Childhood Obesity

What is childhood obesity?

Childhood obesity is a complex chronic (long-term) condition that happens when your child is above a healthy weight for their age, height and sex assigned at birth.

The medical definition of childhood obesity is having a body mass index (BMI) at or above the 95th percentile for age and sex in children aged 2 years and older.

Children’s BMI factors differ from adults. For children, BMI is age- and sex-specific because their body compositions naturally change as they age. Healthcare providers use special growth charts to assess a healthy BMI for children.

How common is childhood obesity?

Obesity is one of the most common childhood chronic conditions.

According to studies the U.S. Centers for Disease Control and Prevention (CDC) conducted from 2017 to 2020, obesity affected about 19.7% of children and adolescents aged 2 to 19 years in the United States. That’s about 14.7 million children and adolescents.

Childhood obesity affects the following age groups:

• 12.7% of children aged 2 to 5.
• 20.7% of children aged 6 to 11.
• 22.2% of adolescents aged 12 to 19.

Childhood obesity is more common among certain populations. It affects:

• 26.2% of Hispanic children.
• 24.8% of non-Hispanic Black children.
• 16.6% of non-Hispanic white children.
• 9.0% of non-Hispanic Asian children.

Lastly, having overweight and obesity are more common in children who:

• Live in poverty.
• Live in under-resourced communities.
• Are part of families that have immigrated.
• Experience discrimination or stigma.

What causes childhood obesity?

Childhood obesity is a complex condition that has many contributing factors.

Your child needs a certain amount of calories for growth and development. But when they take in more calories than they use, their body stores the extra calories as body fat (adipose tissue).

Several factors also affect how much food we eat, the type of food we eat and how our body uses that energy. Every child’s body — and situation — is unique. Some children are at a greater risk for weight gain than others. Obesity doesn’t develop from laziness or a lack of willpower.

Genetics and epigenetics

Genetic factors can increase the likelihood that your child will have obesity. Children whose biological parents or siblings have obesity may be more likely to develop the condition themselves. Studies show that various genes may contribute to weight gain. But not all children with a family history of obesity will develop it.

Epigenetics is the study of how your behaviors and environment can affect the way your genes work. People, including children, who experience adversity — like racism or violence — can have changes in their genes that affect their immune system and metabolism. These changes can increase your child’s risk for having obesity due to how their body uses energy.

Other epigenetic factors that may increase your child’s risk for having obesity include:

• Pre-pregnancy obesity of either or both biological parents.
• Gestational diabetes.
• Excessive weight gain in the birthing parent during pregnancy.

Family and home environment factors

Shared family behaviors and home environment factors can contribute to childhood obesity, including:

• The type of food parents and caregivers offer their children and how often.
• Having sugar-sweetened beverages.
• Eating larger portion sizes.
• Increased snacking behavior of highly processed foods.
• Dining out instead of cooking meals at home.
• Increased screen time.
• Lack of physical activity (sedentary behavior).
• Lack of quality sleep.
• Secondhand smoke exposure.
• Adverse childhood experiences (ACEs).

Social determinants of health

Social determinants of health (SDoHs) are the conditions in the environments where you’re born, live, learn, work and play that can affect your health.

Where your family lives can have a direct effect on your child’s risk of developing obesity. The foods and drinks that schools and daycare centers serve your child affect their eating patterns. They also contribute to the amount of physical activity your child gets every day. Other socioeconomic factors that contribute to childhood obesity include:

• The cost and accessibility of healthy food options.
• Proximity (closeness) of fast food.
• Transportation access.
• Your network or social support system.
• Limited access to recreational facilities or parks in your community, or other safe places to be active.

Cultural factors

Advertising for fast food restaurants and unhealthy foods and beverages can contribute to childhood obesity. Children see advertising for these foods through commercials on TV and advertisements online and in grocery stores.

Studies show that even a brief exposure to unhealthy food and beverage marketing targeted at children resulted in increased food intake during and after the exposure.

Other health conditions

Rarely, other health conditions may be a contributing factor to childhood obesity.

Hormonal imbalances that can contribute to childhood obesity include:

• Hypothyroidism.
• Hypothalamic tumor.
• Growth hormone deficiency.
• Cushing syndrome.

Rare genetic conditions that can contribute to childhood obesity include:

• Prader-Willi syndrome.
• Bardet-Beidl syndrome.
• Alstrom syndrome.
• Congenital leptin or PCSK1 deficiencies.

Some medications, like second-generation antipsychotics and corticosteroids, can also increase your child’s risk for having overweight and obesity.

What are the complications of childhood obesity?

Children who have obesity have a higher risk of developing various health conditions. The most common complications include:

• High blood pressure.
• High cholesterol (dyslipidemia).
• Insulin resistance, prediabetes and Type 2 diabetes.
• Nonalcohol-related fatty liver disease.

Other complications include:

• Asthma.
• Obstructive sleep apnea.
• Polycystic ovarian syndrome (PCOS).
• Depression.
• Joint pain.
• Blount’s disease.
• Heart disease.

In addition, children who have obesity are at a higher risk of experiencing:

• Bullying.
• Social isolation.
• Low self-esteem.

Children who have obesity are more likely to carry the condition over into adulthood.

Your child’s pediatrician will recommend tests to screen for these complications and will offer treatment plans if any of them arise.

How is childhood obesity diagnosed?

Pediatricians typically diagnose overweight and obesity at well-child checks. They use BMI-for-age growth charts to measure size and growth patterns in children.

A high BMI may be a sign of high body fat. BMI doesn’t measure body fat directly. But it alerts your child’s provider that your child may need more tests to see if excess body fat is an issue. BMI percentile cutoffs define a level above which your child may be more likely to develop weight-related health issues.

Your child’s pediatrician will do a physical exam and ask you questions about your child’s health history, behaviors and environment. They’ll likely order other tests, like blood or imaging tests, to check for possible underlying causes of obesity and/or any obesity-related health conditions.

What is the treatment for childhood obesity?

Your child’s healthcare provider will determine if your child’s health is at risk due to their weight. If this is the case, you may want to consider a formal treatment program.

Obesity treatment programs should have a variety of health professionals on the staff. The best programs may include:

• Pediatricians.
• Registered dietitians.
• Exercise physiologists or physical therapists.
• Family physicians.
• Nurse practitioners.
• Child psychologists.
• Psychiatrists.

Comprehensive obesity treatment typically includes:

• Providing intensive, long-term treatment.
• Evaluating and monitoring your child for obesity-related medical and psychological complications.
• Identifying and addressing social drivers of health (like access to affordable healthy foods).
• Using non-stigmatizing approaches to treatment that consider your child and family’s unique qualities and situation.
• Using motivational interviewing that addresses nutrition, physical activity and health behavior change.
• Setting holistic treatment goals, like those related to improving or resolving health complications and improving quality of life and self-image.
• Integrating intensive health behavior and lifestyle treatment (IHBLT) with weight loss medications and/or metabolic and bariatric surgery if necessary.
• Adjusting treatment to the ongoing and changing needs of your child and family.

Experts in childhood obesity highly recommend the use of intensive health behavior and lifestyle treatment (IHBLT). This treatment educates and supports families in nutrition and physical activity changes that promote long-term health.

IHBLT is most often effective when it:

• Happens face-to-face.
• Engages the whole family.
• Involves at least 26 hours of nutrition, physical activity and behavior change lessons over three to 12 months.

Can I prevent childhood obesity?

There’s no simple way to prevent childhood obesity. And it’s important to remember that preventing childhood obesity isn’t just your and your family’s responsibility — it’s the collective responsibility of federal and local governments, schools, communities and corporations. Several genetic and medication-based factors contribute to obesity as well. These factors are outside of your control.

One step you can take is to establish healthy eating habits and physical activity early. The eating habits your child picks up when they’re young will help them maintain a healthy lifestyle when they’re adults. If you’re unsure how to select and prepare a variety of foods for your family, ask your child’s healthcare provider. They can refer you to a registered dietitian for nutrition counseling. They can also point you in the direction of resources in your community that offer healthy food options.

Other recommendations for childhood obesity prevention include:

• Breastfeeding (chestfeeding) exclusively until around 6 months of age.
• Having fun physical activity daily.
• Limiting screen time to less than one to two hours per day.
• Avoiding sugar-sweetened beverages and limiting 100% fruit juice intake.

Check with your pediatrician for more information about these and other health-promoting recommendations.

How can I help my child with obesity?

The most important thing you can do to help your child is to focus on their health, not their weight. It’s very important that you support your child in their journey toward better health. Your child’s feelings about themselves are often based on your feelings about them. If you accept your child at any weight, they’ll be more likely to feel good about themselves. Avoid placing blame on your child, yourself or others.

It’s also important to talk to your child about their weight in a nonjudgmental way. You should allow your child to share their concerns with you. You can help your child by gradually changing your family's physical activity and eating habits. That way your entire family can benefit from new healthy behaviors.

There are many ways to involve the entire family, but increasing physical activity is especially important. Aim for your child to get at least one hour of regular physical activity each day. Some ways to accomplish this include:

• Lead by example: If your child sees that you’re physically active and having fun, they’re more likely to be active and stay active for the rest of their lives.
• Plan family activities: Plan activities that provide everyone in your family with exercise. These activities may include walking, biking or swimming.
• Be sensitive to your child’s needs: It’s important to help your child find physical activities they enjoy and that aren’t too difficult.
• Take a break from the screens: Try to reduce the amount of time your family spends doing stationary (sedentary) activities. This includes activities such as watching TV or playing video games. You should limit your child’s screen time to no more than two hours a day.
• Developing good sleep habits: Having a regular bedtime and keeping electronics out of your child’s bedroom can help promote healthy sleep.

Other approaches you can take to help your child include:

• Guide your family’s choices rather than dictate foods: Try to provide a wide variety of healthy foods in your house. This practice will help your child learn how to make their own healthy food choices.
• Involve your child in food shopping and preparing meals: These activities can help you teach your child about nutrition and provide them with a feeling of accomplishment. In addition, your child may be more willing to eat or try foods that they help prepare.
• Encourage your child to eat slowly: Your child can detect hunger and fullness better when they eat slowly.
• Eat meals together as a family as often as possible: Try to make mealtimes pleasant with conversation and sharing, not scolding or arguing. If mealtimes are unpleasant, your child may try to eat faster to leave the table as soon as possible. Then, they may associate eating with stress. Try to eat only in designated areas of your home, like the dining room or kitchen.
• Try not to use food to reward your child: When you use foods such as sweets as a reward, your child may assume these foods are better than other foods. For example, telling your child they’ll get a dessert if they eat all their vegetables sends the wrong message about vegetables.
• Monitor your child’s meals outside your home: Find out if your child’s school lunch program provides a balanced meal. If you can, pack your child’s lunch to include a variety of foods. When dining out at restaurants, choose healthier items and think about portion sizes.

When should my child see a healthcare provider?

It’s important to keep your child’s well-child appointments and to attend all appointments related to obesity treatment. Your child’s healthcare provider can support you and your child on their journey toward a healthy future.