think that your child is overweight, it is important to arrange an appointment with the child's doctor. In determining whether or not a child is overweight, the doctor will measure the child's weight and height to determine if his or her weight is within a healthy range. The doctor will also consider the child's age and growth patterns. Assessing obesity in children can be difficult because children can grow in unpredictable spurts. For example, it is not unusual for boys to gain weight and they may appear overweight, but they may grow taller and thus "into the weight" later on.

If my child is overweight, in what ways can I help?

If your child is overweight, it is very important that you allow him or her to know that you will be supportive. Children's feelings about themselves often are based on their parents' feelings about them and if you accept your children at any weight, they will be more likely to feel good about themselves. It is also important to talk to your children about their weight, allowing them to share their concerns with you.

It is not recommended that parents set children apart because of their weight. Instead, parents should focus on gradually changing their family's physical activity and eating habits. By involving the entire family, everyone is taught healthful habits and the overweight child does not feel singled out.

There are many ways to involve the entire family, but increasing the family's physical activity is especially important. Some ways to accomplish this include the following suggestions::

  • Lead by example. If your children see that you are physically active and having fun, they are more likely to be active and stay active for the rest of their lives.
  • Plan family activities that provide everyone with exercise, like walking, biking, or swimming.
  • Be sensitive to your child's needs. Overweight children may feel uncomfortable about participating in certain activities. It is important to help your child find physical activities that they enjoy and that aren't embarrassing or too difficult.
  • Make an effort to reduce the amount of time you and your family spend in sedentary activities, such as watching TV or playing video games.

Whatever approach parents choose to take, the purpose is not to make physical activity and healthy eating a chore, but to make the most of the opportunities you and your family have to be active.

Develop healthy eating habits

Another essential step that can help not only your overweight child but your entire family is to teach them healthy eating habits. The eating habits your children pick up when they are young will help them maintain a healthy lifestyle when they are adults.

One of the most important approaches to eating is cutting down on fat intake. Simple ways to accomplish this include eating low-fat or nonfat dairy products, poultry without skin and lean meats, low-fat or fat-free breads and cereals, and calorie-free or sugar-free juices.

If you are unsure about how to select and prepare a variety of foods for your family, ask a physician or registered dietitian for nutrition counseling.

It is important that you do not place your child on a restrictive diet. Children should never be placed on a restrictive diet to lose weight, unless a doctor supervises one for medical reasons.

Other approaches parents can take in helping their overweight child include:

  • Guide your family's choices rather than dictate foods. Make a wide variety of healthful foods available in the house. This practice will help your children learn how to make healthy food choices.
  • Encourage your child to eat slowly. A child can detect hunger and fullness better when eating slowly.
  • Eat meals together as a family as often as possible. Try to make mealtimes pleasant with conversation and sharing, not a time for scolding or arguing. If mealtimes are unpleasant, children may try to eat faster to leave the table as soon as possible. They then may learn to associate eating with stress.
  • Involve children in food shopping and preparing meals. These activities offer parents hints about children's food preferences, teach children about nutrition, and provide children with a feeling of accomplishment. In addition, children may be more willing to eat or try foods that they help prepare.
  • Plan for snacks. Continuous snacking may lead to overeating, but snacks that are planned at specific times during the day can be part of a nutritious diet, without spoiling a child's appetite at meal times. You should make snacks as nutritious as possible, without depriving your child of occasional treats such as chips or cookies, especially at parties or other social events.
  • Discourage eating meals or snacks while watching TV. Try to eat only in designated areas of your home, such as the dining room or kitchen. Eating in front of the TV may make it difficult to pay attention to feelings of fullness, and may lead to overeating.
  • Try not to use food to punish or reward your child. Withholding food as a punishment may lead children to worry that they will not get enough food. For example, sending children to bed without any dinner may cause them to worry that they will go hungry. As a result, children may try to eat whenever they get a chance. Similarly, when foods, such as sweets, are used as a reward, children may assume that these foods are better or more valuable than other foods. For example, telling children that they will get dessert if they eat all of their vegetables sends the wrong message about vegetables.
  • Make sure your child's meals outside the home are balanced. Find out more about your school lunch program, or pack your child's lunch to include a variety of foods. Also, select healthier items when dining at restaurants. Be mindful of large portion sizes when eating out. Be a good example for your children and take half of the meal home for a second meal.

Should I consider enrolling my child in a weight-loss program?

If your efforts at home are unsuccessful in helping your child reach a healthy weight and your physician determines that your child's health is at risk unless he or she loses weight steadily, you may want to consider a formal treatment program.

Look for the following characteristics when choosing a weight-control program for your child. The program should:

  • Be staffed with a variety of health professionals. The best programs may include registered dietitians, exercise physiologists, pediatricians or family physicians, and psychiatrists or psychologists.
  • Perform a medical evaluation of the child. Before being enrolled in a program, your child's weight, growth, and health should be reviewed by a physician. During enrollment, your child's weight, height, growth, and health should be monitored by a health professional at regular intervals.
  • Focus on the whole family, not just the overweight child.
  • Be adapted to the specific age and capabilities of the child. Programs for 4-year-olds are different from those developed for children 8 or 12 years of age in terms of degree of responsibility of the child and parents.
  • Focus on behavioral changes.
  • Teach the child how to select a variety of foods in appropriate portions.
  • Encourage daily activity and limit sedentary activity, such as watching TV.
  • Include a maintenance program and other support and referral resources to reinforce the new behaviors and to deal with underlying issues that contributed to the child becoming overweight.