Childhood obesity is a serious medical condition that affects millions of children and adolescents in the United States. While obesity has risen to epidemic levels over the past few decades, research has shown it may be preventable. This paper will analyze the underlying factors behind the childhood obesity epidemic and propose recommendations to curb this growing public health concern.
Obesity is defined as a body mass index (BMI) at or above the 95th percentile for children and teens of the same age and sex (CDC, 2018). A high BMI can be an indicator of high body fatness. BMI is calculated using a person’s weight and height and screening children’s BMI is an effective way to identify potential weight issues or risks (CDC, 2018). Being overweight or obese increases the risks for both immediate and long-term health problems.
According to the Centers for Disease Control and Prevention (CDC), obesity affects around 13.7 million children and adolescents aged 2–19 years in the United States. The prevalence of childhood obesity has tripled since the 1970s. In 2015-2016, the prevalence was 18.5% among children and adolescents aged 2-19 years. Furthermore, nearly 1 in 5 school-aged children and young people have obesity. Childhood obesity rates vary greatly between states from 9.8% to 27.5% depending on the state. Both genetics and the environment play a role in childhood obesity. While genes influence metabolism and body weight regulation, the modern environment is largely contributing to the sharp increase seen over the past few decades.
Many factors have contributed to an environment that promotes increased food intake, non-healthy eating habits and reduced physical activity. These include changes in dietary patterns, physical activity behaviors and environmental factors. Overall calorie intake has risen dramatically in recent decades while estimated calorie expenditure has declined concurrently. Several dietary behaviors have facilitated this calorie imbalance. Portion sizes, particularly of high-calorie foods, have increased dramatically. The consumption of sugar-sweetened beverages has risen exponentially. In addition, consumption of fast food and food that is prepared outside the home has also increased. Beyond dietary factors, physical activity levels among children and youth have declined substantially due to less active transportation and reduced physical education in schools.
Also fueling the childhood obesity epidemic is a modern environment that exposes children to abundant options for convenient, highly palatable, and cheap calorie-dense foods. Factors such as increased access to less healthy foods, aggressive food marketing to youth, larger portion sizes, and fewer options for free and safe outdoor play and physical activity during nonschool hours are environmental risk factors. Emerging research suggests that exposure to endocrine disrupting chemicals in food packaging, toys, personal care products and other environmental sources may also be playing a role through developmental and metabolic pathways.
Access to healthy, affordable foods and opportunities for safe physical activity vary depending on where a child lives, learns, and plays. Neighborhoods characterized as “food swamps,” where the availability of cheaper, less nutritious foods far outweigh access to healthier options, put families living in these conditions at higher risk for making nutritionally poor but economically necessary choices. The intersection between poverty, food insecurity, and limited neighborhood resources contributes to a web of social and economic circumstances which predispose children living in high-poverty areas to obesity at disproportionately higher rates. Families battling economic hardship and food insecurity struggle to afford healthy diets even if the option exists.
The costs of childhood obesity are extensive. Childhood obesity is associated with both immediate and long-term health consequences that persist into adulthood. Obese children and adolescents are at greater risk for cardiovascular disease factors such as high cholesterol and triglyceride levels, prediabetes, bone and joint problems, sleep apnea and social and psychological problems. Obesity in children significantly increases their risk of premature death and disability in adulthood. Children who are overweight or obese are much more likely to be overweight or obese adults. Some of the costs of obesity reflect increased medical care needs and associated healthcare spending. Obese children and teens are more likely to be prescribed medications and require healthcare visits, procedures and hospitalizations. Studies have estimated the medical costs of obesity in youth are already costing the nation billions each year. Beyond healthcare costs, the economic losses from the impact of obesity on overt productivity in adulthood are difficult to estimate but the long term societal costs are undoubtedly substantial.
Childhood obesity is clearly a complex public health problem with myriad contributing factors. Preventing and reducing obesity in the United States will require a multifaceted, systems-thinking approach. As childhood obesity has environmental and societal drivers, solutions must also be Environmental and policy strategies are needed alongside continued improvements to physical and nutrition education. Interventions must be culturally sensitive and equitably available across varied demographics. Coordination is needed between sectors of education, transportation, food policy and urban planning. Addressing neighborhood characteristics that impede healthy choices while also improving family economic security through policies like a federal minimum wage increase could help support behavior changes. Overall societal shifts towards increased access to affordable healthy foods, safe places for recreation, less digital screen time and community environments conducive to routine physical activity will be important for stemming the childhood obesity epidemic. With strategic, collaborative action informed by ongoing research, stemming and even reversing current obesity trends seems achievable. Reducing obesity nationwide is critical for improving child and adolescent health as well as long term economic productivity.
Andrew Stroud