Childhood Obesity: Has the Tide Really Turned?

By Joseph A. Skelton, MD

Hi. I’m Dr. Joey Skelton, Associate Professor of Pediatrics and Epidemiology and Prevention at Wake Forest Baptist Medical Center in Winston-Salem, North Carolina. I am also Director of Brenner FIT (Families in Training), which is an obesity research and treatment program here at Brenner Children’s Hospital.

I’m here today to talk about the recent publication in JAMA called ” Prevalence of Childhood and Adult Obesity in the United States, 2011 to 2012.”[1] It was published by Cynthia Ogden and her colleagues at the National Center for Health Statistics, part of the Centers for Disease Control and Prevention.

The big thrust from this study overall has been that obesity prevalence in both adults and children has continued to plateau. It is sort of staying around the same rate. Overall, in children ages 2 to 19 years, obesity prevalence is about 17% (16.9%). In adults, the prevalence has also stayed the same, with an obesity rate of about 35% (34.9%). Overall, the numbers are still the same when you consider overweight and obesity in the United States. About a third of children have a problem with their weight and are overweight or obese. About two thirds of adults have problems with their weight and are overweight or obese.

I am going to focus on the children’s data because that has been of big interest. A lot of the discussion about this study has been about a decrease in obesity prevalence in the youngest age group the researchers looked at, which was 2- to 5-year-olds, or the toddler age group. They did do some weight-for-length measurements in infants, but overall, much like the rest of children and adults, there has been no change in prevalence over the past several years.

Overall, this latest set of data found that about 17% of 2- to 19-year-olds are obese. When the researchers looked back at past years, specifically 2003 and 2004, they found that, in that period, about 14% (13.9%) of children 2 to 5 years old were considered obese. The next year, those numbers dropped down to 10.7%, and the prevalence stays at about that range over the next several years. In the years 2009 to 2010, the obesity prevalence in that age group — again, these are children ages 2 to 5 years old — is 12.1%. In this past cycle, 2011 to 2012, the obesity prevalence in 2- to 5-year-olds dropped to 8.4%.

The big discussion has been that, when you compare this most recent cycle of NHANES data (with an 8.4% prevalence of childhood obesity in 2- to 5-year-olds) to the period 2003-2004, there has been a huge drop — from almost 14% down to a little over 8% now. People have noted that that is almost a 50% drop in the prevalence rate, and that is one of the few significant changes that we found over the past 10 years with this data.

A lot of the media has picked up on this conclusion, with headlines saying that obesity rates plummeted in this youngest age group. And that is a good sign. But if you really look a little closer at this data, I would caution that we haven’t seen that much change over the past 10 to 15 years.

A past publication, also in JAMA, from the same NHANES dataset in the years 2001 to 2002, documented an obesity prevalence of 10.6% in children ages 2 to 5 years.[2] In the next cycle, 2003 to 2004, that jumped up to 13.9%. And in the next cycle, 2005 to 2006, it dropped back down to 10.7%. That 2003-2004 cycle that was used as a comparator in this most recent publication was really a bump-up in the prevalence. There is some sort of anomaly there that is probably real numbers. This is a very well-done study, but that number went up a lot in that year — 10% up to 14% and then back down to 10%. If you compare the most recent prevalence of 8.4% to the prevalence in 2003-2004 — that is a big jump. But if you look across all those years, even going back to 1999 and 2000, when the obesity prevalence in children ages 2 to 5 years was 10.4% also, there has really not been that much of a change. It has stayed around 10%, with that little bump-up in 2003 to 2004, and then most recently in this just-published cycle, down to 8.4%.

I’m throwing out a lot of numbers here and I know that it can be very confusing. But I would say that we must interpret these numbers, and the coverage in the media, very carefully. There really has not been that much of a change over the past decade. There was one year with a really high prevalence and, most recently, there is a positive change, down to 8.4%. The conclusion by Ogden and her colleagues is that over the past 10 years for children ages 2 to 19 years and all adults, there has been no significant change, on the basis of their analysis of the data. There have been no significant changes in obesity prevalence.

So it is great news that this epidemic has seemed to slow down some, but I would definitely not say that the tide is turning. We are starting to see an overall decrease in obesity prevalence. We have a small bit of hope in this youngest group of 2- to 5-year-olds. In tracking BMI (body mass index), there may be a small decrease in this most recent cycle. However, overall I would caution against saying that obesity rates have plummeted in toddlers. The truth is — much like with all kids and all adults over the past decade — prevalence has stayed pretty much the same. About a third of children have a problem with being overweight and obese; about two thirds of adults have a problem with being overweight and obese.

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Child obesity rates drop 43% in past decade

The level of obesity among the nation’s kids ages 2-5 fell significantly over a roughly eight-year period, but some experts caution the figures may be somewhat misleading.

By Liz Szabo

With so little good news about obesity in the USA, public health advocates are celebrating a rare victory: a sharp decline in obesity rates among young children.

The problem of childhood obesity has gotten a national platform in recent years, through first lady Michelle Obama’s “Let’s Move” campaign. Obama has even appeared with Elmo and Big Bird on Sesame Street to talk about nutrition and exercise.

Today, with the release of new obesity numbers, Obama suggests that her preschool audience has taken her advice to heart.

While obesity rates for most Americans haven’t changed significantly over the past decade, among kids ages 2 to 5 the obesity rate dropped from 14% in 2003-2004 to just over 8% in 2011-2012, according to a report out Tuesday from the Centers for Disease Control and Prevention. That represents a drop of 43%, CDC said.

“I am thrilled at the progress we’ve made over the last few years in obesity rates among our youngest Americans,” Obama said in a statement. “Healthier habits are beginning to become the new norm.”

STORY: CDC: Childhood obesity rates falling in many states

Also on Tuesday, Obama announced new rules to ban the marketing of unhealthy foods in schools during the school day. “Our classrooms should be healthier places where kids aren’t bombarded with ads for junk food,” Obama said in a statement.

Some obesity researchers say the new report offers little reason to celebrate.

According to the CDC report, older children made no progress, with nearly 18% of kids ages 6 to 11 remaining obese, as well as 20.5% of kids ages 12 to 19. In women over age 60, obesity rates climbed from 31% to 35.4% in the same period, the study shows.

Obesity “remains at historic highs,” says David Ludwig of Boston Children’s Hospital, who has warned that today’s kids could be the first generation in history to live shorter, less healthy lives than their parents. He described the declining obesity rates among youngsters only as an “encouraging preliminary finding.”

Thomas Robinson, a professor of pediatrics at Stanford University, notes that obesity rates among kids ages 2 to 5 have gone up and down significantly over the past decade. Although the survey included 9,120 people, only 871 were ages 2 to 5 years old. And of those children, only about 70 were obese. So in any given year, a relatively small number of children can have a big impact on obesity rates.

Still, Robinson says he’s happy just to see the nation’s obesity rate leveling off. And he notes that, if the country were to truly make progress against obesity, it would not be surprising to see those victories in the youngest kids, who have spent the least amount of time exposed to the bad habits behind the country’s weight problem.

CDC research has found two dietary changes that could help explain any progress: Americans are consuming fewer sugary drinks and more women are breastfeeding.

“We continue to see signs that, for some children in this country, the scales are tipping,” said CDC director Tom Frieden in a statement. “This confirms that at least for kids, we can turn the tide and begin to reverse the obesity epidemic.”

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Obesity Rate for Young Children Plummets 43% in a Decade

By Sabrina Tavernise

Federal health authorities on Tuesday reported a stunning 43 percent drop in the obesity rate among 2- to 5-year-old children over the past decade, the first broad decline in an epidemic that often leads to lifelong struggles with weight and higher risks for cancer, heart disease and stroke.

The drop emerged from a major federal health survey that experts say is the gold standard for evidence on what Americans weigh. The trend came as a welcome surprise to researchers. New evidence has shown that obesity takes hold young: Children who are overweight or obese between age 3 and 5 are five times as likely to be overweight or obese as adults.

A smattering of states have reported modest progress in reducing childhood obesity in recent years, and last year federal authorities noted a slight decline in the obesity rate among low-income children. But the figures on Tuesday showed a sharp fall in obesity rates among all 2- to 5-year-olds, offering the first clear evidence that America’s youngest children have turned a corner in the obesity epidemic. About 8 percent of 2- to 5-year-olds were obese in 2012, down from 14 percent in 2004.

“This is the first time we’ve seen any indication of any significant decrease in any group,” said Cynthia Ogden, a researcher for the Centers for Disease Control and Prevention, and the author of the report, which will be published in JAMA, The Journal of the American Medical Association, on Wednesday. “It was exciting.”

She cautioned that these very young children make up a tiny fraction of the American population and that the figures for the broader society had remained flat, and that for women over 60, the obesity rate had even increased. Still, the lower obesity rates in the very young bode well for the future, she said.

Experts point to several possible explanations for the fall, but say a full understanding remains elusive.

Children now consume fewer calories from sugary beverages than they did in 1999. More women are breast-feeding, which can lead to a healthier range of weight gain for young children. Federal researchers have also chronicled a drop in overall calories for children in the past decade, down by 7 percent for boys and 4 percent for girls, but health experts said those declines were too small to make much difference.

Another explanation is that some combination of state, local and federal policies aimed at reducing obesity is starting to have an effect. Michelle Obama has led a push to change young children’s eating and exercise habits and 10,000 child care centers across the country have signed on. Many scientists doubt that anti-obesity programs actually work, but proponents of the programs say a broad set of policies applied systematically over a period of time can affect behavior.

The news announcement from the C.D.C. included a remark from Mrs. Obama: “I am thrilled at the progress we’ve made over the last few years in obesity rates among our youngest Americans.”

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Why It’s Important to Prevent Childhood Obesity

By Mary Bodel

There are a lot of things to consider when dealing with a touchy topic such as childhood obesity. The kids are touchy about it. They know what they look like and reminders aren’t always appreciated. The parents are touchy because they think it shows that they have bad parenting skills. The rest of society is touchy because they don’t necessarily want to do what it will take to stop the epidemic. Here are a few reasons we might want to take the touchy part out of it.

1) Bullies: Any child who is different is going to be a target for bullying. While more and more of our children are overweight, those who stand out in that category are going to be dead on bullseye. Being teased and tormented doesn’t help in any way, shape or form. In fact it’s harmful because the child may turn to food for comfort, making the problem worse.

2) Eating Disorders: People, especially children, want to fit in. Once a child has discovered that overeating is the cause (or one of them) for being out of the ordinary, they may try any number of methods to stop. Unfortunately, these methods can lead to bulimia, anorexia and other eating disorders.

3) Education: A miserable child may have difficulties concentrating on what he or she is trying to learn. The focus may be inward, which makes listening and focusing on classwork extremely difficult.

4) Health Issues: This is the most important reason we need to protect our children from weight related issues. Young people in their early twenties are having strokes and heart attacks. Children are being treated for high blood pressure, high cholesterol and diabetes in growing numbers. Being overweight can cut years off of a life, and cause life altering conditions.

5) Self Esteem: Even without bullying, self esteem is going to suffer. All it takes is a mirror and the television set. Knowing that you are over the weight limit can cause poor body image. This can lead to depression and sometimes to serious problems. Some may become cutters, and some have committed suicide over this issue.

6) National Security: Because of the health issues caused by obesity, many men and women who want to join the military are being turned away. This matter has been brought up on news reports, and it is something to pay attention to. If our military has trouble getting new recruits, how are we going to be able to defend ourselves?

While everyone can help deal with this issue, the greatest burden is on parents. Instead of knocking them about having overweight children, we should offer them the support they need to make educated decisions on what their children consume and do.

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Tips for Tackling Childhood Obesity

Written by The Healthline Editorial Team

The Department of Health report that one in ten children in the UK are obese. Obese children carry a higher risk than children of normal weight for: cardiovascular disease, bone and joint problems, sleep apnea, and low self-esteem. Obese children are also more likely to grow up to be overweight or obese adults, and therefore more likely to fall victim to heart disease, diabetes, stroke, cancer, and osteoarthritis. The statistics are difficult to hear, but even more difficult to deal with if you’re a parent concerned about your child’s health.

You want to help, but you’re not sure how. You want to talk to your child about it, but you’re afraid of saying the wrong thing. Your child’s future, health, and well being are in jeopardy–how do you turn it all around? Advertisement The Challenge for Parents Studies show that parents of obese children four to five years old are often unaware that their child’s weight is a problem. As children grow older, most parents feel a mixture of guilt, responsibility, and helplessness. They may feel attacked by other family members, neighbours, and acquaintances who seem to blame them, and they often feel the pain their children go through as victims of teasing and ridicule in school. Most parents make efforts to help their children, but may give up when those efforts prove unsuccessful. The relationship between parents and children can become strained as the issue grows larger, particularly if parents try to restrict certain types of foods or implement other controlling methods in efforts to curb behavior. The whole issue seems likes a minefield where it’s much too easy to take a wrong step.

Fortunately, studies have found that reversing childhood obesity is possible–it’s just a matter of making a few key lifestyle changes. Diet, Exercise, and Positive Reinforcement The most important elements in helping a child to attain a normal weight revolve around diet, activity, and emotional support. This isn’t news to most parents. The challenge lies in figuring out just how to change lifestyle habits without getting into arguments and damaging a child’s self esteem. Here are some tips from the experts: Accept your child just as he or she is. Psychologists say this is the most important thing you can do. Otherwise, he or she will feel direct or implied disapproval which could undermine all your other attempts. Try not to make his or her weight a big deal by engaging in lots of serious discussions or lectures. Instead, begin incorporating changes into your family’s daily activities as naturally as possible. Realize you have more control than you think. Commit yourself to making small changes over time rather than large ones all at once.

Family Changes Mean Healthier Kids
Tackling childhood obesity is a family affair. Everyone will benefit from healthier habits, so rather than focus on just one member, get everyone involved. Here’s how:

  • Lead by example. Studies show one of the most important things you can do is to model healthy behavior. If you want your child to eat more fruits and vegetables, you must eat more fruits and vegetables. If you want your child to exercise more, you must exercise more. Talk to your child about your new habits and invite him to join you.
  • Turn off the television. Studies show inactivity is the most significant factor in childhood obesity. You may say that your child doesn’t want to do anything but watch TV or play video games, but try inviting her to do something with you, like take a bike ride, a trip to the park, a walk around town, or a game of catch. Start small–30 minutes a day–then ask your kids for their ideas on how they’d like to get moving.
  • Shop healthier. Help your child develop a better relationship with food by taking him or her grocery shopping. Let your child decide which fruits and vegetables will make the weekly menu.
  • Make meals a priority. Children who eat breakfast are less likely to be overweight than those who don’t. Similarly, families who eat a healthy dinner together are more likely to teach healthy eating habits. Keep meals at regular times to avoid unhealthy snacking.
  • Get help. If after a few months you don’t see your child making progress, you may want to consider getting help from a dietician, psychologist, or even a weight-control program. New ideas and trained experts may be just what your child needs to turn his or her health–and life–around.

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Obesity Is Found to Gain Its Hold in Earliest Years


For many obese adults, the die was cast by the time they were 5 years old. A major new study of more than 7,000 children has found that a third of children who were overweight in kindergarten were obese by eighth grade. And almost every child who was very obese remained that way.

Some obese or overweight kindergartners lost their excess weight, and some children of normal weight got fat over the years. But every year, the chances that a child would slide into or out of being overweight or obese diminished. By age 11, there were few additional changes: Those who were obese or overweight stayed that way, and those whose weight was normal did not become fat.

“The main message is that obesity is established very early in life, and that it basically tracks through adolescence to adulthood,” said Ruth Loos, a professor of preventive medicine at the Icahn School of Medicine at Mount Sinai in New York, who was not involved in the study.

These results, surprising to many experts, arose from a rare study that tracked children’s body weight for years, from kindergarten through eighth grade. Experts say they may reshape approaches to combating the nation’s obesity epidemic, suggesting that efforts must start much earlier and focus more on the children at greatest risk.

The findings, to be published Thursday in The New England Journal of Medicine, do not explain why the effect occurs. Researchers say it may be a combination of genetic predispositions to being heavy and environments that encourage overeating in those prone to it. But the results do provide a possible explanation for why efforts to help children lose weight have often had disappointing results. The steps may have aimed too broadly at all schoolchildren, rather than starting before children enrolled in kindergarten and concentrating on those who were already fat at very young ages.

Previous studies established how many children were fat at each age but not whether their weight changed as they grew up. While valuable in documenting the extent of childhood obesity, they gave an incomplete picture of how the condition developed, researchers said.

“What is striking is the relative decrease in incidence after that initial blast” of obesity that occurs by age 5, said Dr. Jeffrey P. Koplan, the vice president of the Emory Global Health Institute in Atlanta. “It is almost as if, if you can make it to kindergarten without the weight, your chances are immensely better.”

Dr. Koplan, a former director of the Centers for Disease Control and Prevention, was not associated with the new study, although its lead author, Solveig A. Cunningham, is an assistant professor in the School of Public Health at Emory.

The study involved 7,738 children from a nationally representative sample. Researchers measured the children’s height and weight seven times from kindergarten to eighth grade.

When the children entered kindergarten, 12.4 percent were obese — defined as having a body mass index at or above the 95th percentile — and 14.9 percent were overweight, with a B.M.I. at or above the 85th percentile. By eighth grade, 20.8 percent were obese and 17 percent were overweight. Half of the obese kindergartners were obese when they were in eighth grade, and nearly three-quarters of the very obese kindergartners were obese in eighth grade. The risk that fat kindergartners would be obese in eighth grade was four to five times that of their thinner classmates, the study found.

Race, ethnicity and family income mattered in younger children, but by the time the overweight children were 5 years old, those factors no longer affected their risk of being fat in later years.

The study did not track the children before kindergarten, but the researchers had their birth weights. Overweight or obese children often were heavy babies, at least 8.8 pounds, something other studies have also found.

The study’s results, Dr. Koplan and others said, “help focus interventions.”

Most efforts to reduce childhood obesity concentrate on school-age children and apply the steps indiscriminately to all children, fat and thin — improving meals in schools, teaching nutrition and the importance of physical activity, getting rid of soda machines.

“This suggests that maybe one reason it didn’t work so well is that by the time kids are 5, the horse is out of the barn,” said Leann L. Birch, a professor in the department of foods and nutrition at the University of Georgia, who was not involved with the study.

The most rigorous studies of efforts for school-age children, conducted in the 1990s, randomly assigned thousands of children to either participate in intensive programs that encouraged them to exercise and improve their diets, or go on as usual.

One study involved 1,704 third graders in 41 elementary schools in the Southwest, where most of the students were Native Americans, a group that is at high risk for obesity. A second study included 5,106 children in 96 schools in California, Louisiana, Minnesota and Texas.

Neither study found any effect on children’s weights.

Some obesity researchers said the new study following kindergartners over the years also hinted at another factor: the powerful influence of genetics on obesity, something that can be a challenge to overcome.

Genetic influences tend to show up early in life, said Dr. Stephen O’Rahilly, an obesity researcher who is a professor of clinical biochemistry and medicine at the University of Cambridge.

“We have known for 50 years that B.M.I. is highly heritable,” he said. “Surprise, surprise, if you tend to be fat, you tend to be fat at an early age.”

Body mass index is not quite as heritable as height, Dr. Loos said. But genes are not necessarily destiny. Exercise and a healthy diet can often reduce, but not completely overcome, the effects of genes.

Steven L. Gortmaker, a professor of the practice of health sociology at the Harvard School of Public Health, said he saw a bright side to the findings. Young children, he said, can cross a line between being fat or normal weight by gaining or losing just a few pounds. For adults, it can be 20 to 30 pounds, or even 40 to 50 pounds.

“It can take a long time to turn that around,” said Dr. Gortmaker, who wrote an editorial accompanying the new study.

And, he said, a number of randomized studies involving young children have shown that it is possible to stop or reverse excess weight gain. One, for example, had some fat children ages 4 to 7 reduce their television and computer viewing time, and had others keep theirs the same. Children in the intervention group — especially those from poorer families — consumed fewer calories, and their body mass index fell.

But effective programs for young children involve time and effort, and the costs are not reimbursed by health insurers, said Denise Wilfley, an obesity researcher at Washington University in St. Louis.

“We can effectively treat these children,” Dr. Wilfley said. But other than entering children in research studies, parents can get help only by paying out of their pocket — about $1,500 to $3,000 for an intervention that usually lasts a year.

Advice offered by a family doctor — if it is given at all — is usually ineffective, Dr. Wilfley said. All too often, parents tell her, their worries about a child’s weight are dismissed.

“I just saw a mom who was in tears because her little girl, who is 11 years old, weighs 212 pounds,” Dr. Wilfley said. The child has been fat since she was a toddler, but, Dr. Wilfley said, “the provider told her mom she would outgrow it.”

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Teasing obese kids doesn’t help them lose weight. It can backfire.

By Nan Feyler

The recent report of drops in the rates of obesity and severe obesity in Philadelphia’s public school children is good news. Not only has the overall obesity rate dropped nearly 5 percent, the greatest decline is in African American male and Hispanic female students who are among those at highest risk of obesity. While it is too soon to be certain what caused these declining numbers, for the past several years the School District of Philadelphia, the city health department’s Get Healthy Philly campaign, and non-profits like The Food Trust have focused on a public health strategy to create a healthier food environment in schools.

At the same time, for overweight and obese children the school environment can feel lonely, hostile and unsafe because of teasing, bias and unchecked bullying.

Students report that weight is among the most common reasons that their peers are bullied. In one national study, 84 percent of adolescent students surveyed saw overweight students being called names, being teased in a mean way, and teased during physical activities. Over two-thirds reported observing overweight and obese peers being excluded, ignored, avoided, teased in the cafeteria, and targetted by negative rumors. The majority of students observed verbal threats and physical threats.

While peers are the most common perpetrators, teachers and parents also contribute to stigmatizing obese and overweight children. Teachers, including physical education teachers, report lower expectations for overweight students compared to thinner students, endorse negative stereotypes or believe that overweight and obese children have family problems. Even at home, children may face critical and negative comments, with significant numbers of overweight and obese children reporting weight-related teasing and criticism from their parents.

The psychological, social and even academic consequences of weight discrimination for youths are serious. Overweight and obese kids who are teased and bullied are at risk for low self-esteem, depression, social isolation and poor body image. They are two to three times more likely to engage in suicidal thoughts and behaviors compared to overweight peers who are not bullied. They report feeling sad, bad about themselves, angry and sometimes afraid. Weight-based victimization harms school performance, with overweight students reporting that being teased hurts their grades as well as their attendance at school.

Some people believe that stigma is helpful for motivating weight loss – that making it uncomfortable or undesirable to be overweight will somehow help people lose weight. But a body of research – and common sense – disputes this notion. Studies show that youth often cope with teasing about their weight by trying to lose pounds in harmful ways (fasting, diet pills, vomiting, and chronic dieting), binge eating, and avoiding physical activity – all unhealthy behaviors that can actually impede weight loss and potentially reinforce weight gain.

Confronting stigma, bullying and weight bias needs to go hand-in-hand with efforts to reduce the prevalence of obesity nationwide. Underlying weight-related stigma is the belief that being overweight or obese reflects a personal weakness and that people are personally responsible for their weight – they are overweight because they are lazy, unmotivated, lack self-discipline and willpower. For example, in experimental research, high school girls were more favorable toward peers whose excess weight was attributed to a thyroid condition compared to girls whose obesity was not explained. This belies the scientific understanding that obesity is a result of a complex interplay of environmental, genetic, behavioral and social factors, with many significant contributors beyond the control of individuals. There is also considerable scientific consensus – and plenty of anecdotal evidence from dieters around the world – about the challenge of significant long-term weight loss.

Public health campaigns to reduce obesity – and the nation’s focus on the costs and consequences of excess weight — have the potential to further stigmatize people who are obese. It is a tricky balance, where we celebrate success in reducing the prevalence of childhood obesity without blaming or castigating the individual child who is overweight or obese.

Educators, parents and policy makers should be applauded when making a healthier school food environment, but in equal measure they must make sure there are similar expectations and opportunities for children regardless of their body size, intervene promptly to stop weight-based teasing and bullying, and challenge assumptions that marginalize, blame or stigmatize overweight or obese children.

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Childhood Obesity Takes Psychological Toll, Too

By Jeanna Bryner

The ballooning waistlines of children hit the spotlight when Michelle Obama admitted publicly her daughters had an unhealthy body mass index. And while many urge kids to slim down to avoid heart disease and other physical ailments, the emotional consequences from teasing and low self-esteem could be just as debilitating, scientists say.

About 37 percent of children in the United States are overweight and roughly 16 percent of children ages 2 to 19 are obese, according to the Centers for Disease Control and Prevention. Among 6- to 19-year-olds, obesity has tripled over the past two decades, according to the National Health and Nutrition Examination Survey.

We’ve heard that these fat children may be set up for a life at the doctor’s office with health risks including type-2 diabetes, high cholesterol and blood pressure, and sleeping problems. But these same kids are more likely to have a hard time with emotions and with their peers.

“Overweight kids are more likely to have depression and low self-esteem, to be teased or bullied, and to bully other children,” said Catherine Davis, associate professor of pediatrics at the Medical College of Georgia. “These can be serious problems for these children.”

Researchers point out that no matter your age, carrying around lots of extra weight has its psychological consequences.

“Overweight and obesity are terribly stigmatizing conditions, regardless of age,” said Sara Gable of the University of Missouri, Columbia.  “Living as a member of a stigmatized group is stressful and can produce feelings of anxiety, depression, and loneliness.”

Gable said research on other stigmatized groups, such as racial minorities, shows these negative feelings can interfere with academic performance and other aspects of a person’s life, and “there is good reason to think” these findings would apply to children struggling with weight problems, Gable told LiveScience.

While some responded to the First Lady’s divulging of her kids’ weight problems as insensitive, psychologists say pretending the issue isn’t there doesn’t help anyone involved. And they offer tips for how parents can be sensitive to their child’s feelings while encouraging healthy behaviors.

Toughest spot: the playground

Playground teasing may seem like a childhood rite of passage, but overweight children get more of it. And that name-calling can grate on a child’s self-esteem. “A lot of who we are is based on how others interact with us,” said Eric Storch of the Departments of Pediatrics and Psychiatry at the University of South Florida. “With kids who are overweight they internalize others’ feedback, ‘You’re fat, you’re no good, no one wants to go out with you.’ That contributes to anxiety and depression.”

He estimates rates of depression are as high as 20 percent in kids who are overweight.

“It’s not simply being overweight that leads to depression,” Storch said in a telephone interview. “It’s being overweight and getting a bunch of crap about it from peers that leads to anxiety or depression.”

While one paradigm suggests weight leads to teasing, which then leads to psychological issues, another reverses those arrows to suggest depressed kids are less likely to exercise and more likely to gain weight.

In fact, Storch and his colleagues studied 100 overweight children and those at risk for being overweight, ages 8 to 18, to find out the effects of bullying. About a quarter of the children reported significant problems with bullies during the prior two weeks. The study, published in a 2007 issue of the Journal of Pediatric Psychology, revealed bullying often caused kids to avoid situations where they had been picked on, such as gym class and sports fields.
Storch’s team also found bullied kids were more likely to be depressed, lonely and anxious.

“When you think about it, it makes intuitive sense, when you consider the hallmark signs of depression – sadness, fatigue, lack of interest in things you used to like,” Storch said in a statement about the study. “When kids are having a tough time with peers, and struggling with depression, then this can translate to reduced rates of physical activity.”

Problems start early

Though steering clear of physical activity may, in part, lead to a heavy child, it doesn’t explain the weight gain in very young kids. Before the age of 2 and as early as three months old, infants could be on the path toward obesity, according to a new study published this month in the journal Clinical Pediatrics.

And just as the extra weight comes early in life, so do the social and psychological consequences. A nationally representative study of about 8,000 children who were followed from kindergarten through third grade, beginning in 1998, showed the psychological ramifications of being plus-sized start young. For instance, by third grade overweight kids reported less favorable peer relations and feeling unpopular.

The study, published last year in the journal Applied Developmental Science, also showed overweight girls were also more likely to act out – fighting and arguing – than slim peers, according to their teachers.

Kids with weight problems from the start (in kindergarten) were more likely to be sad, lonely and to worry than kindergarteners without extra poundage, according to reports by their teachers and the kids themselves. As overweight kids entered higher grades, these feelings just got worse.

The fact that overweight boys and girls reported more loneliness and worrying suggests that, as early as first grade, they may have an understanding of the stereotypes that accompany living with the stigma, the researchers say.

What’s a parent to do?

For parents wanting to help their children slim down while also keeping self-confidence intact, the key is balance, researchers say. A mom who’s constantly nagging Billy about his weight is not going to see a positive outcome, Storch said. But neither will a laissez-fare parent who lets a kid eat with abandon.

Parents should let children know they are concerned about their health, not kids’ looks, Davis said.

“Pretending the child is not overweight or obese sends a harmful message that they should ignore their health,” Davis said. “Rather than being punitive or setting dietary rules that only the child has to follow, have the whole family improve their diet and physical activity habits together.”

And when overweight or obese children get out and exercise, the results can be a boost to their self-esteem, in addition to any physical gains.

A study published last year in the Journal of Pediatric Psychology suggested 40 minutes a day of exercise lessened depression in overweight kids and made them feel better about themselves.

The study, conducted by Davis and her colleagues, included more than 200 overweight children who either continued their sedentary lifestyle, or engaged in 20 minutes or 40 minutes of fun activities that increased heart rate, such as running games, jumping rope, basketball and soccer.

“Just by getting up and doing something aerobic, they were changing how they felt about themselves,” said the lead researcher and Davis’ colleague at MCG Karen Petty. “Hopefully these children are taking home the idea: Hey, when we do this stuff, we feel better.”

Overall, the emotional consequences are just as bad as the physical ones.

“Comparing the emotional consequences of pediatric obesity to the health related consequences is sort of like missing the forest for the trees,” Gable said. “Obesity has the potential to interfere with all areas of human functioning; that’s part of what makes its treatment during childhood such a tricky undertaking.  Children suddenly get lots of attention for the exact reason that makes – at least some of them – feel really bad.”

Tips for overweight children

Gable and her colleagues put together some tips to help children navigate a world they say is “critical of body size.” Among them:

  1. Create an environment where children learn to feel good about themselves. For instance, you could introduce children to different hobbies, sports and neighborhood activities. And encourage them to pursue what they enjoy. And help children recognize that taking care of their bodies allows them to do what they like to do.
  2. Help children learn how to deal with teasing and bullying. You could role play (and talk about) ways to avoid reacting to unkind words and actions, and how to calmly walk away from these peer provocations. Also, help children to develop positive “I messages,” such as “I’m going to ignore these words because I know they are not true.”
  3. Set and maintain limits on the amount of time children spend watching TV and playing computer games. Make sure to turn off the TV during meals and when no one is watching it. Bottom line: make television a special activity, not a routine one.
  4. Help children to like healthy foods. Involve them in menu planning and have them munch on fruits and veggies between meals rather than fatty, sugary and salty snacks.

The researchers also suggest you keep track of the visual media that children see. Limit the number of fashion, glamour and muscle-building magazines that come into your home.

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Love your fat child, don’t shame them

By Marianna Kirby

As I read Stephen Fry’s wonderful letter to his 16-year-old self, I considered what I would have to say to my own younger self. I am only 31 years old, but it feels like light years away from the experiences I was having as a teenager. And, unlike Fry, I don’t feel that trading away the things I have now for the intensity of my teenaged misery would be a good deal. But as I catalogued encouraging thoughts for the past incarnation of myself, I realised that it is not what I want to tell my adolescent self that would have made the most difference, it’s what I wish I’d had the words to tell my parents.

My parents are great people. They have loved me very much and I have loved them the same. And so it is with most parents of fat children. They love their children and, in the manner of parents everywhere, just want what’s best for them. Unfortunately, even with all the loving intention in the world, there are some things parents do that just make life harder for fat kids. I can’t cross space and time (curse these limitations) to pass these things on to my own parents, but hopefully these three basic messages might help some fat kids now.

1. Your kid knows that s/he is fat. If your child has any degree of socialisation, consumes any popular culture, interacts with any peer groups, they know their body is different from those around them. Very young children may not be able to put words to it yet, but the age at which children are expressing body hatred is getting younger and younger. Even kids who aren’t fat don’t like their bodies. So your kids don’t need you to jump on the bandwagon telling them they’re freaks of fat-nature. Your children need to know that you, as their parents, love them unconditionally. And, depending on their age, they may have only marginal skills at distinguishing between the body they live in and the person they are. If you tell your kids there is something wrong with their body, it’s going to read as there being something wrong with them. Remember, kids aren’t masters of subtlety.

2. Don’t tell your kids they aren’t really hungry. Telling your child that they are not feeling what they are feeling is a super way to completely destroy any mind-body connection your kid is developing. Keep in mind that there is no research into the long-term effects of dieting on pre-adolescent kids. In fact, there’s not even enough research to begin to determine what sort of effect a change in diet (much less dieting) would have on a school-aged child. Though everyone seems to agree that a good breakfast is a good start. Respect your child enough to believe them when they tell you something basic about their body. I’m not suggesting that you become a slave to your child’s whims, of course. But there are better ways, better language to negotiate these situations than “No, you aren’t hungry”.

3. Don’t make deals with your child. Don’t promise to pay your child for losing weight. Don’t bargain with your child on the basis of pounds lost. It might seem like positive reinforcement – the same way you try to reinforce good grades or completing chores – but it’s setting your child up for disappointment, failure, and shame. Because when your child doesn’t lose weight – and chances are more than good that they won’t because their bodies are constantly in transition – they are going to get the message that it is their own personal fault. And, especially if egged on by the body hatred of their parents, kids are going to feel ashamed of their failure to control their bodies. Never mind that their bodies are growing and developing. Never mind the way bodies put on weight as a precursor to puberty. Never mind growth spurts, changes in figure, changing metabolism, or, hell, genetics.

I understand that parents are worried. The media fury surrounding the issue of childhood obesity is enough to concern even people who don’t have kids. With people accusing parents of fat children of child abuse, it’s no wonder that parents are desperate to do something, no matter what that something is.

The most important thing a parent can do for a child is to let them know they are loved. Again, that doesn’t mean caving in to your children. But it means setting a good example – no more moaning about your thighs in front of your daughters. It means teaching your children that physical activity makes their body feel better no matter what their body looks like – it isn’t punishment for having a nonconforming body. It means teaching your children that there are lots of different foods in the world and that eating the healthful ones can also make your body feel better – no matter what size that body happens to be.

Don’t use your child’s weight as the sole indicator of their health. Or of their worth. You are their parents; they need you to love them. Your kids probably don’t have the words for this, but their future selves will thank you: if you’ll excuse the pun, fat kids have enough on their plate without being burdened with your body shame, too.

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Is Your Child Being Teased About His Weight?

Edward Abramson, Ph.D.

It’s hard being an overweight child or teen. There are the obvious health risks; 60 percent of obese kids are at risk for diabetes or cardiovascular disease, but for most overweight children the actual consequences won’t come until later in life. The eventual health consequences aren’t trivial; it’s been suggested that this may be the first generation in America to have a shorter lifespan than their parents.

Although the medical consequences of childhood obesity may not emerge until adulthood, the psychological effects are immediately present. Studies have shown that discrimination against overweight kids begins in kindergarten or earlier. One study of five year-olds found that they described an overweight child as “lazy, dirty, stupid, and ugly.” A new study found that 4 – 8 year old children were less likely to help overweight peers with everyday tasks like picking up toys. Another study reported that virtually all overweight teenage girls had been verbally abused. College students when asked to rate the desirability of a potential spouse rated cocaine users, embezzlers, and shoplifters as better marriage partners than an obese person.

The psychological consequences of the stigmatization of overweight children cannot be overestimated. In addition to lowering the child’s self-esteem, there can be depressive symptoms and suicidal thoughts.  It’s understandable that, instead of playing with other kids and risking humiliation, an overweight kid may retreat and engage in solitary (usually sedentary) activities. Sometimes parents don’t recognize the suffering of their overweight child because the child is too embarrassed to tell Mom or Dad about the indignities they’ve suffered.

If you suspect that your child might be teased or harassed because of her weight there are several things you can do. Perhaps the single most important thing you can do is to listen. When your child is describing the problem it’s natural to want to tell them what they should do, but it’s better to just listen without offering advice or comments until your child has told you the whole story. When your child is describing what happened you can express your understanding and concern by maintaining eye contact and nodding sympathetically.

When your child is finished you can explain that it’s likely that the kid doing the teasing is insecure. The teaser is trying to make himself feel better by putting you down. Sometimes the teaser is unpopular and thinks that he will be accepted by the more popular kids if they see him making fun of you.

To help “inoculate” your child against future harassment you can suggest:

  • Don’t look embarrassed or intimidated
  • Don’t give the bully any pleasure by responding or showing any emotion
  • Tell the teacher or other trusted adult. This isn’t tattling but rather you are showing the bully that you can’t be intimidated
  • If it is a friend or family member doing the teasing let them know that teasing won’t help you lose weight.

Since overweight kids frequently are socially isolated you can help your child become more social by getting him or her involved in afterschool activities. Would your child enjoy the Boy or Girl Scouts? Could he join a youth group at your church or synagogue? For younger kids you could arrange a play date and invite neighborhood children. Anything that increases your child’s socializing will tend to decrease teasing and ultimately help your child get to a healthy weight.

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