• Despite its toll taken in death and disability, obesity does not receive the attention it deserves from government, the health care profession or the insurance industry.

• Research is severely limited by a shortage of funds.
• Inadequate insurance coverage limits access to treatment.

• Discrimination and mistreatment of persons with obesity is widespread and often considered socially acceptable.

Severe obesity has long-term effects on you and others

Fact: Mortality risks associated with severe obesity have been estimated at 6 to 12 times greater than that of a normal-weight population.
Source: Kenler, et al, American Journal of Clinical Nutrition

Today's youth are considered the most inactive generation in history caused in part by reductions in school physical education programs and unavailable or unsafe community recreational facilities. In the U.S., only the state of Illinois requires daily physical education for students in grades K to 12.

Many adverse health effects associated with overweight are observed in children and adolescents. Overweight during childhood and particularly adolescence is related to increased morbidity and mortality in later life.

Many parents are rightly concerned about their child's weight and how it affects them. They look for specific answers for prevention and treatment options. Unfortunately, the state of the science is a lot less precise than we would like. Are kids too concerned about their weight? What are the best strategies for prevention? What treatments work over a long time? Researchers are trying to answer those and many other questions. In many cases, common sense works well.

In situations where there are serious health, psychological or social problems, parents should seek out the best possible advice.

Modifiable causes include:

• Physical Activity - Lack of regular exercise.

• Sedentary behavior - High frequency of television viewing, computer usage, and similar behavior that takes up time that can be used for physical activity.

• Socioeconomic Status - Low family incomes and non-working parents.

• Eating Habits - Over-consumption of high-calorie foods. Some eating patterns that have been associated with this behavior are eating when not hungry, eating while watching TV or doing homework.

• Environment - Some factors are over-exposure to advertising of foods that promote high-calorie foods and lack of recreational facilities.

Non-changeable causes include:

• Genetics - Greater risk of obesity has been found in children of obese and overweight parents.

Prevalence and Identification

About 15.5 percent of adolescents (ages 12 to 19) and 15.3 percent of children (ages 6 to 11) are obese. The increase in obesity among American youth over the past two decades is dramatic, as shown in the tables below.

A measurement called percentile of Body Mass Index (BMI) is used to identify overweight and obesity in children and adolescents. The Centers for Disease Control (CDC), the supplier of national growth charts and prevalence data, avoids using the word "obesity" for children and adolescents. Instead, they suggest two levels of overweight: 1) the 85^th percentile, an "at risk" level, and 2) the 95^th percentile, the more severe level.

The American Obesity Association uses the 85^th percentile of BMI as a reference point for overweight and the 95^th percentile for obesity.

Prevention of Morbid Obesity in Children

Teaching healthy behaviors at a young age is important since change becomes more difficult with age. Behaviors involving physical activity and nutrition are the cornerstone of preventing obesity in children and adolescents. Families and schools are the two most critical links in providing the foundation for those behaviors.

Families coping with Morbid Obesity in Children

Parents are the most important role models for children. Results from an American Obesity Association survey show that:

• The majority of parents in the U.S. (78 percent) believe that physical education or recess should not be reduced or replaced with academic classes.

• Almost 30 percent of parents said that they are "somewhat" or "very" concerned about their children's weight.

• 12 percent of parents considered their child overweight.

• Comparing their own childhood health habits to their children's, 27 percent of parents said their children eat less nutritiously, and 24 percent said their children are less physically active.

• 35 percent of parents rated their children's school programs for teaching good patterns of eating and physical activity to prevent obesity as "poor," "non-existent," or "don't know."

• Among six choices of what they believed to be the greatest risk to their children's long-term health and quality of life, 5.6 percent of parents chose "being overweight or obese." More parents selected other choices as the greatest risk: alcohol (6.1 percent), sexually transmitted disease (10 percent), smoking (13.3 percent), violence (20.3 percent), and illegal drugs (24 percent).

• In terms of their own behavior, 61 percent of parents said that it would be either "not very difficult" or "not at all difficult" to change their eating and/or physical activity patterns if it would help prevent obesity in any of their children.

Create an Active Environment:

• Make time for the entire family to participate in regular physical activities that everyone enjoys. Try walking, bicycling or rollerblading.

• Plan special active family-outings such as a hiking or ski trip.

• Start an active neighborhood program. Join together with other families for group activities like touch-football, basketball, tag or hide-and-seek.

• Assign active chores to every family member such as vacuuming, washing the car or mowing the lawn. Rotate the schedule of chores to avoid boredom from routine.

• Enroll your child in a structured activity that he or she enjoys, such as tennis, gymnastics, martial arts, etc.

• Instill an interest in your child to try a new sport by joining a team at school or in your community.

• Limit the amount of TV watching.

Create a Healthy Eating Environment:

• Implement the same healthy diet (rich in fruits, vegetables and grains) for your entire family, not just for select individuals.

• Plan times when you prepare foods together. Children enjoy participating and can learn about healthy cooking and food preparation.

• Eat meals together at the dinner table at regular times.

• Avoid rushing to finish meals. Eating too quickly does not allow enough time to digest and to feel a sense of fullness.

• Avoid other activities during mealtimes such as watching TV.

• Avoid foods that are high in calories, fat or sugar.

• Have snack foods available that are low-calorie and nutritious. Fruit, vegetables and yogurt are some examples.

• Avoid serving portions that are too large.

• Avoid forcing your child to eat if he/she is not hungry. If your child shows atypical signs of not eating, consult a healthcare professional.

• Limit the frequency of fast-food eating to no more than once per week.

• Avoid using food as a reward or the lack of food as punishment.

Health Risks, Diagnosis and Treatment

Determining if a child or adolescent has a weight problem can be challenging. How do you know if the excess weight your child has is part of the natural growth process, and will your child just "grow out of?" How do you know if your child's weight may be negatively affecting his or her health?

Health Risks of Morbid Obesity

Along with the rise in childhood obesity, there has been an increase in the incidence and prevalence of medical conditions in children and adolescents that had been rare in the past. Pediatricians and childhood obesity researchers are reporting more frequent cases of obesity-related diseases such as type 2 diabetes, asthma and hypertension that once were considered adult conditions.

Diagnosing Morbid Obesity

There are some signs that may help you determine if your child has or is at risk for childhood obesity, such as:

• Family history of obesity.

• Family history of obesity-related health risks such as early cardiovascular disease, high cholesterol, high blood pressure levels, type 2 diabetes.

• Family history of cigarette smoking and sedentary behaviors.

• Signs in the child of obesity-related health risks from a pediatrician's evaluation including:

  • Cardiac Risk Factors. Studies of children with obesity show higher than average blood pressure, heart rate and cardiac output when compared to children without obesity.

  • Type 2 Diabetes Risk Factors. This involves glucose intolerance and insulin levels that are higher than average.

  • Orthopedic Problems. Some symptoms include weight stress in the joints of the lower limbs, tibial torsion and bowed legs, and slipped capital femoral epiphysis (especially in boys).

  • Skin disorders. Some are heat rash, intertrigo, monilial dermatitis and acanthosis nigricans.

  • Psychological / Psychiatric Issues. Poor self-esteem, negative self-image, depression, and withdrawal from peers have been associated with obesity.

• Patterns of sedentary behavior (such as too much television viewing) and low physical activity levels.

• Taller height - children with obesity are often above the 50th percentile in height.

• Smoking initiation. Research studies show that youngsters use smoking as a method of weight control. Parents, pediatricians and schools should work together to discourage smoking as a weight control behavior for three main reasons: a) smoking is not likely to be successful in controlling weight, b) smoking is itself harmful, and c) smoking is associated with a decrease in sound nutrition and physical activity patterns.