Weighing in on Childhood Obesity
According to the Centers for Disease Control, approximately 20% of children in the U.S. are considered obese, with the highest rates of pediatric obesity ranging among children between the ages of 12 to 19 years old. Statistics for Oklahoma’s children follow the same pattern as the national statistics. Childhood obesity can lead to physical and mental health issues throughout life, but there are steps parents can take to ensure that their children are on a path to good health.
Colony S. Fugate, D.O., FACOP of OSU Pediatrics, is board certified in pediatrics and obesity medicine and serves as a diplomate on the American Board of Obesity Medicine. Additionally, she is a Clinical Professor of Pediatrics, and Director for Pediatric Clinical Research at Oklahoma State University Center for Health Sciences. We asked Dr. Fugate to answer some questions regarding children and obesity. (Answers have been edited for clarity and length.)
TK: To help us understand how to identify this condition, how is obesity defined?
Dr. Fugate: Obesity is a complex chronic disease characterized by excess adipose tissue, or body fat, which increases an individual’s risk for heart disease, diabetes, structural and inflammatory diseases such as sleep apnea and arthritis, cancer, psychological and many other disorders. A child’s health care provider will likely use pediatric growth charts to diagnose overweight or obesity, but it is important to understand that obesity is more than excess weight.
TK: Why are the statistics for childhood obesity so high?
Dr. Fugate: The causes of pediatric and adult obesity are complex and numerous. Causes may be biological, environmental or behavioral and may or may not be within the control of the individual or family. They include, but are not limited to, genetic predisposition, social determinants of health, health literacy, medication side effects, endocrine disease, obesogenic environments which make it difficult for individuals to adopt and sustain healthy behaviors, excess intake of high calorie food of low nutritional value, and physical inactivity.
Children and adults from certain populations are at greater risk than others for developing obesity. For example, children who have experienced adversity (or adults with a history of adverse childhood experiences) and weight-based victimization are at greater risk for developing and worsening obesity. Individuals living in rural communities, those living in poverty, individuals who are Black and/or Hispanic, children with a family history of obesity, diabetes or cardiovascular disease are all at greater risk for developing obesity, as are children with neurodevelopmental disabilities.
Obesity rates began to increase more rapidly in the 1980s; thus, there is likely a strong association with food systems and environmental factors. It is important to understand that the cause of obesity is not a lack of individual willpower. Hunger, fullness and food cravings are tightly controlled by hormones in the gastrointestinal tract and brain and are not within an individual’s capacity to control without medical or surgical intervention.
TK: What problems can arise from children being obese?
Dr. Fugate: Children who are overweight or obese are at risk for developing diseases typically associated with adults such as metabolic dysfunction-associated steatotic liver disease (formerly known as non-alcoholic fatty liver disease), diabetes, high cholesterol, hypertension and sleep apnea. In fact, these are quite common.
Further, children with obesity are more likely to experience social isolation, weight-based victimization, depression and anxiety. Children should have routine well-child visits, and families should seek the guidance of their medical provider if they have concerns.
TK: What are the top things parents can do to maintain a healthy weight in their children?
Dr. Fugate: Parents can support their children by role modeling healthy behaviors, providing healthy foods such as fruits and vegetables, providing opportunities for active play and other forms of formal and informal physical activity, and promoting good sleep habits. It is important for adult caregivers to provide children with the tools to make healthy lifestyle choices such as helping children learn what is healthy and what is not, and having healthy foods available.
I give the example of teaching children to make their bed. Children need certain things to make their bed: The tools such as sheets and maybe a blanket, and they also need the knowledge of why and how to make their bed. Finally, children need to practice the skill of making their bed, becoming increasingly independent over time.
As parents, we need to allow our children room to make their bed imperfectly – maybe with the sheet crooked or days when they slip and forget to make their bed – while role modeling by making our own beds and acknowledging our own imperfections to promote autonomy and self-efficacy – the “I can do it myself” attitude – as we won’t always be with our children to help them make their bed or to remind them to make their bed.
Promoting healthy behaviors is similar. Children need the tools to make healthy choices (water, fruits and vegetables, a place to be physically active), knowledge of what habits are healthy and unhealthy, and the opportunity to practice the skills of making healthy choices around food, drink, activity, sleep and other health behaviors. Finally, children need a supportive role model who allows the child to have increased levels of independence over time, praises the child when they make healthy choices, and is supportive and understanding when they have slips – as we all do! Just like making the bed, we will not always be with our children to make the healthy choice for them or to remind them to do so. Taking this approach allows for children to make healthy choices at school, at a party, at a family member’s home or anywhere else they may go without us.
Further, it is important to acknowledge that children are by nature impulsive, which means the front part of their brain – the prefrontal cortex – is not fully developed. I call this the “stop and think about the consequences of our actions” part of the brain or the “stop” brain.
In addition to an immature “stop and think” part of their brain, children – like all humans – have a part of the brain that leads them to seek out foods that are high in fat, salt and sugar. I call this area the “go” brain, but scientifically it is called hedonic eating. For example, when children see a large bag of chips (or a plate of cookies, etc.) they will eat the whole thing. They don’t stop to think whether eating all the chips is healthy or if it will give them diabetes later in life or that someone else might want some chips or that they might want to save some for the next day.
As adults, our “go” brain is still there telling us to eat those fatty, sugary and salty foods, but we have one advantage – our “stop” brain is more matured. This difference in brain development can create tension between the parent and child around food and other health behaviors. The easiest way to reduce this tension and to help children and adults is stimulus control – that is, create a food-safe home where unhealthy foods and drinks are less available.
TK: Are pediatricians and other healthcare professionals talking to parents about childhood obesity?
Dr. Fugate: Yes! The State of Oklahoma periodically updates the State Obesity Plan. Further, the American Academy of Pediatrics released updated guidance for the evaluation and treatment of child and adolescent overweight and obesity in 2023. Families and providers have the support of numerous private, state, federal and professional groups including the American Academy of Pediatrics Institute for Healthy Childhood Weight.
TK: What else would you like parents to know?
Dr. Fugate: Every adult or child has their own unique body shape and size. Overweight and obesity are complex and rarely within the control of the individual both at biological and environmental levels, especially children. Focus on health and health behaviors – not weight. Focus on what you can do to support your health and the health of those you care about. Families get so many mixed messages on what is healthy and what is not, which can be confusing and overwhelming. Healthy habits include:
- Eating plenty of fruits and vegetables (fresh, frozen, or canned/raw or cooked)
- Drinking water (eliminating sugary beverages)
- Being active (in play, at work, in formal and informal settings)
- Reducing screen time
- Getting good sleep
Do your best. None of us can make the healthiest choices all the time. Most of us have many ways that we can be healthier. Keep it simple and work on what is easiest and most important to you and your family. Work on only one or two measurable goals at a time and adjust as needed. Show yourself and those you care for self-compassion. We all have slips. It is okay to acknowledge when challenges arise and try again the next day.
Resources
Here are some helpful resources for individuals and families:
- Shape Your Future Oklahoma: shapeyourfutureok.com
- The Ellyn Satter Institute: ellynsatterinstitute.org
- The American Academy of Pediatrics Institute for Healthy Childhood Weight: aap.org/en/patient-care/institute-for-healthy-childhood-weight
- Oklahoma State University Community Nutrition Education Program: extension.okstate.edu/county/tulsa/community-nutrition-education.html
Macy Goodnight is a freelance writer and photographer from Broken Arrow. She loves spending time with her family and friends, and has a keen interest in studying history, gardening, hiking, and traveling.
