Currently browsing posts about: Obesity-in-kids

Chinese scientists have published Global Prevalence of Overweight and Obesity in Children and Adolescents: A Systematic Review and Meta-Analysis.

This exceptionally well written paper lists obesity prevalence for nearly 200 countries.

From this chart, regional variations are evident.

The prevalence of pediatric obesity in the US is 18.6%, while that in Japan, another high-income country, is 3.9%. Differences in dietary habits may play a role in this disparity. European countries and the US often embrace a diet preference of processed food, which are typically abundant in unhealthy fats, added sugars, and refined carbohydrates. In contrast, diets rich in whole grains and vegetables, which are generally regarded as healthier options, have historically been prioritized in Southeast Asian countries.

The paper describes factors associated with childhood obesity:

• age
• sex
• school type
• maternal obesity
• having breakfast
• number of meals per day
• hours of playing on the computer per day
• maternal smoking in pregnancy
• birthweight
• regular exercise
• sleep duration

Some are fixed and can’t be changed.  But most can.  This list suggests a range of policy options, all of them worth consideration.

Obesity prevalence is increasing among children.  We need to act now.

The World Obesity Atlas 2023, published by World Obesity Federation, predicts that unless preventive interventions succeed, by 2035:

• The global economic impact of overweight and obesity will reach $4.32 trillion annually and constitute nearly 3% of global GDP.
• The majority—51% or more than 4 billion people—will be living with overweight or obesity.
• One in four people—nearly 2 billion—will have obesity.
• The economic impact of overweight and obesity is estimated to be over $370 billion a year in low and lower-middle income countries alone.
• Childhood obesity could more than double.

Here’s the prediction for the U.S.

In the report, the World Obesity Federation:

• Notes that member states of WHO committed to halt the increase in obesity rates at 2010 levels by 2025. No country is on track to meet these targets.
• Calls on governments to develop national action plans.
• Calls on governments to improve health care.
• Calls for building on the ROOTS framework for tackling obesity: Recognising the root causes, monitoring Obesity data, investing in Obesity prevention, ensuring access to Treatments, and adopting a Systems-based approach.

The documents:

• The press release
• The World Obesity Atlas 2023  (this includes predictions for WHO member nations) 

Comment

This is a global problem requiring global solutions., and actions by every government, including ours.   We need a national obesity prevention plan focused on strategies like to work (reduction of food insecurity, improved health care, better education, restrictions on marketing junk food, etc).

Otherwise,  we are all headed to Wall-E, which will turn out to be prescient, rather than dystopian.

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So many readers have asked me to comment on the American Academy of Pediatrics’ Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents With Obesity that I thought I ought to say something about it.

The guideline report is so long and detailed that I cannot imagine anyone actually reading it.  I started with the introduction, which summarizes basic facts.

• 14.4 million children and adolescents are affected by obesity.
• Obesity is a chronic disease with potentially serious health consequences
• Childhood obesity is strongly affected by social determinants of health (poor education, poverty, racism, exposure to toxins, etc)
• Childhood obesity is stigmatized in ways that fail to acknowledge social determinants.

What got press attention—and the attention of readers of this blog—is the AAP’s endorsement of drug and bariatric surgical treatment of obese children.

I cut right to the chase and looked at Appendix I, which gives the AAP’s algorithm for deciding on treatment options.  

The report’s major conclusions expand on this chart (the report does not define KAS, but I think it means Knowledge, Attitudes, and Skills):

KAS 9.  Pediatricians and other PHCPs should treat overweight (BMI ≥ 85th percentile to <95th percentile) and obesity (BMI ≥ 95th percentile) in children and adolescents, following the principles of the medical home and the chronic care model, using a family-centered and nonstigmatizing approach that acknowledges obesity’s biologic, social, and structural drivers.

KAS 10.  Pediatricians and other PHCPs should use motivational interviewing (MI) to engage patients and families in treating overweight (BMI ≥ 85th percentile to <95th percentile) and obesity (BMI ≥ 95th percentile).

KAS 11.  Pediatricians and other PHCPs should provide or refer children 6 y and older (Grade B) and may provide or refer children 2 through 5 y of age (Grade C) with overweight (BMI ≥ 85th percentile to <95th percentile) and obesity (BMI ≥ 95th percentile) to intensive health behavior and lifestyle treatment. Health behavior and lifestyle treatment is more effective with greater contact hours; the most effective treatment includes 26 or more hours of face-to-face, family-based, multicomponent treatment over a 3- to 12-mo period.

KAS 12.  Pediatricians and other PHCPs should offer adolescents 12 y and older with obesity (BMI ≥ 95th percentile) weight loss pharmacotherapy, according to medication indications, risks, and benefits, as an adjunct to health behavior and lifestyle treatment.

KAS 13.  Pediatricians and other PHCPs should offer referral for adolescents 13 y and older with severe obesity (BMI ≥ 120% of the 95th percentile for age and sex) for evaluation for metabolic and bariatric surgery to local or regional comprehensive multidisciplinary pediatric metabolic and bariatric surgery centers.

What is not in this guideline is anything that addresses the social determinants of childhood obesity.  What we have here is a focus on treating the symptoms, but getting nowhere near the cause.

It is difficult for someone like me who is not affected by those determinants to even imagine how drugs and surgery could be thought even remotely acceptable for children, even those over the age of 12, but I am not treating these kids.

Providers who do treat obese children tell me they are relieved to be able to offer options that might help kids achieve healthier weights.

As I see it, these should be absolute last resorts if used at all. And this is without even getting into issues of cost or our dysfunctional health care system.

In public health terms, drugs and surgery are “downstream” solutions to a problem that began way upstream with all those societal determinants.

If ever we needed upstream approaches, chldhood obesity is a prime example.

Upstream means policy changes that make healthy eating more appealing, accessible, and affordable  That’s what pediatricians need to be calling for.

This AAP report deliberately separates treatment from prevention.  It promises a discussion of prevention in a subsequent report.  I hope it is as hard hitting as any AAP report has ever been.

If childhood obesity teaches us anything, it is that our society needs to change in ways that are healthier for our children.

Additional supporting documents

• Executive Summary: Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents With Obesity
• Appraisal of Clinical Care Practices for Child Obesity Treatment. Part I: Interventions
• Appraisal of Clinical Care Practices for Child Obesity Treatment. Part II: Comorbidities

Thanks to all the people who wrote me about this.  Much appreciated.

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It’s a sad sign of the times that the CDC has found it necessary to revise its standard growth charts for boys and girls in order to expand Body Mass Index ranges to include current weights.

The 2000 CDC BMI-for-age growth charts, based on data from 1963-1980 for most children, do not extend beyond the 97th percentile. So, CDC developed new percentiles to monitor very high BMI values. These extended percentiles are based on data for children and adolescents with obesity – including from 1988-2016 – thus increasing the data available in the reference population. See the report on alternative BMI metrics for more information.

Here’s what the comparison looks like (thanks to David Ludwig):

The comparison for girls extends to a BMI of 56.

What are we to make of this?  In revising the growth charts, the CDC is recognizing reality: children weigh more than they used to, and sometimes a lot more.

Why: the quick-and-dirty answer:  junk food (more calories consumed) and electronic media plus imprisonment (fewer calories expended).

The world has changed.  When I was a kid, and when my kids were kids, we didn’t eat a lot of junk food (more politely, ultra-processed), we weren’t allowed to snack all day, and we were free—required!—to walk to school and play outdoors unaccompanied.

Shouldn’t the CDC be engaging in campaigns to promote healthier eating and more activity among children?

One can wish.

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Here’s what’s happening with kids and food these days.

I.  Amedeo Bettauer’s video on kids’ menus in restaurants: “Kids Menus Suck”

Amedeo Bettauer, a.k.a. Kid Pundit, is my 12-year-old neighbor in New York.  His opinion:

Kids menus are unhealthy, have no variety, and are teaching bad eating habits to young kids. Here’s why.

He would appreciate Likes if you are so inclined.

II.  The Robert Wood Johnson Foundation’s State of Childhood Obesity Report 2021

From the press release for this report:

One in six young people nationwide, 16.2 percent of youth ages 10-17, have obesity, according to the newest available data. The data reveal sharp disparities, with the highest obesity rates among youth of color and youth from households with low incomes. ..The report, available at www.stateofchildhoodobesity.org, includes the latest data on childhood obesity rates and offers policy recommendations for prioritizing health and equity.

III.  Center for Science in the Public Interest report on that status of kids’ meals in restaurants: “Selling Out Kids’ Health: 10 Years of Failure from Restaurants on Kids’ Meals”

Overall, 98% of the 9,556 children’s meal combinations across the 38 top 50 restaurant chains offering kids’ meals in 2018 failed to meet nutrition standards. When each restaurant chain’s evaluation was weighted by its number of outlets in the United States to reflect the likelihood of a family visiting any given restaurant, results were still poor, with 71.9% of kids’ meals failing to meet nutrition standards. These results are virtually the same as when this data was last collected in 2012, when 71.8% of meals failed to meet nutrition standards (when also weighted by number of outlets per chain).

Among the report’s dismal conclusions:

The most commonly offered beverage type was juice, with 76% of restaurants offering 100 percent fruit juice or juice without added sweeteners on the children’s menu. However, two-thirds of restaurants had soft drinks on their children’s menu, and few (26%) had water as an option.

IV.  Healthy Eating Research has feeding recommendations for kids ages 2 to 8.    The complete report is here.  

Here’s an example of its recommendations:

Here’s some good news for a change.  The CDC announces that young children enrolled in the WIC program are reducing their prevalence of obesity.

The study: State-Specific Prevalence of Obesity Among Children Aged 2–4 Years Enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children — United States, 2010–2016.  Morbidity and Mortality Weekly Report (MMWR) November 22, 2019 / 68(46);1057–1061.

The happy result:  “Among children aged 2–4 years enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), obesity prevalence decreased from 15.9% in 2010 to 13.9% in 2016 and during 2010–2014, decreased in 34 of the 56 WIC state or territory agencies.”

One possible explanation:  WIC revised its food packages a few years ago to emphasize healthier food options in order to

promote fruit, vegetable, and whole wheat product purchases; support breastfeeding; and give WIC state and territory agencies more flexibility to accommodate cultural food preferences….In addition, the availability of healthier foods and beverages in authorized WIC stores has increased. Children enrolled in WIC consumed more fruits, vegetables, and whole grain products and less juice, white bread, and whole milk after the revisions than they did before.

Comment: Here is evidence that eating more healthfully promotes healthier body weights.  Let’s do more of this.

Note: The Robert Wood Johnson Foundation’s State of Childhood Obesity report provides an interactive map, state by state.

On World Obesity Day, I posted links to three recent reports.

An editorial in The Lancet made me realize that I had not read this one nearly carefully enough.  It deserves careful reading.

It comes from Sallie Davies, who just stepped down as Britain’s Chief Medical Officer.  In another Lancet piece, she and her colleagues insist that children have a right to live in a healthy environment:

Today, government legislation is necessary not simply because we have an obligation to protect vulnerable children, but because children have rights. The UN Convention on the Rights of the Child (UNCRC), the most widely ratified international human rights treaty, sets out children’s rights to protection, education, health and health care, shelter, and good nutrition…a child rights approach requires us to recognise childhood obesity as the responsibility of the state and as an issue that must be addressed across society…It is time to address childhood obesity as a rights issue.

In her report, she insists that government should enact legislation to ensure a healthy food environment; Annex A lists recommendations:

• Increase taxes on sugary drinks
• Require product reformulation to reduce sugar and calories
• Tax unhealthy foods
• Label calories
• Provide free drinking water
• Remove tax exemptions for advertising
• Phase out marketing of unhealthy products
• Ban eating and drinking on public transport
• Only permit healthy options at sports facilities
• Promote smaller portion sizes

Her report also suggests ways to promote physical activity.

Worth a try?  I think so.

Simón Barquera.  ¿Hasta que los kilos nos alcancen? Una introducción desde la ciencia sobre el aumento de la obesidad y la forma de enfrentar esta epidemia [My and Google’s translation: Until the kilos reach us?  A scientific introduction to the increase in obesity and how to confront this epidemic]. Instituto Nacional de Salud Publica and SPM Ediciones, 2019 (119 pages, hard cover).

I did a blurb for this book (it’s in Spanish on the back cover):

I can’t think of a better target audience for a book about the social, economic, and political causes of obesity than the young people who will be tomorrow’s leaders and policymakers.  Simón Barquera gives them–and readers of any age—the skills to recognize how food and beverage companies promote corporate profits over public health, and to act on this knowledge through advocacy for regulating conflicts of interests.  These skills are essential for preventing obesity and creating healthier food systems.

I’ve wrote about Barquera’s work a couple of years ago; he is one of the Mexican soda-tax advocates who had spyware installed on his phone, and is a researcher at the public health institute in Cuernavaca where I went on a Fulbright in February 2017.

I hadn’t seen the book’s illustrations when I did the blurb.  If I had, it would have been hard to talk about anything else because they are beyond charming.  It’s hard to pick a favorite, but I especially like this one.

This book needs an English translation!  I hope someone is doing one.

If you want a copy, try this link.