Childhood obesity is a serious medical condition that affects children and adolescents. It occurs when a child is well above the normal weight for his or her age and height.
Childhood obesity is particularly troubling because the extra pounds often start children on the path to health problems that were once confined to adults, such as diabetes, high blood pressure and high cholesterol. Childhood obesity can also lead to poor self-esteem and depression.
One of the best strategies to reduce childhood obesity is to improve the diet and exercise habits of your entire family. Treating and preventing childhood obesity helps protect the health of your child now and in the future.
Not all children carrying extra pounds are overweight or obese. Some children have larger than average body frames. And children normally carry different amounts of body fat at the various stages of development. So you might not know just by looking at your child if his or her weight is a health concern.
Your child's doctor can help you figure out if your child's weight could pose health problems using growth charts and, if necessary, other tests.
When to see a doctor
If you're worried that your child is putting on too much weight, talk to his or her doctor. Your child's doctor will consider your child's history of growth and development, your family's weight-for-height history, and where your child lands on the growth charts. This can help determine if your child's weight is in an unhealthy range.
Lifestyle issues — too little activity and too many calories from food and drinks — are the main contributors to childhood obesity. But genetic and hormonal factors may play a role as well. For example, recent research has found that changes in digestive hormones can affect the signals that let you know you're full.
Though not common, there are also genetic diseases and hormonal disorders that can make a child prone to obesity.
Many factors — usually working in combination — increase your child's risk of becoming overweight:
- Diet. Regularly eating high-calorie foods, such as fast foods, baked goods and vending machine snacks, can easily cause your child to gain weight. Soft drinks, candy and desserts also can cause weight gain.
- Lack of exercise. Children who don't exercise much are more likely to gain weight because they don't burn as many calories. Too much time spent in sedentary activities, such as watching television or playing video games, also contribute to the problem.
- Family factors. If your child comes from a family of overweight people, he or she may be more likely to put on weight. This is especially true in an environment where high-calorie foods are always available and physical activity isn't encouraged.
- Psychological factors. Some children overeat to cope with problems or to deal with emotions, such as stress, or to fight boredom. Their parents may have similar tendencies.
- Socioeconomic factors. People in some communities have limited resources and little access to supermarkets. As a result, they may opt for convenience foods that don't spoil quickly, such as frozen meals, crackers and cookies. In addition, people who live in lower income neighborhoods may not have access to safe places to exercise.
Childhood obesity can have complications for your child's physical, social and emotional well-being.
- Type 2 diabetes. Type 2 diabetes is a chronic condition that affects the way your child's body uses sugar (glucose). Obesity and a sedentary lifestyle increase the risk of type 2 diabetes.
- Metabolic syndrome. Metabolic syndrome isn't a disease itself, but a cluster of conditions that can put your child at risk of developing heart disease, diabetes or other health problems. This cluster of conditions includes high blood pressure, high blood sugar, high triglycerides, low HDL ("good") cholesterol and excess abdominal fat.
- High cholesterol and high blood pressure. Your child can develop high blood pressure or high cholesterol if he or she eats a poor diet. These factors can contribute to the buildup of plaques in the arteries. These plaques can cause arteries to narrow and harden, which can lead to a heart attack or stroke later in life.
- Asthma. Children who are overweight or obese may be more likely to have asthma.
- Sleep disorders. Obstructive sleep apnea is a potentially serious disorder in which a child's breathing repeatedly stops and starts when he or she sleeps. It can be a complication of childhood obesity.
- Nonalcoholic fatty liver disease (NAFLD). This disorder, which usually causes no symptoms, causes fatty deposits to build up in the liver. NAFLD can lead to scarring and liver damage.
- Early puberty or menstruation. Being obese can create hormone imbalances that may cause puberty to start earlier than expected.
Social and emotional complications
- Low self-esteem and bullying. Children often tease or bully their overweight peers, who suffer a loss of self-esteem and an increased risk of depression as a result.
- Behavior and learning problems. Overweight children tend to have more anxiety and poorer social skills than normal-weight children have. At one extreme, these problems may lead overweight children to act out and disrupt their classrooms. At the other, they may cause overweight children to socially withdraw.
- Depression. Low self-esteem can create overwhelming feelings of hopelessness in some overweight children. When children lose hope that their lives will improve, they may become depressed. A depressed child may lose interest in normal activities, sleep more than usual or cry a lot. Some depressed children hide their sadness and appear emotionally flat instead. Either way, depression is as serious in children as in adults.
Your child's family doctor or pediatrician will probably make the initial diagnosis of childhood obesity. If your child has complications from being obese, you may be referred to additional specialists to help manage these complications.
Because appointments can be brief, and there's often a lot of ground to cover, it's a good idea to be well-prepared for any appointments you have with your child's health care team. Here's some information to help you get ready for your appointment and know what you can expect.
What you can do
- Be aware of any preappointment restrictions. If your doctor is going to test your child's blood sugar or cholesterol, your child may need to fast for eight to 12 hours. When you're making an appointment, ask if any type of fasting is necessary.
- Write down any symptoms your child is experiencing, including any that may seem unrelated.
- Ask a family member or friend to join you, if possible. Managing childhood obesity requires you to retain a lot of information, and it can sometimes be difficult to remember all of the information provided during an appointment.
- Bring a notebook and a pen or pencil to write down important information.
- Write down questions to ask your doctor.
- Bring any growth measurements you may have recorded at home to show your child's doctor.
- Also bring the weights of siblings and parents.
- Record a typical week of meals that your child eats to show your child's doctor.
Your time with your doctor is limited, so preparing a list of questions can help you make the most of your time together. List your questions from most important to least important in case time runs out. For childhood obesity, some basic questions to ask your doctor include:
- What other health problems might my child have?
- What are the treatment options for my child?
- Are there medications that might help manage my child's weight and other health conditions?
- How long will treatment take?
- What can I do to help my child lose weight?
- Are there any brochures or other printed material that I can take home with me?
- What websites do you recommend visiting?
In addition to your prepared questions, don't hesitate to ask additional questions that may come up during your child's appointment.
What to expect from your doctor
During the appointment, your child's doctor or other health provider is likely to ask you a number of questions about your child's eating, activity, mood and thoughts, and any symptoms your child might have. You may be asked such questions as:
- What does your child eat in a typical day?
- How much activity does your child get in a typical day?
- What are the factors that you believe affect your child's weight?
- What diets or treatments, if any, have you tried to help your child lose weight?
- Do you have any family members with weight problems?
- Are you ready to make changes in your family's lifestyle to help your child lose weight?
- What do you think might prevent your child from losing weight?
- How often does the family have meals together? Does the child help prepare the food?
- Does the child, or family, eat while watching TV or using a computer?
What you can do in the meantime
If you have several days or weeks before your child's scheduled appointment, start keeping a record of what your child eats and how much he or she exercises.
As part of regular well-child care, the doctor calculates your child's body mass index (BMI) and determines where it falls on the BMI-for-age growth chart. The BMI helps indicate if your child is overweight for his or her age and height.
Using the growth chart, your doctor determines your child's percentile, meaning how your child compares with other children of the same sex and age. For example, you might be told that your child is in the 80th percentile. This means that compared with other children of the same sex and age, 80 percent have a lower weight or BMI.
Cutoff points on these growth charts, established by the Centers for Disease Control and Prevention, help identify overweight and obese children:
- BMI-for-age between 85th and 94th percentiles — overweight
- BMI-for-age 95th percentile or above — obesity
Because BMI doesn't consider things like being muscular or having a larger than average body frame and because growth patterns vary greatly among children, your doctor also factors your child's growth and development into consideration. This helps determine whether your child's weight is a health concern.
In addition to BMI and charting weight on the growth charts, the doctor also evaluates:
- Your family's history of obesity and weight-related health problems, such as diabetes
- Your child's eating habits
- Your child's activity level
- Other health conditions your child may have
Your child's doctor may order blood tests if he or she finds that your child is obese. These tests may include:
- A cholesterol test
- A blood sugar test
- Other blood tests to check for hormone imbalances
Some of these tests require that your child not eat or drink anything before the test. Your child's doctor should tell you whether your child needs to fast before a blood test and for how long.
Treatment for childhood obesity is based on your child's age and if he or she has other medical conditions. Treatment usually includes changes in your child's diet and level of physical activity. In certain circumstances, treatment may include medications or weight-loss surgery.
Treatment for overweight children
The American Academy of Pediatrics recommends that children over the age of 2 and adolescents whose weight falls in the overweight category be put on a weight-maintenance program to slow the progress of weight gain. This strategy allows the child to add inches in height but not pounds, causing BMI-for-age to drop over time into a healthier range.
Treatment for obese children
Children ages 6-11 who are obese may be put on a diet for gradual weight loss of no more than 1 pound (or about 0.5 kilogram) a month. Older children and adolescents who are obese or severely obese may be put on a diet that aims for weight loss of up to 2 pounds (or about 1 kilogram) a week.
The methods for maintaining your child's current weight or losing weight are the same: Your child needs to eat a healthy diet — both in terms of type and amount of food — and increase his or her physical activity. Success depends largely on your commitment to helping your child make these changes.
Parents are the ones who buy groceries, cook meals and decide where the food is eaten. Even small changes can make a big difference in your child's health.
- When food shopping, choose fruits and vegetables. Cut back on convenience foods — such as cookies, crackers and prepared meals — which are often high in sugar, fat and calories. Always have healthy snacks available.
- Limit sweetened beverages. This includes those that contain fruit juice. These drinks provide little nutritional value in exchange for their high calories. They also can make your child feel too full to eat healthier foods.
- Limit fast food. Many of the menu options are high in fat and calories.
- Sit down together for family meals. Make it an event — a time to share news and tell stories. Discourage eating in front of a screen — such as a TV, computer or video game — which can lead to fast eating and lowered awareness of how much you're eating.
- Serve appropriate portion sizes. Children don't need as much food as adults do. Allow your child to eat until he or she is full, even if that means leaving food on the plate. And remember, when you eat out, those portion sizes are often significantly oversized.
A critical part of achieving and maintaining a healthy weight, especially for children, is physical activity. It not only burns calories but also builds strong bones and muscles and helps children sleep well at night and stay alert during the day. Good habits established in childhood help adolescents maintain healthy weight despite the hormonal changes, rapid growth and social influences that often lead to overeating. And active children are more likely to become fit adults.
To increase your child's activity level:
- Limit TV and recreational computer time to no more than 2 hours a day. A good way to increase your child's activity levels is to limit the number of hours he or she is allowed to watch TV each day. Other sedentary activities — playing video and computer games or talking on the phone — also should be limited.
- Emphasize activity, not exercise. Children should be moderately to vigorously active for at least an hour a day. Your child's activity doesn't have to be a structured exercise program — the object is just to get him or her moving. Free-play activities — such as playing hide-and-seek, tag or jump-rope — can be great for burning calories and improving fitness.
- Find activities your child likes to do. For instance, if your child is artistically inclined, go on a nature hike to collect leaves and rocks that your child can use to make a collage. If your child likes to climb, head for the nearest neighborhood jungle gym or climbing wall. If your child likes to read, then walk or bike to the neighborhood library for a book.
In some situations, medication may be prescribed for adolescents as part of an overall weight loss plan. Only one prescription weight-loss drug is available in the U.S. for adolescents. Orlistat (Xenical) prevents the absorption of fat in the intestines. The risks of taking a prescription medication over the long term are unknown, and the medication's effect on weight loss and weight maintenance for adolescents is still questioned.
Weight-loss surgery may be an option for severely obese adolescents who have been unable to lose weight using conventional weight-loss methods. However, as with any type of surgery, there are potential risks and long-term complications. Also, the long-term effects of weight-loss surgery on future growth and development are largely unknown.
Weight-loss surgery in adolescents is uncommon. But your doctor may recommend this surgery if your child's weight poses a greater health threat than do the potential risks of surgery. It's important that a child being considered for weight-loss surgery meet with a team of pediatric specialists, including a pediatric endocrinologist.
Weight-loss surgery isn't a miracle cure. It doesn't guarantee that an adolescent will lose all of their excess weight or that they'll be able to keep it off long term. It's also important to keep in mind that surgery doesn't replace the need for following a healthy diet and getting regular physical activity.
Your child's best chance to achieve and maintain a healthy weight is to start eating a healthy diet and exercising more. Here are some steps you can take at home to help your child succeed:
- Be a role model. Choose healthy foods and active pastimes for yourself. If you need to lose weight, doing so will motivate your child to do likewise. Children are good learners and they often mimic what they see.
- Involve the whole family. Make healthy eating a priority and emphasize how important it is for the whole family to be physically active. This avoids singling out the child who is overweight.
Parents play a crucial role in helping children who are obese feel loved and in control of their weight. Take advantage of every opportunity to build your child's self-esteem. Don't be afraid to bring up the topic of health and fitness but do be sensitive that a child may view your concern as an insult. Talk to your kids directly, openly, and without being critical or judgmental.
In addition, consider the following advice:
- Be sensitive to your child's needs and feelings. Becoming active is an important lifestyle change for your child to make, but your child is more likely to stick to those changes if you let him or her choose what physical activities he or she is comfortable with.
- Find reasons to praise your child's efforts. Celebrate small, incremental changes but don't reward with food. Choose other ways to mark your child's accomplishments, such as going to the bowling alley or a local park.
- Talk to your child about his or her feelings. Help your child find ways to deal with his or her emotions that don't involve eating.
- Help your child focus on positive goals. For example, point out that he or she can now bike for more than 20 minutes without getting tired or can run the required number of laps in gym class.
- Be patient. Many overweight children grow into their extra pounds as they get taller. Realize, too, that an intense focus on your child's eating habits and weight can easily backfire, leading a child to overeat even more or possibly making him or her more prone to developing an eating disorder.
Whether your child is at risk of becoming overweight or currently at a healthy weight, you can take proactive measures to get or keep things on the right track. Here are some key points to remember:
- Limit your child's consumption of sugar-sweetened beverages
- Provide plenty of fruits and vegetables
- Eat meals together as a family as often as possible
- Limit eating out, especially at fast food restaurants
- Adjust portion sizes appropriately for age
- Limit TV and other "screen time" to less than 2 hours a day
Also, be sure your child sees the doctor for well-child checkups at least once a year. During this visit, the doctor measures your child's height and weight and calculates his or her BMI. An increase in your child's BMI or in his or her percentile rank over one year is a possible sign that your child is at risk of becoming overweight.
April 10, 2015
- About BMI for children and teens. Centers for Disease Control and Prevention. http://www.cdc.gov/healthyweight/assessing/bmi/childrens_BMI/about_childrens_BMI.html. Accessed Feb. 27, 2015.
- Understanding childhood obesity. American Heart Association. http://www.heart.org/HEARTORG/GettingHealthy/WeightManagement/Obesity/Childhood-Obesity_UCM_304347_Article.jsp. Accessed Feb. 27, 2015.
- Normal childhood nutrition & its disorders. In: Hay WW, et al. Current Diagnosis & Treatment: Pediatrics. 2nd ed. New York, N.Y.: The McGraw-Hill Companies; 2014. http://www.accessmedicine.com/. Accessed Feb. 27, 2014.
- Huang JS, et al. Childhood obesity for pediatric gastroenterologists. Journal of Pediatric Gastroenterology and Nutrition. 2013;56:99.
- Klish WJ. Definition; epidemiology; and etiology of obesity in children and adolescents. http://www.uptodate.com/home. Accessed Feb. 27, 2015.
- Barlow SE, et al. Expert committee recommendations regarding the prevention, assessment and treatment of child and adolescent overweight and obesity: Summary report. Pediatrics. 2007;120:S164.
- Currie C, et al. Is obesity at individual and national level associated with lower age at menarche? Evidence from 34 countries in the Health Behaviour in School-aged Children Study. Journal of Adolescent Health. 2012;50:621.
- Keeping children at a healthy weight: A review of the research on ways to avoid becoming overweight or obese. Agency for Healthcare Research and Quality. http://effectivehealthcare.ahrq.gov/search-for-guides-reviews-and-reports/?pageaction=displayproduct&productID=1714. Accessed Feb. 17, 2015.
- Skelton JA. Management of childhood obesity in the primary care setting. http://www.uptodate.com/home. Accessed Feb. 27, 2015.
- Petjar R, et al. Pharmacological management of obese child. Archives of Diseases in Childhood Education and Practice Edition. 2013;98:108.
- Sherafat-Kazemzadeh R, et al. Pharmacotherapy for childhood obesity: Present and future prospects. International Journal of Obesity. 2013;37:1.
- Braet C, et al. The assessment of eating behaviour in children who are obese: A psychological approach. A position paper from the European childhood obesity group. Obesity Facts. 2014;7:153.
- Klish WJ. Clinical evaluation of the obese child and adolescent. http://www.uptodate.com/home. Accessed March 2, 2015.
- Media and children. American Academy of Pediatrics. https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/pages/media-and-children.aspx. Accessed March 2, 2015.
- Klish WJ. Comorbidities and complications of obesity in children and adolescents. http://www.uptodate.com/home. Accessed March 3, 2015.
- Papoutsakis C, et al. Childhood overweight/obesity and asthma: Is there a link? A systematic review of recent epidemiologic evidence. Journal of the Academy of Nutrition and Dietetics. 2013;113:77.
- Helping your overweight child. Weight-control Information Network. http://win.niddk.nih.gov/publications/over_child.htm#d. Accessed March 25, 2015.
- Barlow SE, et al. Expert Committee Recommendations Regarding the Prevention, Assessment, and Treatment of Child and Adolescent Overweight and Obesity: Summary Report. American Academy of Pediatrics. Pediatrics. 2007;120:S164.
- Fitch A, et al. Prevention and management of obesity for children and adolescents. Bloomington, Minn.: Institute for Clinical Systems Improvement; 2013.