Childhood Obesity

Introduction:
Childhood obesity has been a significant problem around the world, especially in the
United States, and has been increasing throughout the years until recently being
stabilized. Childhood obesity often leads to obesity and overweight into the
adolescent and adult years, providing an increased risk in nutrition problems in later
years. Research has been done on the effectiveness of reducing the rate of
overweight and obese children. The research encompasses many aspects: including
breastfeeding and reducing overweight and obesity; the nutrition implications of a
high fat; low protein diet; adiposity rebound ages and the correlation with
overweight and obesity rates; and different prevention policies that show correlating
effects on reducing overweight and obesity among children.
Description:
Overweight and obesity have been on the rise in children, doubling in children in the
last 30 years and quadrupling in adolescents (CDC, 2013). NHANES 2009-2010
reports that as many as 8.4% of the 2-5 year old children are obese, 18% of
children between the ages of 6-11, and 20.5% of 12-19 year old children. (CDC,
2013 and Brown, 2014) The classification for children to be overweight and obese is
based on their BMI but unlike adults, the BMI is put onto a growth chart to see the
difference between other children of the same sex and age. To be classified as
overweight, the childs BMI when graphed on the growth chart is between the 85 th
and 94th percentile compared to other children of the same sex and age. To be
classified as obese, the childs BMI on the growth chart is at or above the 95 th

percentile compared to other children of the same sex and age. (CDC, 2013) The
maps published on the CDC website illustrate the prevalence of obesity in the high
school students across the United States. The maps are from 2005 and 2013. It is
clear that obesity is on the rise. In almost all of the states, the percentage either
stayed the same or went up from 2005 to 2013.
Percentage of high school students who were obese* selected U.S.
states, Youth Risk Behavior Survey, 2013.

Percentage of high school students who were obese* selected U.S.

states, Youth Risk Behavior Survey, 2005

Overweight and obesity also varies by ethnicity and race not just by state. The
highest percentage of obese children and adolescents are Non-Hispanic black at
24.3%, followed by 21.2% of Hispanic children, 14% of Non-Hispanic White children,
and 8.6% Non-Hispanic Asian children. Genes, social status, education level, and
family structure all play a role in the formation of overweight and obesity, along
with more controllable factors of physical activity, diet and nutrition, and even the
amount of television watched each day. (CDC, 2013 and Brown, 2014) Income
status also plays a key role in the development of obesity. According to the CDC the
lower the income, the higher the percentage of being obese. (CDC, 2013) As weight
increases, so can the risk factors for many diseases. With children being overweight
and obese, the risk for hypertension, hyperlipidemia, sleep apnea, and insulin
resistance causing type 2 diabetes, are all at an increased risk. Making the situation
even worse, is the fact that all of these are risk factors for cardiovascular disease as
well. According to the CDC, 70% of obese children have at least one risk factor for
cardiovascular disease and as many as 39% of obese children have 2 or more risk
factors for cardiovascular disease. Not only do these children have to deal with
being overweight and obese, but they also have increased overall health risks and
many will also develop low self-esteems. (CDC, 2013 and Brown, 2014) Overweight
and Obesity in children needs to be reduced in order to lower the prevalence for
overweight and obesity in adults, and to decrease the overall risk of many other
diseases.
Research
Research has been done, to see what can lower the risk of overweight and obesity
and what measures can be done to prevent it from happening in the first place. A
study was done on the diet changes that have occurred since 1970 when

overweight and obesity really started to increase in children. What was noticed is
that fat intake decreased while protein intake increased. The association with
converting from whole milk to low fat milk such as skim milk was considered. In
recent years, the trend of overweight and obesity in children has started to plateau,
and in some countries, decrease slightly. In the International Journal of Obesity, they
conducted a study that suggested that the amount of energy in the diet from
protein decreased from 16% in 1997 to 14.4% in 2005, while at the same time fat
intake increased from 28% in 1997 to 34.2% in 2005 in infants from birth to 30
months old. The study suggests that the higher fat, along with the lower protein,
resembles the nutritional value of breast milk, which has a protein content of 6%
and a fat content of 52%, which might be the reason for the decreased/ stabilized
obesity rates that are being seen. (Rolland, 2010)
Similarly, data was analyzed from Hawaiis Special Supplemental Nutrition Program
for Women, Infants, and Children (WIC) from 2005-2009, finding that breastfeeding
helped to reduce the percent of children who were both overweight and obese.
Table 3, shown below, suggests that women who never breast fed, had children with
an overweight percentage of 13.8% and an obesity percentage of 8.9% while the
women who breastfed 6 months or more had children with an overweight
percentage of 11.5% and an obesity percentage of 6.4%. Breastfeeding for less than
a month, between 1 and 2 months, and between 3 and 5 months, was also looked
at, showing that even breastfeeding for a short period had a positive impact on
reducing the percentage of children in both the overweight and obesity categories,
except for obesity went up to 9.4% in breastfeeding between 1 and 2 months. These
numbers represent only the population of Hawaii that was enrolled in the WIC

program, suggesting that further research should be done to see if other

populations will show the same effect. (Anderson, 2014)

Another thought as to what a contributor to childhood obesity may be is at what age

at which adiposity rebound occurs. Adiposity rebound or BMI rebound is the point in
which BMI starts to increase after it has hit its lowest point. Typically adiposity
rebound occurs between 4 and 6 years old. (Brown, 2014) According to Boonpleng
and the NHANES data from 1999-2008, the average age of adiposity rebound was 5
years old, with girls typically experiencing adiposity rebound at an earlier age. This
age has gone down since the 1965-1971 NHANES study when adiposity rebound
occurred at 5.5 years of age. This age is also influenced by ethnicity with NonHispanic black boys and girls having the lowest adiposity rebound age, followed by
Mexican American boys and girls, and then Non-Hispanic White boys and girls. The
average age of each gender and ethnicity is shown in the table below.

Other factors that were discussed throughout this analysis was the fact that high
maternal weight gain during pregnancy and high birth weights led to an increase in
overweight and obesity in children. Another discovery was the fact that obese
parents increase the risk for having children who are overweight and obese, and
data supports that there is a correlation between low income and an increase in BMI
in adults. (Boonpleng, 2012)
New York like many other states and countries are finding that obesity has started
to stabilize and maybe even start to decrease, but the question as to why is it now
starting to be looked at? New York City is one area that is seeing a decrease in
obesity after a large increase since the 1970s. Most of the decrease that has been
seen has been with the children between 2 and 4 years old that are receiving
benefits from the WIC program and also students from kindergarten to 8 th grade in
the public school system. A decrease from 18% of children who have obesity in
2002 to 13.9% in 2010 was seen. The data collected from the WIC program also

states that obesity rates decreased in Non-Hispanic blacks and whites and Hispanics
but there was an increase in obesity rates for Asians. Even though there was an
increase in obesity rates for Asians in the WIC program, this group had the second
highest decrease in obesity rates in the New York City Public Schools, right after
Non-Hispanic White Children. Hispanic and Non-Hispanic Blacks had lower
decreases in prevalence of childhood obesity. The children in the public schools from
kindergarten to 8th grade saw a decrease in obesity from 21.9% to 20.7%. The
biggest decrease in obesity rates was seen in children 5-6 years of age and among
white children, as previously stated. The graph below shows the decrease among
the different age groups from the New York City Public Schools, along a timeline that
shows the different legislation changes that occurred during the same time span.
This graph suggests that there may be a correlation between the legislation and the
decrease in childhood overweight and obesity.

Even though there seems to be a direct correlation with the legislation and the
decrease in obesity in children, the study states Most changes did not fit the
observed data well. Many of the differences that were seen happened too quickly
after the legislation to have had a direct impact in the decrease in weight among
the children in New York City Public Schools. The change from whole milk to low fat
milk options reducing calorie intake by 40 calories per 1 cup serving, the sum
calculation of calorie reduction over a 200 day school year is 8000 calories, just
from the switch to low fat milk. Calorie reduction was also put into place in the
vending machines, by reducing the sugary drink options. Beverages in vending
machines, in both elementary and middle schools, had to have less than 10 calories
per 8 ounce serving; a reduction in 53 calories per day was seen between 2003 and
2008. Also in 2005, BMI reports were sent home to the parents of the public school
children. Arkansass obesity rates were stabilized after this, but California saw no
change. From the surveys that were completed, overall calorie consumption in 2-6
year old children in both the WIC program and in New York City Public Schools
decreased. In 2003-2004 the calorie consumption was 1735, in 2005-2006 calorie
consumption was 1614, and by 2007-2008 calorie consumption was lowered to
1584 calories per day. (Farley, 2014)
Discussion:
The studies that were conducted through the Hawaii WIC and for the International
Journal of Obesity concluded to results that correlate well with each other. The WIC
results indicated that when women who breastfed their children for 6 months or
more had lower prevalence of overweight and obese children than the other groups
that were breastfed for a shorter time span. (Anderson, 2014 and Rolland, 2010)
The results from the International Journal of Obesity suggested that children with a

higher diet of fat and a lower diet of protein may be the reason that obesity has
stabilized and has decreased in some groups in recent years. (Rolland, 2010) This
data correlates together because breast milk contains a higher percentage of fat,
52% and a lower percentage of protein, 6%. If people are feeding their children a
diet with more fat and less protein, they are resembling breast milk, and when
women breast feed, the prevalence of overweight and obese children decrease.
(Anderson, 2014 and Rolland, 2010) In contrast to this, the study done in New York
suggests that they are unsure whether the women who breastfeed have a better
diet than the ones who do not breastfeed, or if the breast milk is the key factor in
helping to reduce overweight and obesity in children. (Farley, 2014) More research
should be done on looking at the diets of women who breastfeed and those who do
not and correlating it with the weight of their children at various ages to see if this
information remains true over many populations, not just the women of Hawaii.
Throughout all of these studies and research, they have suggested that
breastfeeding helped to lower the risk of overweight and obesity, but also that high
maternal weight gain during pregnancy, high birth weights, obese parents, and low
income have an increased risk of the child becoming overweight or obese. All of
these factors suggest steps should be taken to decrease the prevalence of
overweight and obesity before the child is even born. The New York City study
suggests that legislation may be what has helped to lower obesity rates in children
in the WIC program and also within public schools. The changes that show the most
potential for impact, are the switch from whole milk to low fat milk, and the low
calorie and sugar drinks that are in vending machines. The switch from whole milk
to low fat milk shows that there is an 8000 calorie reduction in the 200 day school
year. (Farley, 2014) 3,500 calories is the equivalent to 1 pound of weight gain, which

means that if the child would not burn off this extra fuel, they would be gaining 2.28
pounds more in the 200 day school year span. Also, the decrease in calories and
sugar content from the vending machines, aids in the overall decrease in calorie
consumption for the student. The study from New York City says that Most changes
did not fit the observed data well. Even though the data doesnt fit, the changes
will. There was still a decrease in overweight and obesity among children. The
conclusion of this study suggests that the media may have been the overall factor
in these changes. As legislation is being passed, the media is covering the hot
topics, and parents are catching wind of these changes. As a result, their diet and
the diet of their children may have started to change. This may be why the change
in overweight and obesity in the younger children have been more pronounced.
Their diets are controlled by their parents more than a middle school child who
practices some freedoms when it comes to food choices. Later on after these
policies have been put into effect, behavior is being positively reinforced in the
household and causing the changes to pursue. The impact from these policy
changes will be seen down the road, and hopefully will show an even greater
decrease in the rates of overweight and obesity among children. (Farley, 2014)
Adiposity Rebound was a factor that may be able to predict the risk of the chance of
overweight and obesity in children. The decrease in the age from 5.5 in the NHANES
1965-1971 to 5 in the NHANES 1999-2008 is a place for concern. The decrease in
age for adiposity rebound is occurring at the same time that there is an increase in
obesity rates. (Boonpleng, 2012) A question raised here is whether or not adiposity
rebound predicts obesity or whether obesity rates are decreasing the average age
of adiposity rebound. More research will be needed in order to determine the
answer to this question. If adiposity rebound is truly able to predict obesity, then

prevention awareness can be brought up during doctor visits and calorie restriction,
less television time, and increased physical activity could be discussed. (Brown,
2014)
The underlying theme that is seen among the data of all the research looked at,
shows a correlation in the decrease risk of obesity among races/ethnic groups. NonHispanic Whites have an overall decreased percentage of children who are
overweight or obese at 14% of the population. These children also have an
increased age in which adiposity rebound occurs compared to the other groups.
Girls experience adiposity rebound at the age of 7 and boys at the age of 5. Also,
Non-Hispanic Whites have seen the greatest decrease in obesity at 12.5% in New
York City. Hispanics are next on this list with 21.2% of the population being
overweight and obese, with the age of adiposity rebound at 5 years old for both
boys and girls. Hispanics have seen a decrease in obesity of 3.4% in the New York
City population. Non-Hispanic Blacks have the highest prevalence of overweight and
obesity at 24.3% of the population, along with the lowest adiposity rebound ages,
with boys experiencing adiposity rebound at the age of 4 and girls at the age of 3.
Non-Hispanic Blacks also have the lowest decrease in obesity in New York City at
1.9%. Non-Hispanic Asians have shown decreases and increases in the data and are
not represented will in many of the studies, so insuffiecient evidence leads to a lack
of conclusive evidence for any conclusion to be drawn. (Anderson, 2014; Boonpleng,
2012; Brown, 2014; CDC, 2013; Farley, 2014) Research needs to be done among
ethnic groups/races to see if the adiposity rebound is the key, or whether other
factors may have the greatest impact. Other factors may include income, genes,
and the eating habits that differ between these groups. Looking at the percentages
of each ethnic group and breastfeeding would also help to see the differences

among nutrition and why obesity is more prevalent among some groups and not
others.
Conclusion:
Overall, the studies that were conducted show that overweight and obesity in
children has been increasing since the 1970s and has just recently begun to
stabilize and even slightly decrease. Non-Hispanic Whites have seen the best
improvements, followed by Hispanics, with Non-Hispanic Blacks showing the least
progress. Adiposity rebound may be the reason for this, and breastfeeding may also
play a part, but more research needs to be done before a complete answer is given.
Media has been correlated to helping in decreasing the rate of overweight and
obesity in younger children because of their dependency on their parents compared
to the older children. Continued research on the topic of childhood obesity is going
to be extremely important in keeping the trend of overweight and obesity stabilized
and hopefully decreasing the rates of overweight and obesity in children even
further. Thus, causing a decrease in adult overweight and obesity and a decrease in
cardiovascular diseases as well. To overcome adult overweight and obesity we will
have to overcome childhood obesity first and all of the challenges that are
presented with it.

References
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