The Road of the Childhood Obesity Epidemic: What Are Some Culprits?
The Road of the Childhood Obesity Epidemic: What Are Some Culprits?
Joy Stepinski, MSN, RN-BC
June 13, 2023
With rising childhood obesity, many concerns are raised on the nutritional intake of the younger population. Looking back to 2010, the White House created a task force to solve this very issue. The plan included a strategy, benchmarks, and a goal to end childhood obesity within a generation. By 2030, the national plan for childhood obesity was determined to drop 5% to rates equivalent to 1970 [1]. According to the report, one in three children between the ages of 2 through 19 were overweight or obese. A concern was documented that obesity led to shorter life spans, chronic diseases like diabetes, less military readiness, and increased healthcare spending. The progress report [2] submitted to the President one year later reported successful adoption of measures towards empowering parents to make healthier choices, serving healthier options in school, ensuring access to affordable and healthy food, and encouraging physical activity.
However, the outcome of these efforts from one decade ago has seemingly fallen short. According to the most recent statistics provided by the National Institute of Health, childhood obesity is at an all-time high. The prevalence of obesity among children ages 2 – 19 doubled between 1988 - 1994 and 2017 – 2018 [3]. The younger age groups have historically seen some fluctuation, but recent data shows an increased rate. Unfortunately, efforts to raise public awareness have not been too fruitful.
The Centers for Disease Control and Prevention (CDC) defines childhood obesity according to body mass index (BMI) [4]. These values are compared among children of the same age and sex. While healthy weight is defined as children in the 5th through 85th percentile for weight, overweight is 85th through 95th percentile, and obesity is greater or equal to 95th percentile. According to the CDC, 1 in 5 children are affected by unhealthy weight.
As one study acknowledges, there is a significant relationship between childhood obesity and quality-of-life (QOL) [5]. In a cross-sectional study of 106 children, the researchers compared QOL indicators among obese children and adolescents to those who were healthy and those with cancer. The findings showed that health-related QOL was considered impaired among obese children, compared with non-obese children. In contrast to children and adolescents diagnosed with cancer, results were surprisingly similar. Children with more weight were affected in all QOL domains, including physical, emotional, psychosocial, and school functioning. Not only were chronic disease states like diabetes and rheumatoid arthritis prevalent, but children were described as experiencing decreased physical functioning, lower grades, and more absenteeism at school.
An abundance of articles is available on the lack of nutrition faced by today’s children. In recent decades, the trend has shifted from meal consumption at home to frequently eating away from home. One historical study reviewed nationally representative data of 29,217 children and determined a significant increased energy intake (of 179 kcal/day) by children in 2006, as compared with 1977 [6], with a correlating increase in calories (255 kcal/day). Eating fast food or store-prepared food was seen as the cause of this increase. While the study was published a number of years ago, it can shed light on the same problems that are seen today. The research found that food prepared away from home became the main source of energy for children, with fast food as the largest supplier of calories.
The tendency to eat away from home has skyrocketed in the United States, according to Statista [7], an organization stating to be the leading provider of market and consumer data. Eating out, takeout, and delivery significantly increased between 2009 and 2019. Although this number fell in 2020 during the pandemic, the site claims that sales were still higher than most of the prior 20 years. More chain restaurants, more food options, and more ability to eat anywhere other than home seems very feasible. This food access greatly affects nutrition, particularly among children as the obesity epidemic increases.
A contributing factor to prepared meals is that of ultra-processed foods. Another cross-sectional study used data available through NHANES of 9,469 participants [8]. For preschool-aged children, energy sources were cakes, cookies, salty snacks, reconstituted meats, manufactured breads, breakfast cereals, and milk-based drinks. Among school-aged children ages 6 to 11, the kids also ate pizza, soft drinks, and fruit juices. Adolescents consumed similar food, but showed a 50% increase in soft drinks and fruit juices, and a decrease in milk-based drinks, cakes, and cookies. The authors discovered that ultra-processed food pertains to 65% of total energy intake among children, with 92% of energy from added sugars.
These findings raised several concerns. Ultra-processed foods were habit-forming, set the stage for taste preference, and created a conditioned partiality for low-nutrient and high-energy dense foods. Nutritional quality was deeply impacted, showing a lack of dietary fiber, micronutrients, and phytochemicals [9]. Inadequate dietary fiber, a contributing factor to constipation, is more prevalent in obese children than non-obese [8]. Not only are insufficient nutrients linked with obesity, but also with disease later in life, including dental caries, obesity, cardiovascular disease, metabolic syndrome, type 2 diabetes, asthma, gastrointestinal disorders, and depression [8, 9].
One study discovered an inverse correlation between preschool obesity, and fruit and vegetable intake [10]. Analyzing data from 78 children, the authors noted that fruit intake was linearly associated with the number of grocery stores near the child’s home. If there was an increased proximity to a store within two to four miles, there was more fruit intake. On the other hand, vegetable intake appeared to be inversely related to the amount of fast food consumed. Access to healthy food, like fruits and vegetables, are incredibly important to support healthy nutrition.
What can be done about the chronic disease status of America’s children? For one, consider eating more meals at home, with some suggestions in my recent blog post. Plan meals centered around whole plant foods, like fruits, vegetables, and whole grains. Limit ultra-processed foods high in fat and sugar. If there are an abundance of fast-food joints and restaurants near the home, awareness is key. When eating out, food selection is paramount. Instead of opting for the kids’ menu of hot dogs, grilled cheese, and French fries, encourage children to choose a healthier plant food, such as a vegetable or whole grain from the adult menu. Teach children to grow food by planting a garden. Ask a child to help pick out a new and different fruit or vegetable at a farmer’s market that they may be willing to try. Examine the meal options served in schools and teach children to opt for healthier food. Finally, encourage children to move around and be active. While the road to childhood obesity has been a long and winding one, getting back to the basics can be simple. Teaching kids to be aware of food choices and healthier meal options can reverse this trend!
References:
1. Task Force on Childhood Obesity. (2010). Solving the problem of childhood obesity within a generation: White House Task Force on childhood obesity report to the President. https://letsmove.obamawhitehouse.archives.gov/sites/letsmove.gov/files/TaskForce_on_Childhood_Obesity_May2010_FullReport.pdf
2. The Domestic Policy Council. (2011). White House Task Force on childhood obesity: One year progress report. https://letsmove.obamawhitehouse.archives.gov/sites/letsmove.gov/files/Obesity_update_report.pdf
3. U.S. Department of Health and Human Services. (2021). Overweight & obesity statistics. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/health-statistics/overweight-obesity#trends
4. Centers of Disease Control and Prevention. (2023). Defining child BMI categories. https://www.cdc.gov/obesity/basics/childhood-defining.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fobesity%2Fchildhood%2Fdefining.html
5. Schwimmer, J. B., Burwinkle, T. M., & Varni, J. W. (2003). Health-related quality of life of severely obese children and adolescents. JAMA, 289(14), 1813-1819. https://doi.org/10.1001/jama.289.14.1813
6. Poti, J. M., & Popkin, B. M. (2011). Trends in energy intake among US children by eating location and food source, 1977-2006. Journal of the American Dietetic Association, 111(8), 1156–1164. https://doi.org/10.1016/j.jada.2011.05.007
7. Statista. (2021). Eating out behavior in the U.S. – Statistics & facts. https://www.statista.com/topics/1957/eating-out-behavior-in-the-us/#topicOverview
8. Neri, D., Martinez‐Steele, E., Monteiro, C. A., & Levy, R. B. (2019). Consumption of ultra‐processed foods and its association with added sugar content in the diets of US children, NHANES 2009‐2014. Pediatric Obesity, 14(12), e12563. https://doi.org/10.1111/ijpo.12563
9. Zhu, L., Liu, W., Alkhouri, R., Baker, R. D., Bard, J. E., Quigley, E. M., & Baker, S. S. (2014). Structural changes in the gut microbiome of constipated patients. Physiological genomics, 46(18), 679-686. https://doi.org/10.1152/physiolgenomics.00082.2014
10. Kepper, M., Tseng, T. S., Volaufova, J., Scribner, R., Nuss, H., & Sothern, M. (2016). Pre‐school obesity is inversely associated with vegetable intake, grocery stores and outdoor play. Pediatric obesity, 11(5), e6-e8. https://doi.org/10.1111/ijpo.12058