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Childhood Obesity
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Source
ERIC Clearinghouse on Teaching and Teacher Education
Contents
Defining Obesity in Children and Adolescents
The Problem of Obesity
Treatment of Childhood Obesity
Prevention of Childhood Obesity
References
Forums
Health, Safety, Nutrition and Kids
Raising our Kids
Related Articles
Beverages Play Important Role in Child Nutrition
Between 5-25 percent of children and teenagers in the United
States are obese (Dietz, 1983). As with s, the prevalence of
obesity in the young varies by ethnic group. It is estimated that
5-7 percent of White and Black children are obese, while 12
percent of Hispanic boys and 19 percent of Hispanic girls are
obese (Office of Maternal and Child Health, 1989).
Some data indicate that obesity among children is on the
increase. The second National Children and Youth Fitness Study
found 6-9 year olds to have thicker skinfolds than their
counterparts in the 1960s (Ross & Pate, 1987). During the same
period, others documented a 54 percent increase in the prevalence
of obesity among 6-11 year olds (Gortmaker, Dietz, Sobol, &
Wehler, 1987).
Back to the Top
Defining Obesity in Children and Adolescents
Obesity is defined as an excessive accumulation of body fat.
Obesity is present when total body weight is more than 25 percent
fat in boys and more than 32 percent fat in girls (Lohman, 1987).
Although childhood obesity is often defined as a
weight-for-height in excess of 120 percent of the ideal, skinfold
measures are more accurate determinants of fatness (Dietz, 1983;
Lohman, 1987).
A trained technician may obtain skinfold measures relatively
easily in either a school or clinical setting. The triceps alone,
triceps and subscapular, triceps and calf, and calf alone have
been used with children and adolescents. When the triceps and
calf are used, a sum of skinfolds of 10-25mm is considered
optimal for boys, and 16-30mm is optimal for girls (Lohman,
1987).
Back to the Top
The Problem of Obesity
Not all obese infants become obese children, and not all obese
children become obese s. However, the prevalence of obesity
increases with age among both males and females (Lohman, 1987),
and there is a greater likelihood that obesity beginning even in
early childhood will persist through the life span (Epstein,
Wing, Koeske, & Valoski, 1987).
Obesity presents numerous problems for the child. In addition to
increasing the risk of obesity in hood, childhood obesity is
the leading cause of pediatric hypertension, is associated with
Type II diabetes mellitus, increases the risk of coronary heart
disease, increases stress on the weight-bearing joints, lowers
self-esteem, and affects relationships with peers. Some
authorities feel that social and psychological problems are the
most significant consequences of obesity in children.
Back to the Top
Causes of Childhood Obesity
As with -onset obesity, childhood obesity has multiple
causes centering around an imbalance between energy in (calories
obtained from food) and energy out (calories expended in the
basal metabolic rate and physical activity). Childhood obesity
most likely results from an interaction of nutritional,
psychological, familial, and physiological factors.
The Family
The risk of becoming obese is greatest among children who have
two obese parents (Dietz, 1983). This may be due to powerful
genetic factors or to parental modeling of both eating and
exercise behaviors, indirectly affecting the child's energy
balance. One half of parents of elementary school children never
exercise vigorously (Ross & Pate, 1987).
Low-energy Expenditure
The average American child spends several hours each day watching
television; time which in previous years might have been devoted
to physical pursuits. Obesity is greater among children and
adolescents who frequently watch television (Dietz & Gortmaker,
1985), not only because little energy is expended while viewing
but also because of concurrent consumption of high-calorie
snacks. Only about one-third of elementary children have daily
physical education, and fewer than one-fifth have extracurricular
physical activity programs at their schools (Ross & Pate, 1987).
Heredity
Since not all children who eat non-nutritious foods, watch
several hours of television daily, and are relatively inactive
develop obesity, the search continues for alternative causes.
Heredity has recently been shown to influence fatness, regional
fat distribution, and response to overfeeding (Bouchard et al.,
1990). In addition, infants born to overweight mothers have been
found to be less active and to gain more weight by age three
months when compared with infants of normal weight mothers,
suggesting a possible inborn drive to conserve energy (Roberts,
Savage, Coward, Chew, & Lucas, 1988).
Back to the Top
Treatment of Childhood Obesity
Obesity treatment programs for children and adolescents rarely
have weight loss as a goal. Rather, the aim is to slow or halt
weight gain so the child will grow into his or her body weight
over a period of months to years. Dietz (1983) estimates that for
every 20 percent excess of ideal body weight, the child will need
one and one-half years of weight maintenance to attain ideal body
weight.
Early and appropriate intervention is particularly valuable.
There is considerable evidence that childhood eating and exercise
habits are more easily modified than habits (Wolf, Cohen,
Rosenfeld, 1985). Three forms of intervention include:
Physical Activity
Adopting a formal exercise program, or simply becoming more
active, is valuable to burn fat, increase energy expenditure, and
maintain lost weight. Most studies of children have not shown
exercise to be a successful strategy for weight loss unless
coupled with another intervention, such as nutrition education or
behavior modification (Wolf et al., 1985). However, exercise has
additional health benefits. Even when children's body weight and
fatness did not change following 50 minutes of aerobic exercise
three times per week, blood lipid profiles and blood pressure did
improve (Becque, Katch, Rocchini, Marks, & Moorehead, 1988).
Diet Management
Fasting or extreme caloric restriction is not advisable for
children. Not only is this approach psychologically stressful,
but it may adversely affect growth and the child's perception of
"normal" eating. Balanced diets with moderate caloric
restriction, especially reduced dietary fat, have been used
successfully in treating obesity (Dietz, 1983). Nutrition
education may be necessary. Diet management coupled with exercise
is an effective treatment for childhood obesity (Wolf et al.,
1985).
Behavior Modification
Many behavioral strategies used with s have been
successfully applied to children and adolescents: self-monitoring
and recording food intake and physical activity, slowing the rate
of eating, limiting the time and place of eating, and using
rewards and incentives for desirable behaviors. Particularly
effective are behaviorally based treatments that include parents
(Epstein et al., 1987). Graves, Meyers, and Clark (1988) used
problem-solving exercises in a parent-child behavioral program
and found children in the problem-solving group, but not those in
the behavioral treatment-only group, significantly reduced
percent overweight and maintained reduced weight for six months.
Problem-solving training involved identifying possible
weight-control problems and, as a group, discussing solutions.
Back to the Top
Prevention of Childhood Obesity
Obesity is easier to prevent than to treat, and prevention
focuses in large measure on parent education. In infancy, parent
education should center on promotion of breastfeeding,
recognition of signals of satiety, and delayed introduction of
solid foods. In early childhood, education should include proper
nutrition, selection of low-fat snacks, good exercise/activity
habits, and monitoring of television viewing. In cases where
preventive measures cannot totally overcome the influence of
hereditary factors, parent education should focus on building
self-esteem and address psychological issues.
Back to the Top
References
References identified with an EJ or ED number have been
abstracted and are in the ERIC data base. Journal articles (EJ)
should be available at most research libraries; documents (ED)
are available in ERIC microfiche collections at more than 700
locations. Documents can also be ordered through the ERIC
Document Reproduction Service: (800) 443-3742. For more
information contact the ERIC Clearinghouse on Teacher Education,
One Dupont Circle, NW, Suite 610, Washington, DC 20036; (202)
293-2450.
Becque, M. D., Katch, V. L., Rocchini, A. P., Marks, C. R., &
Moorehead, C. (1988). Coronary risk incidence of obese
adolescents: Reduction by exercise plus diet intervention.
Pediatrics, 81(5), 605-612.
Bouchard, C., Tremblay, A., Despres, J-P, Nadeau, A., Lupien, P.
J., Theriault, G., Dussault, J., Moorjani, S., Pinault, S., and
Fournier, G. (1990). The response to long-term overfeeding in
identical twins. The New England Journal of Medicine,
322(21), 1477-1482.
Dietz, W. H., & Gortmaker, S. L. (1985). Do we fatten our
children at the television set? Obesity and television viewing
in children and adolescents. Pediatrics, 75(5), 807-812.
Dietz, W. H. (1983). Childhood obesity: Susceptibility, cause,
and management. Journal of Pediatrics, 103(5), 676-686.
Epstein, L. H., Wing, R. R., Koeske, R., & Valoski, A. (1987).
Long-term effects of family-based treatment of childhood obesity.
Journal of Consulting and Clinical Psychology, 55(1),
91-95. EJ 352 076.
Gortmaker, S. L., Dietz, W. H., Sobol, A. M., & Wehler, C. A.
(1987). Increasing pediatric obesity in the United States.
American Journal of Diseases of Children, 141, 535-540.
Graves, T., Meyers, A. W., & Clark, L. (1988). An evaluation of
parental problem-solving training in the behavioral treatment of
childhood obesity. Journal of Consulting and Clinical
Psychology, 56(2), 246-250. EJ 373 116.
Lohman, T. G. (1987). The use of skinfolds to estimate body
fatness on children and youth. Journal of Physical Education,
Recreation & Dance, 58(9), 98-102. EJ 364 412.
Office of Maternal and Child Health. (1989). Child health USA
'89. Washington, DC: U.S. Department of Health and Human
Services, National Maternal and Child Health Clearinghouse. ED
314 421
Roberts, S. B., Savage, J., Coward, W. A., Chew, B., & Lucas, A.
(1988). Energy expenditure and intake in infants born to lean and
overweight mothers. The New England Journal of Medicine,
318, 461-466.
Ross, J. G., & Pate, R. R. (1987). The National Children and
Youth Fitness Study II: A summary of findings. Journal of
Physical Education, Recreation and Dance, 58(9), 51-56. EJ
364 411.
Wolf, M. C., Cohen, K. R., & Rosenfeld, J. G. (1985).
School-based interventions for obesity: Current approaches and
future prospects. Psychology in the Schools, 22, 187-200.
EJ 318 072.
Back to the Top
Credits
ERIC Digest 1990. ED 328556
For More Information Contact:
ERIC Clearinghouse on Teaching and Teacher Education
American Association of Colleges for Teacher Education
(AACTE)
One Dupont Circle, NW, Suite 610
Washington, DC 20036-1186
1-800-822-9229
ericsp@inet.ed.gov
This publication was prepared with funding from the Office of
Educational Research and Improvement, U.S. Department of
Education, under contract no. RI 88062015. The opinions
expressed in this report do not necessarily reflect the positions
or policies of OERI or the Department.
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