Body mass index (BMI) is not necessarily an accurate measurement for overweight or obesity, since it does not distinguish lean mass from fat mass. An athlete, for example, may have a high BMI but is does not have obesity because his/her body weight is muscle.
However, a child’s body composition varies as he or she ages. Obesity is instead assessed as an age- and sex-specific percentile for BMI, plotted on a curve, in children and adolescents aged 2 to 19 years. A BMI above the 85th, but lower than the 95th percentile signals overweight; a child with a BMI at or above the 95th percentile is considered to have obesity.
The incidence of overweight and obesity in Americans has seen a sharp increase in the past 30 years.
Before the obesity epidemic, teenagers with diabetes had almost always had type 1, or the insulin-dependent form. However, 30% of adolescents diagnosed with diabetes now have type 2, or the insulin-resistant form, which typically affects older adults.
Obesity is more than merely an aesthetic problem. Don’t pass off obesity in a child as something the child will outgrow. Children with obesity tend to become adults with obesity (often more severe), with a higher risk of developing other health problems, as well as premature death—the same risks faced by adults, only earlier.
The path to obesity may start early. Interestingly, breastfeeding protects children from developing obesity. However, although 75% of mothers breastfeed, just 13% of infants rely on breast milk alone after 6 months.
In addition, children and adolescents with obesity, already at a vulnerable age, face psychological and social issues, including low self-esteem, discrimination, depression, anxiety, and loneliness—problems that can follow them into their adult years. And they are especially subject to bullying, regardless of socioeconomic status, sex, race, academic achievement, or certain other factors. A study published in Pediatrics in 2010 found that parents of children with obesity rated bullying as their top health concern.
Negative attitudes can persist into adulthood, too. Weight-based stereotypes abound, leading to prejudice, stigma, and discrimination of adults with obesity in the workplace and other areas of living—even among family. Moreover, several studies have shown that weight stigma can actually increase the risk of unhealthy eating habits and lower the level of physical activity, therefore, compounding the problem. Children with obesity who are teased about their weight are more likely to binge on food and engage in other unhealthy behaviors.
Steps to Manage Weight Without Medication
The management of adult and pediatric obesity is similar.
Increase physical activity.
Parents should encourage healthy habits.
Medications should be used only when the above measures don’t improve the problem or other conditions coexist. Surgery is a last resort and, in children with obesity, is appropriate only in a handful of cases.
American Association of Clinical Endocrinologists/American College of Endocrinology. AACE/ACE Consensus Conference on Obesity: Building an Evidence Base for Comprehensive Action. March 23-24, 2014. Washington, DC.
https://www.aace.com/sites/all/files/consensus/obesity/slides/Question-1-What-is-Obesity.pdf. Accessed March 20, 2015.
Centers for Disease Control and Prevention. Adult Obesity Statistics. Updated September 9, 2014. www.cdc.gov/obesity/data/prevalence-maps.html. Accessed March 20, 2015.
Centers for Disease Control and Prevention. Vital Signs: Adult Obesity. Updated August 3, 2010. www.cdc.gov/vitalsigns/AdultObesity/#Whatcanbedone. Accessed March 20, 2015.
Centers for Disease Control and Prevention. Overweight and Obesity: Adult Obesity Facts. Updated September 9, 2014. www.cdc.gov/obesity/data/adult.html. Accessed March 20, 2015.
Centers for Disease Control and Prevention. Defining Overweight and Obesity. Reviewed April 27, 2012. www.cdc.gov/obesity/adult/defining.html. Accessed March 20, 2015.
Centers for Disease Control and Prevention. Obesity in Children. Reviewed April 27, 2012. www.cdc.gov/obesity/childhood/basics.html. Accessed March 20, 2015.
Centers for Disease Control and Prevention. A Growing Problem. Reviewed April 17, 2013. www.cdc.gov/obesity/childhood/problem.html. Accessed March 20, 2015.
Kaufman FR, Lustig RH, Vigersky R, eds. Preventing and Managing Pediatric Obesity: A Parent’s Guide. Hormone Health Network. December 2008. www.hormone.org. Accessed March 20, 2015.
Lumeng JC, Forrest P, Appugliese DP, Kaciroti N, Corwyn RF, Bradley RH. Weight status as a predictor of being bullied in third through sixth grades. Pediatrics. 2010;125(6):e1301-e1307. http://pediatrics.aappublications.org/content/125/6/e1301.long. Accessed March 20, 2015.
Puhl RM, Heuer CA. Obesity stigma: important considerations for public health. Am J Public Health. 2010;100(6):1019-1028. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2866597/. Accessed March 20, 2015.
The State of Obesity. Cost Containment and Obesity Prevention. http://stateofobesity.org/cost-containment/. Accessed March 20, 2015.