How is obesity defined in children?

Your child is considered obese if he or she has a body mass index (BMI) greater than the 95th percentile when compared to children of the same age and gender.

Click here to calculate your child's BMI.

BMI is determined by dividing the weight (in kilograms) by the height squared (in meters).  For children, a graph (or the above calculator) must be used to determine the "age-appropriate" BMI.  Children with BMI's more than the 95th percentile are considered "obese."  Children between the 85th and 95th percentile are considered "overweight."

What causes obesity in children?

Nobody knows for sure.  In fact, researchers are investing vast amounts of time and effort to determine this.  The root cause of obesity seems to be a combination of factors.

Genes - It is no secret that overweight children are more likely to have overweight parents when compared to thin children.  The "fat" gene has not been discovered.  However, the discovery of a hormone called "leptin" has led the way to finding new metabolic pathways affecting hunger and fat deposition.

Behavior - Children who watch TV or play computer games more than 2 hours per day are at increased risk for becoming obese.  Children who are active in sports, bike riding, swimming, etc. are less likely to become obese.

Environment - Food portion sizes have greatly increased in recent years.  The easy availability of fast food, soft drinks and unhealthy snacks has also played a major role in childlhood obesity.  Elevators, moving sidewalks, and automated transportation have made walking and bicycle riding less common events.  Fear of unsafe neighborhoods has forced families to keep children inside where the choices for physical activity are limited.

Do children outgrow obesity?

Some do.  However, half of children who are overweight at 6 years of age, will be overweight adults.  This percentage increases as children become obese adolescents.  Children with obese parents are less likely to "outgrow" obesity.

Can medical tests determine the cause of obesity?

In most cases medical tests are not helpful.  A small number of obese children may have thyroid, adrenal gland or a genetic cause for obesity.  Genetic syndromes that cause obesity are often associated with mental retardation and hormonal causes are typically associated with other medical symptoms.

What are some of the medical side effects of obesity in children?

• High blood pressure
• High cholesterol levels
• Joint damage (especially the hips and knees)
• Diabetes
• Gallstones
• Fatty liver disease
• Asthma
• Sleep apnea

How is obesity in children treated?

This is one of the greatest challenges for pediatricians.  Treatment for obesity must combine diet, exercise, and behavior changes.

Diet

• Reduce portion sizes
• Do not skip meals, this increases snacking
• Only allow non-calorie drinks (i.e., water or diet sodas)
• Pack lunch for school
• Reduce restaurant eating
• Remove unhealthy snacks from the house
• Plan for meals with family, at the dining table, with limited distractions, and for at least 20-30 minutes
• Avoid juices and "low fat" foods (both contain high sugar calories)

Exercise

• Limit TV and computer games
• Participate in extracurricular activities at school or after school
• Encourage outdoor play daily (immediately after school)
• Walk or ride bike for transportation
• Walk and play with the dog
• Work in the yard as a family
• Purchase toys that require activity (i.e., basketball, jump rope, etc.)

Behavior

• Do not use food as a reward
• Develop a health program for the whole family, not just the child
• Parents should model the desired behavior
• Establish realistic goals (weight loss takes time)
• Do not criticize or humilate children trying to lose weight
• Recognize and congratulate success

For the doctor

• Discuss current and possible complications of obesity
• Provide guidance, but don't be critical
• Plan for "baby steps"
• Recommend one change at a time

Are there medicines to treat childhood obesity?

Medicines are not recommended for weight loss in children.

What about surgery for obesity in children?

"Bariatric" surgery, such as stapling the stomach, is recommended in only extreme cases.  Only children who are a high risk of early death from obesity should be considered.  Bariatric surgery is dangerous and should be considered a "last choice" option.

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