20.9: Childhood and Adolescent Obesity

Children need adequate caloric intake for growth, and it is important not to impose very restrictive diets. However, exceeding caloric requirements regularly can lead to childhood obesity, which has become a significant problem in North America. Nearly one in three US children and adolescents are overweight or obese.

There are several reasons for this problem, including:

• larger portion sizes
• limited access to nutrient-rich foods
• increased access to fast foods and vending machines
• lack of breastfeeding support
• declining physical education programs in schools
• insufficient physical activity and a sedentary lifestyle
• media messages encouraging the consumption of unhealthy foods

Children who suffer from obesity are more likely to become overweight or obese adults. Obesity has a profound effect on self-esteem, energy, and activity level. It is a significant risk factor for many diseases later in life, including cardiovascular disease, Type 2 diabetes, stroke, hypertension, and certain cancers.

A percentile for body mass index (BMI) specific to age and sex determines if a child is overweight or obese. This is more appropriate than the BMI categories used for adults because children’s body composition varies as they develop and differs between boys and girls. If a child gains weight inappropriate to grow, parents and caregivers should limit energy-dense, nutrient-poor snack foods. It is also highly beneficial to increase a child’s physical activity and limit sedentary activities, such as watching television, playing video games, or surfing the Internet.

Programs to address childhood obesity can include behavior modification, exercise counseling, psychological support or therapy, family counseling, and family meal-planning advice. For most, the goal is not weight loss but instead allowing height to catch up with weight as the child grows. Rapid weight loss is not recommended for preteens or younger children due to the risk of deficiencies and stunted growth.

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