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Obesity, a chronic medical disease, is defined as accumulation of excessive body adipose tissue stemming from an imbalance between energy intake and expenditure. Body mass index (BMI; kg/m²), an index of weight relative to height, is the most commonly used tool to diagnose overweight and obesity. In youth, BMI is calculated relative to age and sex to account for developmental changes. Overweight in youth is classified as a BMI index between the 85^th and the 95^th percentile based on age and gender norms; obesity is classified as a BMI index at or above the 95^th percentile.

Prevalence and Course

The prevalence of childhood obesity continues to be a serious public health challenge. In the U.S., the prevalence of obesity was 18.5% and combined overweight and obesity prevalence was 35.1% in 2015-2016. These prevalence rates have increased fairly steadily over the past three decades. Prevalence rates of overweight and obesity vary by sex, race/ethnicity, and household income.

Health and Psychosocial Consequences

Youth with obesity are at greater risk for chronic health conditions including type 2 diabetes mellitus, cardiovascular disease, hypertension, asthma, sleep apnea, nonalcoholic fatty liver disease, and musculoskeletal pain. These chronic health conditions persist into adulthood, significantly decreasing overall quality of life and life expectancy. Further, these youth are at increased risk to experience bullying, social bias, rejection, and prejudice, internalizing symptoms, low self-esteem, body dissatisfaction, and maladaptive and health compromising behaviors (e.g., disordered eating behaviors, substance use).

Evidence-based Assessment

The U.S. Preventive Service Task Force (USPSTF) recommends to use BMI-for-age and sex as a screening tool for obesity in youth six years and older. National guidelines are essential to guide assessment of physical activity and dietary intake in youth (e.g., daily 60-minutes of moderate-to-vigorous physical activity, MyPlate healthy eating guidelines). Social and emotional functioning should be evaluated, using obesity-specific measures.

Evidence-based Interventions

Behavioral family lifestyle interventions are the most researched interventions targeting pediatric obesity, with data showing small-to-moderate effect size in interventions addressing childhood overweight and obesity. Behavioral family lifestyle interventions target family environmental modification through behavior change in dietary intake and physical activity. Intervention strategies such as monitoring of health behaviors, goal setting, problem-solving, parent modeling and training in behavior parent management skills are used to facilitate health behavior change and maintenance of change for the entire family. Parents are the agents of change, particularly for younger ages. Behavioral family lifestyle interventions vary in format, content, and dose. The Obesity Society recommends at least 26 hours of patient contact for effective treatment.

Culture, Diversity, Demographic, and Developmental Factors

Prevalence rates of overweight and obesity increase with age;  adolescents 16-19 years have the highest prevalence (41.5%). Female youth have higher prevalence (35.5%) than their male peers (34.8%). Hispanic youth have the highest prevalence rate (45.8%), followed by their non-Hispanic African-American/Black peers (37.8%), non-Hispanic White peers (29.9%), and non-Hispanic Asian peers (23.2%). Youth from middle-income households have the highest prevalence (19.9%), compared to their peers from low- and high-income households (18.9% and 10.9%, respectively). These factors have significant implications on prevention and intervention participation and treatment outcome.

Resources:

• U.S. Preventive Service Task Force on Childhood Obesity Screening (6 years and older)
• https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/obesity-in-children-and-adolescents-screening1
• MyPlate: https://www.choosemyplate.gov
• 5-2-1-Almost None: https://www.nemours.org/services/health/growuphealthy.html
• Traffic Light Diet: Epstein, L. H., Squires, S. (1988). The stoplight diet for children: An eight-week program for parents and children. New York, NY: Little, Brown

 

Authors: Ke Ding & David Janicke

Date of last update: May, 2019

References

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