This week I was on Arizona’s Channel 3 News discussing how childhood obesity may be exacerbated by the pandemic. Of course this was a news story and provided no insight into how parents can help their children. So today, we will talk about how you can prevent or reverse childhood obesity. 

As of 2018 childhood obesity (age 2-19) hit a high of 18.5% nationally, becoming the number 1 disease of childhood. 

CDC, June 24, 2019

What does this mean for children? 

It means children are being faced with diabetes, high cholesterol, hypertension, heart disease, cancers, and even sleep apnea. Pediatricians are talking to children and their families about adult onset diseases… something pediatricians hoped would not be at the top of their diagnoses. 

Not only are obese children being faced with chronic disease, but they are dealing with mental health disorders. The social stigma, and their body mass tends to lower their self esteem and increase depression and anxiety. Obesity creates roadblocks in a child’s life. Hindering their physical and mental growth. 

Now, before we determine causes and ways to improve childhood obesity, we must first understand what it is.

Understanding the diagnosis of Childhood Obesity

The most common tools used to diagnose obesity is BMI. BMI uses a calculation based on weight and height to determine whether a person is underweight, normal weight, overweight, or obese. The tool is limited when a patient is muscular or taller than average. Otherwise, if you’re an average height and are not an athlete or chronic gym bug, the BMI is a great tool to use to determine your risk factors. 

In children we look at growth charts and compare the BMI of the average child, to your child’s BMI. 

If a child’s BMI is above the 95th percentile that means they are heavier than 95% of all children of the same age. And at that point they are considered obese. 

Figure 1: Pediatric BMI chart

Now as a primary care provider I look at other factors, such as weight for age, height for age, and your child’s visual appearance to determine if the BMI is indeed accurate. BMI is accurate most, if not all of the time, in children. 

What Causes Childhood Obesity?

Multiple factors lead to childhood obesity; there is no 1 cause. Each of the following factors play a role in childhood obesity… but all of these factors affect one thing, what the child is eating or their diet. 

The Following Factors May Cause Childhood Obesity

1. The Child’s Eating Schedule and Food Intake AKA Their Eating Patterns
   
   These patterns are always determined by parents and any other adult caring for the child. This is the area you must work on in order to change your child’s health. Below are some habits obese children tend to follow:
   1. Being required or feeling inclined to finish all of their food; even when full.
   2. Skipping breakfast and potentially overeating at lunch time. 
   3. Overeating snacks; such as chips, candy, or dessert.
   4. The constant availability of soda and juice; children decide to drink soda or juice instead of water leading to more calories and less nutrients. 
      
2. Environmental factors
   1. TV/media – TV ads show happy kids drinking bright red juice and eating crunchy chips increasing the happy hormones in their little brains. Fast food offers large meals with high calories and low nutrients that are marketed to children on TV.
   2. Parental influence – Children tend to want to be like their parents, therefore it is important to display good habits when around your children.
   3. Friends – Children want to impress friends who are at school, and will brag about unhealthy and tasty foods their parents buy them.
      
3. Lack of Physical Activity
   1. PE is no longer required at a majority of schools, leading to less physical activity among children.
   2. Kids have shifted to electronics at home preventing them from playing out doors.
      
4. Genetics
   In this case, genetics does not necessarily mean the child cannot avoid this disease. It means they are at high risk of obesity because mom and/or dad are obese. Sure children tend to be obese just like their parents BUT the kids are being taught to eat the same foods. Therefore is this genetics or just parents passing down the same eating patterns? I would say both.
   
5. Family Income AKA Socioeconomic Status
   Low income families have a few things working against them
   1. Lack of education: Those who go to college or have parents who went to college, are more likely to have learned about basic nutrition and exercise recommendations, therefore they can pass these ideas to their children.
   2. Low income & jobs with long hours leads to families purchasing convenience foods which are not necessarily cheaper but require no meal prep. These foods tend to be high in calories. 
      
      As income increases, children still suffer from obesity. Due to more access to food, and more electronics at home. Also, parents with more income tend to rely on convenience foods as well. Therefore, no child is immune to childhood obesity.

Figure 2: How New Food Products and Marketing Correlates With BMI

How Do We Treat Childhood Obesity?

Step One: Clinicians Must Talk To The Parents

Clinicians must let families know, in the most gentle way possible, that a child’s body mass is elevated and what this means for the child’s risk.

Many times clinicians forget to mention these children are now at risk for chronic disease such as diabetes, high cholesterol, high blood pressure, etc. These things must be mentioned. Adults tend to understand the concept of chronic disease more than they do obesity. 

Step Two: Parents Must Consult with a Nutritionist For Help

A nutritionist will educate the child and the parents on nutrition and health. The parents will learn about ways to express the importance of healthy eating to their child by following up with a nutritionist. It is okay to say “I don’t know”, and allow your nutritionist to guide you.

Nutritionists may also discuss behaviors that may be causing the child’s obesity, and ways to improve these behaviors – such as scheduling the child’s meals and physical activity.

Step Three: Monitor child’s eating habits at home

• Parents should watch the child’s eating patterns while at home. Sure you will not have control over habits that the child has when at school or a friends house, but you can teach them good habits when they are home. 
• Ask yourself what pattern is my child following, are they eating 3x daily, 4x, or 5x daily?
• When they do eat, what are they eating?
• When they do drink, what are they drinking?
• Consider buying a watch with an alarm for your child, to help them schedule eating times.

Step Four: Use the plans set by your child’s nutritionist to improve your child’s eating patterns.

For example, if your nutritionist recommends your child eats only 3 x per day with 1 snack between each meal. Consider scheduling the meals for your child. Consider discussing this with your child in a nice and gentle way. Keep your child in the loop, so they feel like they are responsible and confident with your guidance.  

And lastly, consider daily discussions with your family about their eating patterns for the day. Ask everyone what they ate for lunch and breakfast. Discuss whether each meal was packed with nutrients or lacking nutrients. Consider games, and even prizes for who ate the most fruit or veggies for the day.

Children are trained to enjoy food via media and social relationships so they may feel punished at first. Check with your child and be sure they are doing okay during this transition.

As with any habit, it will take about 30 days for your child to form a new habit. So as a parent, set up a 30 day challenge for your child and yourself, and make it a fun!

As always if you have questions moving forward feel free to contact us.

Your’s Truly,