Weighing In On Childhood Obesity

Note to My Readers

Obesity and weight loss in childhood is a complex topic and growing concern in families. Of all developed countries, the United States has the highest rates of overweight and obesity in the world (Harvard, 2017). As a nutrition professional I’ve asked myself, why are one in three American children overweight or obese? (American Heart Association, 2016). How can parents help their children struggling to lose weight?

In this blog post, I discuss the obesity promoting environment in America, current data and health risks, and how to encourage healthy behaviors without putting unhealthy pressure on children to lose weight. The end of the post contains easy-to-use tips for low stress weight loss strategies. Thank you for following the “Food Philosophers” and feel free to leave a comment after the references!

Controversy

In 2012, the state of Georgia sponsored a controversial media campaign addressing childhood obesity with billboards, commercials, and print ads displaying overweight and obese children and strong messages promoting weight loss. The “Strong4Life” series showed children such as a young girl with the quote “It’s hard to be a little girl if you’re not”, and a boy in a tight-fitting shirt with “Warning: Fat Prevention Begins at Home. And the Buffet Line,” plastered on posters (Lohr, 2012). The image to the right shows four of the controversial print ads (image credit: life360.com).

A particularly emotional television advertisement brings the viewer into an emergency room where a 32-year-old man is in critical condition after a heart attack. The video flashes back to the health choices he made throughout his young life from consuming fast food, drinking soft drinks, and developing diabetes with his parents modeling unhealthy behaviors. As a viewer, it is a difficult montage to watch as you are confronted with his obesogenic lifestyle that led to his life-threatening condition. You can view this short video here.

The goal of the controversial program was to confront parents about the rising obesity rates with 40% of Georgian children classified as overweight or obese in 2012 and 75% of their parents claiming they don’t have anything to worry about (Grinberg, 2012). Health professionals and families were not as receptive to the blatant weight loss messages and some found them ostracizing. Critics thought the messages may have caused additional stigma to obese children, while supporters felt the images were an essential wake-up call for parents and obese children (Lohr, 2012).

Rebecca Puhl, Director of weight stigma initiatives and research at the Yale University Rudd Center for Food Policy & Obesity said, “there seems to be this perception that it's OK to shame children and families struggling with obesity [to] provide an incentive to lose weight," (Grinberg, 2012). Puhl continued, "However, research in weight bias shows that when individuals feel shamed or stigmatized because of weight they're actually more likely to engage in behaviors that reinforce obesity: unhealthy eating, avoidance of physical activity, increased caloric intake."

Research following the campaign shows that from 2013 to 2015, obesity rates fell for low-income 2 to 4 year olds from 14.8% to 13.2% in Georgia (Kibbe, Vall, Green, Fitzgerald, Minyard, Cornett, 2016). The state has multiple programs addressing the obesity issues as the 17th highest ranked in the country and continues to implement programs such as a soda tax, Stong4Life, and the Georgia Shape physical activity and nutrition grants for schools to start wellness programs.

Obesity Facts

The two largest factors for growing overweight and obesity in children are: a. increased intake of foods that are high in sugar and fat, while simultaneously being low in vitamins and minerals and b. decreased physical activity (World Health Organization). The Academy of Nutrition and Dietetics published a position paper in 2013 outlining multi-component interventions involving behavioral and environmental priorities as the most effective for weight loss (Hoelscher, Deanna, Kirk, Shelley, Ritchie, Lorrene, Cunningham-Sabo, Leslie, 2013).

Decreased physical activity has been linked to increased sedentary entertainment activities. When we consider the amount of time children spend in front of the television, video games, cell phones, tablets, and computers it averages to about seven hours a day (American Academy of Pediatrics, 2017). Screen time has been linked to obesity through decreased time spent being active, more snacking while watching entertainment, targeted television ads with high sugar and fat content foods, decreased metabolism because of low activity (American Academy of Pediatrics, 2017).

As of 2016, 75% of American teenagers were using at least one social media site and the same percentage owned a personal cell phone. The risk of being overweight as an adolescent is 5 times greater with 5 or more hours of TV time than children who watch 0 to 2 hours and for children ages 4 to 9, watching just 1.5 hours of TV daily increases risk of obesity (American Academy of Pediatrics). To combat these issues the American Academy of Pediatrics recommends setting consistent limits on screen time and for parents to be digital role models.

Current eating patterns of Americans are assessed in the 2015-2020 USDA Dietary Guidelines. About 75% of the US population have an eating pattern too low in fruits, vegetables, dairy, and oils and 70% consume too much added sugar and saturated fats in their diet. The image to the right, from the new Dietary Guidelines, shows where added sugar is coming from in the US diet. Vegetable consumption relative to recommendations is lowest among boys ages 9 to 13 years and girls ages 14 to 18 years (Dietary Guidelines, 2015). The recommended dietary shifts in the next few years are to reduce intakes of added sugar and reduce solid fat intakes while increasing vegetables, fruits, and choosing whole grains.

The typical American eating pattern leads to overweight and obesity in children increasing risk of developing type 2 diabetes, high blood pressure, and elevated cholesterol levels (American Heart Association, 2016). Long term these conditions can lead to heart disease, chronic kidney disease, heart attacks, and death. There are also negative social implications associated with higher body mass indexes including low self-esteem, negative body image, and depression (American Heart Association, 2016).

Take Home

The Academy of Nutrition and Dietetics position paper outlines a great deal of recent pediatric obesity research and methods to promote healthy weights in children. The most important message from this 16-page paper is that overweight and obesity in childhood is not due to one culprit and cannot be solved by one person in the child’s life. Obesity is a systematic issue involving schools, the media, parents, and the child. To see an improved health status within American youth, dietary shifts, increased physical activity, behavioral counseling, and caregiver engagement are needed.

The focus of dietary efforts for obesity prevention and treatment should be on foods and eating patterns associated with risk of development of obesity as wells as family factors, sedentary activity, and physical activity. Foods that lead to higher weights include high caloric density products with little nutrient value i.e. soft drinks, fast food, and processed snack foods. During the ages of 2 to 5, parent involvement is critical and weight goals should be monitored. Children older than 6 years old with extreme obesity (over 99th percentile) may consider more intensive therapies such as structured nutrition prescriptions. Bariatric surgery in adolescents may be another option under the direction of a pediatrician and treatment care team.

Registered Dietitians and the child’s pediatrician need to work closely with parents and the child to develop appropriate strategies for healthy weight loss plans. As a parent, increasing physical activity by modeling an active lifestyle, encouraging outdoor play time, choosing healthy food options, and decreasing added sugars and high fat foods from your family’s diet are all helpful strategies in the home. Remember that carrying excess weight can cause self-esteem issues, so weight loss ought to be focused on the positive and not on punishment or seclusion (Academy of Nutrition and Dietetics, 2016). Healthy eating and physical activity should be fun and normalized in the family, at school, and socially.

5 Systematic Goals from the Academy of Nutrition and Dietetics

1. Make physical activity an integral and routine part of a child’s life

-encourage outdoor play time

-engage in family physical activities

2. Create food and beverage environments that ensure healthy food and beverage options are the simplest choice

-limit soft drinks and high calorie snacks in the home

-have a fruit bowl accessible for healthy snacking, cook more vegetables, and choose whole grains

3. Market healthy messages about physical activity and nutrition

-watch sports, the Olympics, and other entertainment promoting physical activity

-develop a screen time family plan and model limited digital media usage

4. Expand the role of health care providers, insurers, and employers in obesity prevention

-work with the pediatrician and dietitian to develop meal plans

5. Make schools a national focal point for obesity prevention

Tips for Childhood Weight Loss

References

American Academy of Pediatrics. 2017. Media and Children Communication Toolkit. Accessed October 3, 2017 via https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/Pages/Media-and-Children.aspx.

American Heart Association. 2016. Overweight in Children. Accessed October 3, 2017 via http://www.heart.org/HEARTORG/HealthyLiving/HealthyKids/ChildhoodObesity/Overweight-in-Children_UCM_304054_Article.jsp#.Wcsgq8iGM2w

Dietary Guidelines 2015-2020. 2015. United States Department of Agriculture. Accessed October 2017 via https://health.gov/dietaryguidelines/2015/guidelines/chapter-2/a-closer-look-at-current-intakes-and-recommended-shifts/

Grinberg, Emanuella. 2012. Georgia's child obesity ads aim to create movement out of controversy. CNN. Accessed October 3, 2017 via http://www.cnn.com/2012/02/07/health/atlanta-child-obesity-ads/index.html

Harvard. 2017. Obestiy Trends. Obestiy Prevention Source. Accessed October 3, 2017 via https://www.hsph.harvard.edu/obesity-prevention-source/obesity-trends/

Hoelscher, Deanna, Kirk, Shelley, Ritchie, Lorrene, Cunningham-Sabo, Leslie. 2013. Position of the Academy of Nutrition and Dietetics: Interventions for the Prevention and Treatment of Pediatric Overweight and Obesity. Academy of Nutrition and Dietetics. Accessed October 3, 2017 via http://www.eatrightpro.org/~/media/eatrightpro%20files/practice/position%20and%20practice%20papers/position%20papers/position-paper-pediatric-overweight-and-obesity.ashx

Kibbe, Vall, Green, Fitzgerald, Minyard, Cornett. 2016. Addressing childhood obesity in Georgia: Past, present, and future. J Ga Public Health Assoc (2016) Vol 5, No. 3. Accessed October 3, 2017 via https://www.gapha.org/wp-content/uploads/2016/03/197-203-Addressing-childhood.pdf.

Lohr, Kathy. 2012. Controversy Swirls Around Harsh Anti-Obesity Ads. National Public Radio. Accessed October 3, 2017 via http://www.npr.org/2012/01/09/144799538/controversy-swirls-around-harsh-anti-obesity-ads.

World Health Organization. 2017. Global Strategy on Diet, Physical Activity and Health. Accessed October 3, 2017 viahttp://www.who.int/dietphysicalactivity/childhood_why/en/

Image credit: Dietary Guidelines 2015-2020. 2015. United States Department of Agriculture. Accessed October 2017 via https://health.gov/dietaryguidelines/2015/guidelines/chapter-2/a-closer-look-at-current-intakes-and-recommended-shifts/

Image Credit: Georgia Strong4Life Ad Campaign from https://www.life360.com/blog/georgia-anti-obesity-campaign-helping-or-hurting/