Overweight and Obesity in Children

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KEY POINTS

• Children who are overweight or have obesity weigh more than what is healthy for their body type. Overweight and obesity increase your child’s risk for diabetes, asthma, sleep disorders, and other health problems. These children and teens may also face fat shaming, bullying, and self-esteem issues.
• Treatment for overweight or obesity will include lifestyle changes such as a making healthy food choices and getting regular physical activity. If your child has trouble with stress, depression, or anxiety, your child’s healthcare provider may refer your child to a therapist.
• Support and encourage your child. Work with your child's healthcare provider, dietitian, or therapist to find the right plan for a healthy weight for your child.

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What is overweight and obesity?

Children who are overweight or have obesity weigh more than what is healthy for their body type.

Overweight or obesity increases your child’s risk of poor health and major illness, including:

• Diabetes
• High cholesterol
• High blood pressure
• Gallbladder disease
• Sleep disorders
• Asthma

Being overweight or having obesity can also cause your child to be self-conscious about his or her looks or to be teased or bullied. They are at increased risk for depression and substance abuse. Sometimes the pressure from parents and other adults to lose weight causes children to react too strongly. They may think too much about weight, which can lead to an eating disorder.

Another problem is that children who are overweight or have obesity often become overweight adults.

What is the cause?

Several things can cause overweight or obesity.

• Eating more food than the body uses: Your child gets energy (calories) from food eaten. Eating more calories than the body uses means that the extra energy is stored as fat.
• Not getting enough physical activity: Watching TV, using a computer or smartphone, or playing video games for hours every day and not getting physical activity regularly contribute to weight gain. Children who are overweight or have obesity may burn fewer calories than children who are not because it is harder to be physically active.
• Not getting enough sleep: Children who do not get enough quality sleep are at increased risk for gaining weight.
• Metabolism: Children who are overweight or have obesity may use less energy when they are at rest than people who are not overweight or obese.
• Family history: Inherited genes can affect your child's weight. Children whose parents are overweight or have obesity are 10 times more likely to become overweight or have obesity. Unhealthy family eating habits may also be a reason several members of a family are overweight or have obesity.
• Emotions: Depression, anger, anxiety, and stress are emotional problems that can lead to eating more and getting less physical activity.
• Hormone imbalances: Rarely, having an underactive thyroid gland can lead to weight gain and can make losing weight difficult.
• Medicines: Some medicines, such as birth control pills or medicines to treat depression or other behavioral health issues, can cause weight gain.

What are the symptoms?

Putting on too much weight is the first sign that your child may be at risk for overweight or obesity. You may notice that your child's clothing is getting too tight. As your child gains weight, he or she may have symptoms caused by overweight or obesity. These symptoms include:

• Shortness of breath when your child is physically active or having more trouble than other children who are the same age
• Trouble sleeping
• Symptoms of sleep apnea, which include stopping breathing for a short time during sleep and feeling tired during the day
• Pain in the joints and muscles, especially the back, knees, and ankles
• Rashes that develop where the skin rubs together and traps moisture
• Irregular periods in girls

Overweight or obesity increases the risk that your child will have health problems as an adult that may include gallbladder, heart, or liver disease. These children and teens may also face fat shaming, bullying, and self-esteem issues.

How is it diagnosed?

Your child’s healthcare provider will ask about your child’s symptoms and examine your child. Your child’s provider will ask about your child’s medical history, eating habits, and physical activity. Your child may have blood tests to check for hormone problems.

Your child’s healthcare provider will check your child's height and weight against standard growth charts. The body mass index, or BMI, is a measure of weight at a given height, and is used in both adults and children. In children age 2 through 20, BMI charts are used to compare BMI with a peer group.

These growth charts, one for boys and one for girls, help to check weight through the growing years. BMI most accurately shows whether your child is underweight, normal, or overweight. Your child's BMI is compared with that of thousands of children of the same age. This comparison will show what percentile of BMI your child is in.

Overweight is BMI greater than the 85% of BMI for your child's age.

Obesity is usually defined as BMI greater than 95% of BMI for your child's age.

Growth charts are only one part of a larger picture that takes into account your child's medical history and current health. Your child’s healthcare provider can tell you if your child has an increased risk of health problems because of weight. Your child’s provider can also help find a healthy weight program that works for your child.

How is it treated?

Treatment for overweight or obesity will include lifestyle changes. Dietitians and healthcare providers can help you design a safe, healthy, effective program for your child to have a healthy weight.

Healthy meal plan

In general, a healthy meal plan for a healthy weight is one that:

• Includes a lot of fruits, vegetables, whole grains, and beans
• Includes lean meats, poultry, fish, eggs or egg whites, nuts, seeds, and soy foods
• Is low in saturated fats, trans fats, cholesterol, salt, and added sugars

Physical activity

Physical activity is an important part of a successful program for a healthy weight. Almost any activity that involves mild to moderate exertion is good. Your child may choose to walk, jog, swim, cycle, or do aerobics. Walking is a great way for almost everyone to be more active. Using a pedometer can be fun and motivating. A pedometer is a device that attaches to clothing and tracks how many steps your child takes in a day.

Strength training will make your child’s muscles stronger and able to work longer without getting tired. Strength training, or weight training, means doing exercises that build muscle strength. To build muscle, your child can lift free weights, use weight machines, use resistance bands, or use bodyweight such as when doing push-ups, pull-ups, or sit-ups. Check with your child's healthcare provider before your child starts a strength training program.

Ask your child’s healthcare provider what kinds and amounts of physical activity might be right for your child.

Emotions

Some children eat to cope with emotional problems. If your child has trouble with stress, depression, or anxiety, your child’s healthcare provider may refer your child to a therapist. Your child needs to learn how to deal with emotional problems to succeed with a healthy weight program.

Other treatments

If hormone imbalances are contributing to excess weight, which happens rarely, your child’s provider may prescribe medicine to treat the imbalance. Claims have been made that certain herbal and dietary products help with weight loss. Many of these claims are not true. Some supplements can have serious side effects. Talk to your child’s healthcare provider before you allow your child to use herbal and dietary supplements.

Rarely, weight loss medicine may be recommended for some older teens. Bariatric surgery may be a treatment option for older teens with severe obesity and other medical conditions who have not been able to lose weight with other methods.

How can I help my child?

Parents often do not think that their child is overweight or has obesity. Even if they know their child is heavier than other children, parents may think that the child will simply grow out of it. However, if a child is overweight or has obesity, it is often due to unhealthy eating and physical activity habits. Those habits are not likely to change unless parents act.

If several people in your family have diabetes or weight problems, your child is at higher risk. Making healthy lifestyle changes as a family helps everyone. Make one or two changes at a time and let children adjust. Making big changes in meal planning or lifestyle is not easy. Sometimes just eliminating sugary drinks and starting a physical activity program will be enough to help your child have a healthy weight.

Some tips to help your child:

• Use the MyPlate method to teach your children how to eat a balance of healthy foods in the right amounts. Divide a 9-inch plate into portions for vegetables, grains and starches, and proteins. This helps you to choose foods for breakfast, lunch, and dinner. Fill half of the plate with nonstarchy vegetables. The other half of the plate should be split evenly. In one section, put starches including whole grains and starchy vegetables such as potatoes. The last section is for proteins such as lean meat, beans, lentils, tofu, and eggs. Fruit or a cup of low-fat or skim milk or yogurt on the side is OK.
• Make sure your child eats a healthy breakfast every day. Skipping breakfast can leave your child hungry, tired, and likely to eat unhealthy foods and bigger amounts of food later in the day.
• Let your child help plan meals and shop for groceries. Show your child how to read a nutrition label. This helps your child learn and make his or her own decisions about new foods to try. Buy and serve more fruits and vegetables and fewer soft drinks and snack foods.
• Serve low-fat milk, sugar-free drinks, or water instead of a sugary drink. Sugary drinks can add an extra 500 or more calories per day. Don’t keep sugary drinks in the house.
• Keep healthy snacks on hand. Snacks such as chips, cookies, and candy are high in fat and calories. Don’t keep unhealthy snacks in the house.
• Don't use food as a reward or withhold food as punishment.
• Your child should not be put on a strict meal plan unless under the care of a healthcare provider or dietitian. A meal plan that is too strict can interfere with normal growth.
• Encourage your child to be physically active 60 minutes or more every day. Children who are overweight, have obesity, or not used to physical activity need to start slowly. It is always best to check with your child's healthcare provider before starting a physical activity program. Plan activities with your child that include skating, biking, running, or walking. Give your child active chores such as washing the car, vacuuming, or cleaning windows.
• It’s hard to be active when your child spends a lot of time sitting in front of a screen such as when watching TV, using a computer or smartphone, or playing video games. Try to keep screen time to 2 hours or less per day, not including what your child needs to do for school. It is important to turn screens off during meals. Kids who eat with a screen on make worse food choices and eat more.
• Most children like learning on the computer. Although too much computer time is not good, there are kid friendly websites and programs that provide fun ideas to get kids moving and eating healthier.
• Support and encourage your child. Children know when they are overweight or have obesity and don't want to be nagged about it. It's important for your child to know that you love and accept your child at any weight. Look for weight-loss support groups in your community. Support from other children can help motivate your child.
• BAM! Body and Mind (https://www.cdc.gov/healthyschools/bam/teachers.htm) gives kids 9 to 13 years old the information they need to make healthy lifestyle choices.
• Keep your appointments with your child’s healthcare provider, dietitian, or therapist. They can guide you and help keep your child motivated.