Childhood Obesity (Q&A)

10 May 2017

1. What is childhood obesity?

Childhood obesity is a condition of extreme overweight in children and adolescents. Being overweight, consisting mainly of body fat, can lead to health problems, such as cardiovascular disease and type 2 diabetes, sometimes already at an early age. Children may also develop psychological problems, like depression and anxiety, which further reduces their quality of life. Obesity has significant economic consequences, including high health care costs for both the individual and the society. It is important to understand the causes of weight gain, and to learn how to best prevent and treat it.

2. How many children are overweight or obese?

The World Health Organization estimates that the number of obese Europeans has more than tripled since the 1980s, and that around 1 in 3 children aged 6-9 years old are overweight or obese.1

There are large country differences, with the south of Europe having the highest number of overweight children. The statistics also show that the increase in childhood obesity rates has slowed down in developed countries, but not in low- and middle-income countries, where more children are getting ‘extremely obese’ (see the weight categories in question 5).1 Monitoring the prevalence and trends of childhood obesity is important to see if prevention and intervention programmes have an effect.

3. How do children become obese?

Becoming overweight is the result of a combination of several factors that contribute to an energy imbalance over a longer period of time. The below (non-exhaustive) list includes factors that may increase or decrease the risk.

  Increased Risk Decreased Risk
Dietary Factors:
  • Intake of large meals.
  • Intake of sugar sweetened drinks.
  • High fruits and vegetables intake.
Behavioural factors:
  • Frequent snacking (especially on foods high in fat, sugar and salt).
  • Not getting adequate sleep
  • Screen time (television, laptop, tablet, etc.).
  • Skipping breakfast.
  • Physical activity.
  • Limited sitting time.
Physical environment:
  • ‘Obesogenic’ environment stimulating unhealthy eating behaviours.
  • Little physical activity.
  • Healthy meal options in the school canteen.
  • Access to free drinking water.
  • Supporting infrastructures (bicycle lanes, safe walking areas, stairs, etc.).
  • Supporting facilities (sports clubs, recreational facilities, public transport services, etc.).
Social environment:
  • Unhealthy diet- and activity patterns of parents or friends.
  • Familial stress.
  • A lack of acceptance from peers, and a low socioeconomic status.
  • Health education and physical activity programmes at school.
Psychological factors:
  • Impulsivity, depression, self-esteem, and anxiety.
Vice versa, being overweight or obese may lead to psychological and social problems.
 
Pregnancy and early life nutrition:
  • Under- and over-weight of the mother during pregnancy.
  • Breastfeeding
For the health of both mother and child, the WHO recommends exclusive breastfeeding until six months of age, followed by a step-by-step introduction of complementary foods.
Genetics:
  • Several genes
Having one or more of these genes does not necessarily mean that that will happen, likewise for the other abovementioned factors. It a combination of several factors that will define whether a child becomes obese.
 

4. What are the health consequences of childhood obesity?

Obesity in children is strongly linked to health problems, at present, and later in life. Being overweight is likely to be carried over into adulthood, and increases the risk for a variety of physical health problems, including: type 2 diabetes, cardiovascular disease, musculoskeletal problems including joint and muscle pain, reduced mobility and balance, obstructive sleep apnoea, asthma, and early entry into puberty.

Stigmatisation, discrimination, and bullying are psychosocial consequences of childhood obesity. This can lead to a low self-esteem, social isolation, low performance at school and a general low mood, such as depression, self-blame, shame and helplessness.

The financial consequences of childhood obesity and associated diseases are significant. It has been estimated that in the European Union, every year about 7% of the national health budget is spent on the obesity-linked diseases.As the number of obese individuals is likely to increase, so will the costs for the prevention and treatment.

5. How is obesity in children measured?

Assessing obesity in children is different and more complex than in adults, because children grow and develop at different paces at different ages. To assess a child’s weight category, his/her body mass index (BMI) is compared with the ‘BMI-for-age’ chart (Figure 1). The charts reflect the natural growth patterns of children, and may have small country differences.

Figure 1: The World Health Organisation (WHO) BMI chart for boys and girls aged 5 to 19 years old. The numbers of the coloured lines indicate the weight categories: below -3 is ‘severe thinness’, between -3 and -2 is ‘thinness’, between -1 and 1 is ‘normal weight’, between 1 and 2 is ‘overweight’, and higher than 2 is ‘obesity’3

6. How can obesity in children be prevented?

Parents, care givers, teachers, public authorities, businesses, and the wider community all play a vital role in helping children to develop healthy habits. Some by being role models, others by providing a supportive environment. Small, achievable, and realistic changes are recommended for long-term success.

Recommendations and suggestions (non-enhaustive)
parents/care givers schools
  • Pay attention to portion sizes – use smaller plates.
  • Avoid using food to stimulate or reward good behaviour or to satisfy the emotional needs of children – use stickers, play, or exercise as a reward (be creative!).
  • Encourage children to try new foods, so they learn to accept and appreciate a wide range of tastes. Rejection of novel or bitter foods is normal, especially in younger children, but multiple offerings will increase the acceptance.
  • Ensure the child gets enough sleep, between 9 to 14 hours is recommended, depending on the age.4
  • Encourage physical activity. According to WHO, a child should be physically active at least 60 minutes per day!5
  • Develop a supportive social environment for the child, such as family meals, no eating in front of the television, and regular (physical) activities.
  • Promote healthy eating: provide balanced lunches and nutritious snacks.
  • Include healthy options in vending machine (e.g. nuts, dried fruit and rice crackers).
  • Provide access to free drinking water.
  • Provide daily and mandatory physical education.
  • Make playgrounds available and accessible, encourage being active during breaks and lunch periods.
  • Put focus on health education within the classroom. Include interactive activities, like cookery classes, teach children about nutrition and healthy food options.

For more in-depth information about childhood obesity, read EUFIC’s Childhood Obesity Review.

References

  1. Wijnhoven TM, et al. (2014). WHO European Childhood Obesity Surveillance Initiative: body mass index and level of overweight among 6-9-year-old children from school year 2007/2008 to school year 2009/2010. BMC Public Health 14(1):806.
  2. European Union (2014). EU Action Plan on Childhood Obesity 2014-2020.
  3. World Health Organization (2007). WHO BMI for age growth reference.
  4. Sleep Foundation press release ‘’National Sleep Foundation Recommends New sleep times’’. Published 2 February 2015.
  5. World Health Organisation website. Physical activity and young people.
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