Childhood Obesity Causes and Treatments

Childhood obesity is a serious public health concern. In the United States, childhood obesity has more than tripled since 1980. Causes of childhood obesity include genetics, unhealthy eating patterns, low physical activity levels, and inadequate sleep.

Health risks associated with childhood obesity include asthma, sleep apnea, bone and joint problems, type 2 diabetes, high blood pressure, and more. Treatment involves lifestyle changes and behavior modifications.

Causes

There isn't one single cause of childhood obesity. Rather, a variety and combination of factors are at play. Several studies have investigated the reasons for increased rates of childhood obesity, with more studies ongoing. The following are contributing factors.

Lack of Physical Activity

Many studies show a sedentary lifestyle is a significant contributor to obesity.

• One study showed that adolescents who reported more than two hours of daily screen time were 1.8 times more likely to be obese or overweight.
• Watching television for two or more hours daily may be a key factor in the risk of developing heart and blood vessel diseases.
• Researchers have suggested that more time spent in front of the television is associated with poor food choices that lead to overweight and obesity.

The decline in physical education programs and the time allotted for physical activity during the average school day has also been implicated in the rise in childhood and adolescent obesity. 

In addition to obesity itself, lower levels of physical fitness tend to increase the risk of heart disease.

Unhealthy Eating Patterns

Poor nutrition choices of calorie-dense foods have also been linked to childhood obesity. Many studies have found a relationship between certain dietary behaviors, such as consuming sugary beverages, and obesity. 

The intake of sweetened drinks has received a lot of attention, and research has overwhelmingly pointed to an association between their intake and obesity, both in children and adults.

In addition, studies have shown that replacing sugar-containing beverages with noncaloric beverages reduces weight gain and fat accumulation in children. 

Keep in mind that the category of sugary beverages includes:

• Soft drinks (also called soda or soda pop)
• Fruit and juice drinks, including lemonade, fruit punch, and sweetened powdered drinks 
• Flavored waters
• Sports drinks
• Energy drinks
• Sweetened coffee drinks
• Sweetened tea drinks

The intake of sugary beverages has been deemed so hazardous to the health of children and such a major cause of obesity that several cities have placed extra taxes or warning labels on them.

Genetics

Genetic factors can also contribute to the development of childhood obesity. Many of these factors are just now being researched or discovered. For example, scientists have discovered that the FTO gene may contribute to binge eating and the development of obesity in adolescents.

Environmental Factors

Several environmental factors are thought to contribute to childhood obesity, including the following:

• Television commercials and other social media messaging promote unhealthy foods, sweet drinks, and eating habits.
• It is estimated that 40% to 50% of the money spent on food is spent on food eaten outside the home (at restaurants, cafeterias, sporting events, etc.). These venues offer larger portions than are eaten at home, contributing excessive calories.
• Children and adolescents who come from lower-income homes are at greater risk of obesity. Families who struggle financially often opt for convenience foods, which are higher in calories, fat, and sugar. Lower-income children cannot always afford to participate in sports or other extracurricular activities, resulting in less physical activity.
  

Inadequate Sleep

Studies show children who sleep less are more likely to be overweight or obese, and the risk increases with shorter sleep duration. A review of 17 studies found that children of all ages who slept less than the recommended amount had a 58% increased risk of being overweight or obese.

Stress

Personal stress may raise the risk of childhood obesity. One study examined how school-related stress affected weight in children 10 to 12 years old. Researchers found 27% of study participants were overweight or obese, and more than 80% of these children had a medium or high level of stress.

Stress can contribute to weight gain due to hormonal and behavioral changes. Stress can cause the body to release extra hormones, such as cortisol, insulin, and ghrelin. High levels of these hormones can cause feelings of increased hunger and may trigger cravings for foods high in fat and added sugar.

Mental Health Issues

Mental health and obesity are linked and have been shown to affect each other. Studies show that people with depression are more likely to develop obesity, and people with obesity are more likely to have depression.

In children, researchers have also found that those who experience adverse childhood experiences (ACEs) have a higher rate of overweight, obesity, and depression.

Medical Conditions

Certain medical conditions can contribute to weight gain in children. Examples include:

• Prader-Willi syndrome: An inherited condition, it causes feelings of hunger that can't be controlled and a slower metabolism that burns fewer calories than normal. Other symptoms include low levels of sex hormones and poor muscle tone.
• Cushing's syndrome: With this condition, the growth rate slows, but the rate of weight gain increases. Other characteristics include a moon face, acne, easily bruised skin, stretch marks, and fatigue or depression.
• Hypothyroidism: The thyroid gland doesn't produce enough of the thyroid hormones, which affects metabolism, slowed growth, and delayed development in children. 
• Down syndrome: Children with Down syndrome are more likely to develop obesity compared to their typically developing peers. Factors contributing to weight gain with Down syndrome include slower metabolism and other endocrine and metabolic disorders, including hypothyroidism. 

Medications

Certain medications that children may take are more likely to cause weight gain, such as:

• Antidepressants
• Steroids
• Birth control, including injected forms
• Diabetes medications
• Drugs for psychosis
• Anti-seizure medications
  

Health Risks

There are numerous and serious short-term and long-term health risks associated with obesity in children.

Children with obesity are more likely to have:

• Asthma
• Sleep apnea
• High blood pressure (hypertension)
• High blood cholesterol
• Increased risk for future cardiovascular disease (disease of the heart and blood vessels, including the blood vessels that supply the brain)
• Increased risk of developing type 2 diabetes
• Bone and joint problems
• Depression
• Anxiety
• Fatty liver disease (which has been associated with cirrhosis and liver cancer over time)

In one study, 70% of obese children had at least one additional cardiovascular risk factor, and 30% had two or more.

Finally, as many experts have noted, obesity or overweight in childhood often leads to obesity in adulthood.

How Obesity Is Defined in Children

For children aged two to 19 years, obesity is defined using body mass index (BMI). A BMI at or above the 95^th percentile for children of the same age and sex is classified as obesity. A BMI at or above the 85^th percentile but lower than the 95^th percentile is considered to fall into the overweight category.

For children who are younger than 2 years of age, there is currently no nationally recommended and agreed-upon definition for obesity.

Treating Childhood Obesity

Having a child receive a diagnosis of obesity is hard for any parent. If you are worried that your child may have an unhealthy weight, be sure to discuss your concern with your child's pediatrician and ask for help. They can provide strategies that can lead to weight loss and that are appropriate for your child and your situation.

Encourage physical activity. Physically active children have stronger muscles and bones, better cardiovascular fitness, and lower body fat than those who are inactive. Encourage regular physical activity by making it a family affair: Walk the family pet before and after school, ride bikes together, go to the playground, or sign them up for sports or dance. Active chores, such as washing the car, vacuuming, and raking leaves, also count.

Support healthy eating habits. As a parent, model healthy eating habits yourself and make healthy foods available at home. Offer a variety of fruits and vegetables throughout the day. Encourage them to eat a variety of vegetables and fruits, whole grains, lean protein foods, and low-fat and fat-free dairy products. Replace sugary drinks with water, 100% juice, or plain nonfat or low-fat milk.

Eat at home more often. Don’t underestimate the power of eating a home-cooked meal around the family table. Not only does this encourage quality time with your children, but studies have shown there are many health benefits to eating at home.

• One study found that people who ate an average of 11 to 14 lunches and dinners prepared at home each week had a 13% lower risk of developing obesity and type 2 diabetes compared with those who ate zero to six home-prepared lunches and dinners.
• In contrast, studies show meals cooked at home often have higher dietary quality. Researchers found children and adolescents consumed significantly higher intakes of protein, fiber, calcium, iron, folate, and vitamins A, B6, B12, C, and E.

Set a consistent sleep routine. Children who don't get enough sleep are at risk for unhealthy weight gain. Researchers are still learning how sleep is linked to weight gain, but two possibilities include a lack of sleep causing a child to eat more or to be less physically active because they're tired.

Reduce screen time. Too much screen time can lead to poor sleep, weight gain, lower grades in school, and poor mental health. Make a family screen time plan, such as limiting the amount of screen time. Turn off screens an hour before bed, and remove screens from children's bedrooms.

Other treatments. In addition to lifestyle changes, treatments may include anti-obesity medications and bariatric (weight-loss) surgery. While lifestyle changes are first-line therapy for everyone, this is especially true for children. Kids may experience greater side effects from medications or more invasive treatments. However, it is important to discuss all the possibilities and best options for your child with their pediatrician.

Summary

Childhood obesity is a serious public health concern. There are many causes of childhood obesity, including unhealthy eating patterns, low physical activity levels, genetics, inadequate sleep, and more. There are numerous health risks associated with childhood obesity, such as asthma, sleep apnea, bone and joint problems, and chronic health conditions.

Treatment involves lifestyle changes, behavior modifications, and sometimes medications or surgery. Talk with your child's healthcare provider if you need support to help your child manage their weight.