Early Childhood Obesity

By Edward J. Cumella, PhD, CEDS

There is good and bad news when it comes to childhood obesity. The good news: national statistics indicate that the percentage of American children who are obese has probably not increased at all in the past decade. The bad news: there has there been no decrease in the percentage of American children who are obese, with nearly 1 in 5 falling in the obese category.¹ Furthermore, obese children are more likely to develop high blood pressure, high cholesterol, and Type 2 diabetes; suffer ridicule and ostracism by their peers; develop eating disorders; and grow up to be obese adults.²

Measuring Childhood Obesity

Body mass index (BMI) is used as an indicator of obesity in children. A child’s BMI is calculated using height, weight, and standardized growth charts. The Centers for Disease Control and Prevention makes available a free online BMI calculator for children. However, BMI remains an imprecise and controversial measure of obesity.³ A child’s true health status is best established by visiting a medical doctor or dietitian who specializes in weight issues.

Causes

Obesity results from an imbalance between calories consumed and calories used. Bodies use calories for growth, tissue repair, and development, an array of internal metabolic activities, and all physical movements. The calories expended by each of these processes vary from child to child, depending on genes, nutrition, health, environment, and behavior.⁴ Therefore, it is difficult to link childhood obesity to only one factor, such as a lack of physical activity or overeating. The truth is, children in 2010 generally engage in less physical activity than children 50 years ago, and many children today eat a lot of processed and fast foods.

Among these chief behaviors that may lead to childhood obesity is America’s favorite pastime: watching television. The more television a child watches, the more likely he or she will be obese. While the exact relationship between television watching and obesity is not definitive, television viewing encourages excessive snacking, influences children to eat unhealthy foods through the advertising they see, and may lower metabolism.

Consequences

Obese children and teens often exhibit several risk factors for cardiovascular disease, including high cholesterol levels, high blood pressure, and abnormal glucose tolerance.⁵ Other medical problems associated with childhood obesity include asthma, fatty degeneration of the liver, sleep apnea, and Type 2 diabetes. Questions remain, however, if obesity is the cause of these medical complications or, rather, there is an underlying genetic or acquired condition that causes both obesity and health problems. While obesity is often demonized in the media as the cause of multiple medical ailments, it may not be the singular cause. Other factors—such as chemicals in the food supply, viral infection, and/or genetics, or even a combination of modern-day factors— may also contribute to a cluster of conditions, including obesity.

Yet American society remains weightiest, often manifesting unjustified discrimination against obese people.⁶ Some have even suggested that prejudice against obese people is the only “ism” (“weightism”) still tolerated widely in the United States.⁷ For obese children and adolescents, the stress of being stigmatized by peers can lead to low self-esteem, social isolation, and depression, each of which can then hinder the child’s achievement in school, sports, and social activities.

Treatment and Prevention

The most commonly recommended and personally pursued treatment for obesity is dieting. While research indicates that nearly 98 percent of diets result in temporary weight loss, the lost weight is often eventually regained, and sometimes increased.⁸ Diets can be particularly dangerous for children, because a child’s nutritional status can rapidly decompensate due to weight loss, and physical development can be impaired. Surgical options, such as gastric bypass or banding, may also not be safe for children and adolescents.

So, what can be done to assist obese children? Some research now supports an approach called Health at Every Size (HAES). HAES promotes positive thinking, eating well in a natural and relaxed way, and being comfortably active; in short: “Eat well, move around, and enjoy life!” In fact, most weight-related medical problems can vanish without any weight loss if the individual simply increases the level of pleasurable physical activity.⁹

HAES proposes the idea that a healthy weight for each individual cannot be determined by the numbers on a scale, BMI, or body fat percentage. Instead, HAES considers healthy weight as the weight a person’s body naturally finds while progressing toward a more fulfilling and meaningful lifestyle.

HAES can also assist in preventing obesity in children by encouraging children to find physical activities that they enjoy. These do not need be athletic in nature, but can include activities such as playing with animals, dancing to music, walking in a park, or yoga. A second preventive influence involves exposing children to a positive adult role model. An adult who has a healthy relationship with his or her own body and with food—practicing balance, variety, and moderation in eating, drinking, and physical exercise—demonstrates these vital skills to children, counters our culture’s unbalanced messages about food and weight, and thus helps children to develop healthy body image and eating practices.

References:

1. National Health and Nutrition Examination Survey (NHANES), 2007–2008; D.S. Freedman, et al., “Cardiovascular Risk Factors and Excess Adiposity Among Overweight Children and Adolescents: the Bogalusa Heart Study,” Journal of Pediatrics, 150 (2007): 12–17.e2.

2. M.K. Serdula, et al., “Do Obese Children Become Obese Adults? A Review of the Literature,” Preventive Medicine, 22 (1993): 167–177.

3. K. Devlin, “Do You Believe in Fairies, Unicorns, or the BMI?” Mathematical Association of America (2009), www.maa.org/devlin/devlin_05_09.html (accessed April 2010).

4. U.S. Department of Health and Human Services, The Surgeon General's Call to Action to Prevent and Decrease Overweight and Obesity. Rockville, MD: Public Health Service, Office of the Surgeon General (2001).

5. W. Dietz , “Health Consequences of Obesity in Youth: Childhood Predictors of Adult Disease,” Pediatrics, 101 (1998): 518–525.

6. E.J. Cumella, “American Culture and the Production of Eating Disorders,” The Remuda Review, 4 (2004), www.remudaranch.com/articles/26-remuda-review/143-social-dimension-of-eating-disorders-continued (accessed April 2010).

7. R.M. Puhl, T. Andreyeva, and D. Brownell, “Perceptions of Weight Discrimination: Prevalence and Comparison to Race and Gender Discrimination in America,” International Journal of Obesity, 32 (2008): 992–1000.

8. M. Korkeila et al., “Weight-loss Attempts and Risk of Major Weight Gain: A Prospective Study in Finnish Adults,” American Journal of Clinical Nutrition, 70 (1999): 965–975.

9. J. Robison, “Health at Every Size: Toward a New Paradigm of Weight and Health,” MedGenMed, 7 (2005): 13, www.ncbi.nlm.nih.gov/pmc/articles/PMC1681635/ (accessed April 2010).

10. Trust for America's Health and the Robert Wood Johnson Foundation, “F as in Fat: How Obesity Policies Are Failing in America,” (2009), http://healthyamericans.org/reports/obesity2009/Obesity2009Report.pdf (accessed April 2010).

11. S.W. Anderson, and R.C. Whitaker, “ Prevalence of Obesity Among US Preschool Children in Different Racial and Ethnic Groups,” Archives of Pediatric and Adolescent Medicine, 163 (2009): 344-348.

Dr. Edward J. Cumella

Dr. Cumella received a bachelor’s degree from Harvard University, and a master’s degree and PhD in clinical psychology from the University of North Carolina at Chapel Hill. He has been a practitioner in the mental health field for 24 years, specializing in the assessment and treatment of adults and adolescents with eating disorders, depression, and anxiety. Prior to joining the Kaplan University Psychology Department as an adjunct faculty member in 2009, Dr. Cumella was executive director for 12 years at Remuda Ranch, the nation’s largest eating disorder treatment facility. Prior to this, he was in private practice and directed the mental health programs for all Native Americans in the State of Nevada.

Dr. Cumella has presented scientific findings internationally and led conference workshops focusing on eating disorder assessment, treatment outcomes, cultural competency, and related topics. He has been interviewed as a mental health expert on national television, radio, and in many newspapers, including ABC, FOX News, the Discovery Channel, The New York Times, and Reader’s Digest. In addition, he chairs the professional certification program of the International Association of Eating Disorders Professionals and serves on the boards of charitable organizations dedicated to the provision of mental health care to underserved populations.