If you are the parent of an obese child, the information on this page is designed to help you understand more about childhood obesity in general and it’s prevalence, whilst also providing some useful insights on treatment.
Childhood Obesity Statistics
Childhood obesity is a serious problem with important health and social consequences. Statistics show that obesity rates in children began to rise in the UK in the mid-1980s, but there has been a rapid escalation in the last 10 years.
Current statistics for the UK suggest the prevalence of obesity in children is at least four times higher today than it was 30 years ago. In 2008, the Health Survey for England showed:
- 31% of boys aged 2-15 years were overweight/obese
- 29% of girls aged 2-15 years were overweight/obese
- International comparisons confirm that these UK numbers are amongst the highest rates in Europe
Childhood obesity is different from obesity in adults in various ways. The most obvious difference is that children and adolescents need to grow. During puberty, adolescents will double their weight and increase their height by 20%. This will have consequences for the diagnosis of childhood obesity, and also the management strategies for its prevention and treatment. To compound the problem, studies suggest that many parents simply don’t recognise the problem in their children. In one report, 71% of participating parents with overweight or obese toddlers misperceived their child’s weight, identifying it as either a healthy weight or even lighter than a healthy weight.
We are drawing from official NHS Statistics and we have confidence in them. For the sake of balance, however, it’s important to point out that there are voices who argue that the prevalence of childhood obesity is not as widespread as claimed in the media and that the official statistics are distorted to inflate the numbers.
Our view is not to argue about the stats. It is for you to take a view on whether your child is obese and what steps you want to take. If you have a child who has been overweight for many years, they are bitterly unhappy, they may be suffering diminished health and they are obese by any adult measure (i.e. they may be 17 stone and 5 ft tall), this page is aimed at you. Whether it addresses 1% or 25% of children are unimportant to us as we focus instead on individual children/families and the solutions they may explore.
The Causes of Childhood Obesity
It is commonly assumed that today’s children consume more “junk” foods than ever before and that this over-consumption is the main cause of the current epidemic of childhood obesity. Furthermore, the press and media have encouraged the widespread belief that food advertising to children has an adverse effect on children’s food preferences and purchasing behaviour. There are, however, compelling arguments to resist both these claims.
Firstly, evidence suggests that consumption of fatty or sugary foods may not be the primary factor in determining child obesity. Research studies do not show a consistent association between dietary fat or sugar and obesity in young children. Moreover, the current obesity epidemic appears to be taking place against a background of declining calorie intake in children, especially younger children.
Secondly, despite media assertions to the contrary, there is no good evidence that TV advertising has a substantial influence on children’s food consumption and, consequently, no reason to believe that a complete ban on advertising for certain foods (which some politicians and lobbyists have demanded) would have any useful impact on childhood obesity rates. This conclusion is supported by experience from Quebec where, although food advertising to children has been banned since 1980, childhood obesity rates are no different from those in other Canadian provinces.
A similar advertising ban has existed in Sweden for over a decade, but again this has not translated into a reduction in the rates of child obesity.
One of the latest plans is for councils to ban food takeaways in a bid to stop children from eating junk food.
If an increase in calorie intake is not the cause of childhood obesity, then we have to look for an alternative explanation. There are, in fact, good reasons for regarding the current epidemic of childhood obesity as primarily a problem of energy expenditure rather than energy intake. In other words, children are becoming fatter not because they eat too much, but because they are less physically active.
Today, children expend about 600 calories per day less in physical activity than 50 years ago and evidence confirms that the sedentary lifestyle is well established even in pre-school children. Watching television and playing computer games contribute to this, and there has been a large increase in car journeys undertaken on behalf of children. This increasingly sedentary environment contributes greatly to the problems of childhood obesity.
It’s important to stress here that there is a growing consensus that individuals are not to be ‘blamed’ for their overweight and obesity. Recent research at Cambridge University has shown that our genes determine whether we are pre-disposed to be under, normal or overweight. You can read more about this study here (link to our blog or post or the article on genes). It’s important to stress that the research does not say that there is nothing we can do about our weight if we have the ‘wrong’ genes, but it does say it will be harder for some people to maintain a healthy weight, regardless of their environment, simply because of the genes they were born with.
Defining Childhood Obesity
The most common measure used in adults to determine if you are a healthy weight is body mass index (BMI) calculated as weight (kg) /height (m)2. A person is classed as obese if they have a BMI of 30kg/m2 or above.
In childhood, however, constant changes in body composition during growth mean that the relationship between BMI and body fat is age-dependent and further complicated by race and gender. This is why the classification of overweight and obesity in children and adolescents is more problematic than in adults.
Furthermore, BMI does not distinguish between the contribution to the body weight of fat tissue and that of muscle, bone and water, nor does it provide any information about where fat is deposited. This is important because there is good evidence that, compared with children only 20 years ago, modern children are much fatter, have less muscle and more central distribution of body fat, an “apple” as opposed to a “pear” shape.
Consistent with the central distribution of body fat, studies of child obesity have shown a significant increase in waist sizes in children, especially in girls. These changes in fat distribution are of particular concern because they are more likely to lead to obesity problems and the well-known complications of obesity in adult life such as diabetes, heart disease and cancer.
Treatment of Childhood Obesity
The basic approach to the treatment of childhood obesity problems is to reduce calorie intake and increase physical activity. This is no different to that in adults, but there are several additional principles which are required to create a framework for successful treatment in children.
It’s important to say that it is understood these are not easy solutions. Even the most diligent, supportive and engaged parents can find it a tremendous challenge to help their child manage and maintain a healthy weight. Here are three core principles for successful treatment:
1. The whole family must be involved
Wherever possible, parents, brothers and sisters should be involved, as only with genuine commitment from the entire family will the child succeed in losing weight and maintaining a healthy weight. This is why “Fat Camps” don’t work, as although the child may lose weight when away from home, on their return they are exposed to exactly the environment that created the obesity problem in the first place.
2. Children must own the problem
Whilst teenagers are clearly not adults, they have to take responsibility for their obesity problems. It’s important that they are fully on-board with the plans to tackle the problem.
3. Parents must set an example
If a child grows up in a household where no one walks anywhere and where most meals are taken sitting in front of the TV, the chances are that they will develop the same habits. It is important to create an environment where walking to the shops or to school is normal, and where good nutrition is simply part of a normal daily routine.
As I said, it is understood that these are not simple solutions for many families to implement.
Weight Loss Surgery for Childhood Obesity
There is a growing body of evidence from around the world that weight loss surgery is a safe and effective treatment for childhood obesity, and we have some experience of this at Healthier Weight.
Even more so than for adults, it is important to ensure that the environment exists in which the child can be successful after surgery. It needs to be an entire family commitment, the child needs to be fully bought in and understand the changes they will be required to make and additional pre-operative screening by specialists in the treatment of young people will be required, e.g. Pediatric Endocrinologists, etc.
"Weight loss surgery can be a good option for young patients. If you are 15, have a BMI of 50+ and you are already living with Type 2 Diabetes, one could argue that it is incumbent on us to offer weight loss surgery as a treatment option. Nonetheless, most surgeons have reservations due to concerns about the patient's capability to commit to the lifestyle changes required for success. This is a challenge for all patients and even more so when you are dependent on others for meals, etc. So, it is an option but we should take great caution when offering surgical treatment to young patients. They will be living with the procedure potentially for 60+ years ."
Effects of Childhood Obesity – Psychological and Social
Even very young children are aware of the negative view held by society towards obese people, and it seems likely that this could have an adverse impact on the developing sense of self and self-esteem. Unsurprisingly, obese children often suffer from poor self-image, low self-confidence and even depression. The risk of psychological problems increases with age and girls appear to be at greater risk than boys. We also know that children with weight problems are more likely to underperform at school.
It’s also important to recognise that if your child is obese, he or she is statistically much more likely to become an obese adult. In one study 69% of obese 6-9-year olds and 83% of 10-14-year-olds in the UK became obese in adulthood.
Physical Problems of Childhood Obesity
If your child is overweight or obese, he or she is statistically more likely to develop serious physical problems in the future. The conditions which the obese child is likely to develop are those with which we are familiar in adults, including high blood pressure, type 2 diabetes, high cholesterol levels and heart problems and some cancers. They may also suffer from asthma, premature arthritis, gout and liver disease.
Whilst these conditions may not become evident until adulthood, sometimes early damage can be done and the problems may begin to develop while he/she is still a child. For example, one recent UK study of obese children aged between 6-19 years found evidence of damage to the lining of the arteries that were more consistent with those of a middle-aged adult. This helps to explain why some scientists believe the present generation of children could be the first generation to have a shorter lifespan than their parents.
The development of Type 2 Diabetes in children, a condition usually associated with middle-aged obese adults, is of particular concern, given the strong association between diabetes and heart disease, kidney problems and damage to the eyes which can lead to blindness. In some adolescent clinics, type 2 diabetes now represents up to one-half of new cases of diabetes.
The diabetic population in the UK, currently around 2.4 million, is set to double in the next 10-15 years and many of those newly diagnosed cases will be in children.
Diet and Exercise for Child Obesity
If you are significantly overweight and engaging in exercise to lose weight, you should choose non-weight bearing forms of activity such as a static exercise bicycle or swimming. This will improve your fitness and help to get your weight down, whilst avoiding damage to joints and tendons. When your body weight has reduced, you can safely add other activities such as brisk walking and badminton to your routine.
Here are some brief comments about the various forms of weight loss exercise you may try:
Walking is the most natural of all exercises and has been undervalued in terms of its health-promoting properties. Indeed evidence suggests that a brisk walk every day may offer health benefits comparable to those normally associated with more vigorous exercise.
Swimming is an excellent weight loss exercise and a good way of improving fitness, but it also scores well for strength and flexibility. Because the water supports your body weight, swimming is ideal for anyone with back or joint problems, or who is overweight.
Cycling (outdoors) is a great exercise for cardiovascular fitness and, to a lesser extent, strength. It will do little for your flexibility, so you should add some stretching/ flexibility exercises to your weight loss exercise program.
Exercise machines in health-clubs, gyms or at home are used by millions of people. A recent study suggests the treadmill is the most effective indoor exercise machine followed by the stair stepper, rowing machine, cross-country skier and stationary exercise bike.
Jogging and running are still very popular forms of weight loss exercise. Jogging improves cardio-respiratory fitness but does much less for strength and flexibility. What exactly constitutes jogging as opposed to running is difficult to say, although it’s usually taken that jogging is slower and less vigorous.