US Pharm. 2020;45(9):9-12.
Childhood obesity continues to be a national concern and one of the greatest public health challenges of the 21st century. Currently in the United States, childhood obesity prevalence continues to remain high despite ongoing efforts to help address this issue. Over the last 40 years there have been increases in obesity seen across all ages and populations, with the prevalence of childhood obesity nearly quadrupling from 5% in 1971–1974 to almost 19% in 2019.1-5
Obesity in children and adolescents can have detrimental effects; complications secondary to childhood obesity include asthma, obstructive sleep apnea, orthopedic problems, and adverse cardiovascular and metabolic outcomes, including hypertension and diabetes. In addition to these medical outcomes, children and adolescents who are obese may also suffer from more psychological and social issues compared with their healthy-weight peers. Obese children are more likely to report depression and anxiety, a lower perceived quality of life, and low self-esteem. They are also more likely to be victims of negative stereotypes and stigmatization that can have detrimental consequences to mental and physical health.1-5
The negative consequences of childhood obesity do not stop at adolescence; childhood obesity often leads to adult obesity and its related effects. Almost half of overweight adults were overweight as children. The U.S. National Longitudinal Study of Adolescent Health demonstrated that almost 40% of obese adolescents became severely obese by the age of 30 years compared with 5% of normal-weight teenagers. Being overweight as an adolescent also increases cardiovascular risk in adulthood. There is an associated 8.5-fold increase in hypertension, a 2.4-fold increase in high total serum cholesterol levels, a threefold increase in above-normal LDL cholesterol levels, and an eightfold increase in lower levels of HDL cholesterol in adults who were overweight as adolescents. Childhood obesity may also increase the risk of adult morbidity and mortality independently, regardless of current adult BMI.6-9
Many parents often misperceive their child’s weight, stating that their overweight and/or obese child is “about the right weight.” Pharmacists can play a vital role in this prevalent epidemic by increasing awareness about childhood obesity and its potential consequences in adulthood. Additionally, treatment for this patient population mainly relies on intensive lifestyle modifications. Pharmacists can be influential by providing education to children and their parents and/or caregivers about the benefits of such changes.10,11
A BMI assessment and the CDC normative BMI percentiles are used to detect overweight and obesity in children who are aged 2 years and older (TABLE 1). Unlike the adult classification of overweight and obesity, a child’s weight classification is based on age- and sex-specific percentiles for BMI; children’s body composition varies as they age, and differences exist between genders.12
There is no one single cause for childhood obesity. Genetics may play a role; studies of twins have demonstrated that genetic factors can account for up to 70% of variation in BMI between individuals. However, genetics does not necessarily explain the tremendous increase seen in the prevalence of childhood obesity over the past 3 decades. This increase can largely be attributed to environmental and behavioral patterns. It is widely known that increases in weight quite often result from an imbalance between energy intake and expenditure—the latter usually a consequence of a sedentary lifestyle. Children today spend more time in front of a screen, either watching shows, playing video games, using social media, or using the computer. Approximately half of all obese children engage in more than 2 hours of screen time per day; children who reported more than 2 hours of screen time are 1.8 times more likely to be obese or overweight. This, however, is not the only reason for childhood obesity. There has also been a huge shift in dietary patterns, with increased consumption of fast food, sugary beverages, and snack foods, along with an increase in portion sizes. Other risk factors are listed in TABLE 2.13-16
Lifestyle modification is the cornerstone of treatment of childhood obesity. Interventions primarily include dietary changes, physical activity, and behavioral modifications. It is recommended that behavioral interventions for at least 26 contact hours over a 2- to 12-month period be delivered by an interdisciplinary team. To be optimally effective, targeting the home environment and involving the family are necessary.17-19
Children and parents should be educated about healthy eating habits. Both quantity and quality of food should be addressed, including the importance of portion control. Recommendations can be made to reduce the consumption of fast food, ultra-processed foods, sugar-sweetened beverages, and saturated dietary fats. Eating more fruits, vegetables, and fiber; consuming more whole fruit juices; and eating more regular meals with the family should be encouraged. Eating timely, more regular meals should also be strongly encouraged to help minimize snacking. Parents should also be encouraged to help identify any eating cues in their child’s environment such as boredom, stress, loneliness, or screen time.17-19
In addition to dietary modifications, increased physical activity must also be incorporated to facilitate weight loss. It is recommended that at least 60 minutes of physical activity be incorporated per day, with at least 20 of those minutes being of moderate-to-vigorous activity. The activities should be those that are enjoyed by the adolescent or child to help make this sustainable. Nonacademic screen time and other sedentary activities should be limited to less than 2 hours per day. The entire family should be educated regarding the value and benefits of dietary and physical activity modifications. All family members should be encouraged to participate in these lifestyle changes to help support the child or adolescent through this weight-loss journey.17-19
If diet and exercise alone does not achieve weight-loss goals or do not help ameliorate comorbid conditions, pharmacotherapy may be used as adjunctive treatment. Currently there are two approved medications in the U.S. for the management of adolescent obesity. These include orlistat for long-term use in children aged 12 years and older and phentermine for short-term use in those aged 17 years and older. Because of the limited options of pharmacotherapy in the pediatric population, other FDA-approved antiobesity medications are being used in this patient population off-label, including metformin, GLP-1 analogues, phentermine, topiramate, naltrexone/bupropion, and lorcaserin. Further research about the efficacy and safety of these agents in adolescents is needed. Bariatric surgery is another option but is reserved for adolescents with severe obesity.18,20
Preventing childhood obesity is fundamental to helping curb the current obesity epidemic. The authors of the 2017 Endocrine Society Clinical Practice Guideline state, “The prevention of pediatric obesity by promoting healthful diet, activity, and environment should be a primary goal, as achieving effective, long-lasting results with lifestyle modifications once obesity occurs is difficult.”18 Many children who are overweight or obese are more likely to become overweight or obese adults. To help prevent childhood obesity, the same practices that are encouraged for the treatment should be applied. Encouraging physical activity and healthy eating habits facilitates healthy weight maintenance. It is also critical to stress the importance of limiting nonacademic screen time; children and adolescents should be encouraged to find fun activities to do with family members or on their own. Adequate sleep is also important to help prevent obesity; inadequate sleep promotes more eating and less physical activity. School-aged children should be sleeping 8 to 11 hours each night.18,21
Role of the Pharmacist
With childhood obesity recognized as a health epidemic and public health challenge, pharmacists can be instrumental in helping to increase awareness of this problem and promote healthy lifestyle changes. Since prevention and treatment of childhood obesity are mainly focused on lifestyle modifications, pharmacists can easily incorporate these discussions in their daily interactions with many of their adolescent patients and their parents. Primary prevention and treatment regimens should be aimed at educating the child and family about the consequences of childhood obesity and encouraging healthy eating habits, the importance of portion control, and incorporating physical activity into the daily routine.
The number of children who are considered overweight or obese has substantially increased over the past 3 decades. Childhood obesity can negatively affect the child both physically and mentally, leading to many chronic diseases such as diabetes and hypertension, and it can contribute to a decrease in academic performance as well as depression and low self-esteem. These conditions can persist into adulthood if not addressed early. Interventions focused on preventing and controlling childhood obesity center around healthy eating, encouraging physical activity, and decreasing the duration of screen time. This should be a multidisciplinary approach that includes all healthcare providers to help improve outcomes and help move the prevalence of childhood obesity toward a downward trend.
1. Skinner AC, Ravanbakht SN, Skelton JA, et al. Prevalence of obesity and severe obesity in US children, 1999–2016. Pediatrics. 2018;141(3):e20173459.
2. May AL, Freedman D, Sherry B, Blanck HM. CDC. Obesity—United States, 1999–2010. MMWR Suppl. 2013;62(03):120-128.
3. CDC. Childhood obesity facts. June 24, 2019. www.cdc.gov/obesity/data/childhood.html. Accessed August 10, 2020.
4. Trasande L, Chatterjee S. The impact of obesity on health service utilization and costs in childhood. Obesity (Silver Spring). 2009;17(9):1749-1754.
5. Rankin J, Matthews L, Cobley S, et al. Psychological consequences of childhood obesity: psychiatric comorbidity and prevention. Adolesc Health Med Ther. 2016;7:125-146.
6. The NS, Suchindran C, North KE, et al. Association of adolescent obesity with risk of severe obesity in adulthood. JAMA. 2010;304(18):2042-2047.
7. Srinivasan SR, Bao W, Wattigney WA, Berenson GS. Adolescent overweight is associated with adult overweight and related multiple cardiovascular risk factors: the Bogalusa Heart Study. Metabolism. 1996;45(2):235-240.
8. Deshmukh-Taskar P, Nicklas TA, Morales M, et al. Tracking of overweight status from childhood to young adulthood: the Bogalusa Heart Study. Eur J Clin Nutr. 2006;60(1):48-57.
9. Must A, Jacques PF, Dallal GE, et al. Long-term morbidity and mortality of overweight adolescents. A follow-up of the Harvard Growth Study of 1922 to 1935. N Engl J Med. 1992;327(19):1350-1355.
10. De La OA, Jordan KC, Ortiz K, et al. Do parents accurately perceive their child’s weight status? J Pediatr Health Care. 2009;23(4):216-221.
11. Duncan DT, Hansen AR, Wang W, et al. Change in misperception of child’s body weight among parents of American preschool children. Child Obes. 2015;11(4):384-393.
12. CDC. Overweight & obesity: defining childhood obesity. www.cdc.gov/obesity/childhood/defining.html. Accessed August 15, 2020.
13. Chesi A, Grant SFA. The genetics of pediatric obesity. Trends Endocrinol Metab. 2015;26(12):711-721.
14. Sahoo K, Sahoo B, Choudhury AK, et al. Childhood obesity: causes and consequences. J Fam Med Prim Care. 2015;4(2):187-192.
15. Vos MB, Welsh J. Childhood obesity: update on predisposing factors and prevention strategies. Curr Gastroenterol Rep. 2010;12(4):280-287.
16. Barnett TA, Kelly AS, Young DR, et al. Sedentary behaviors in today’s youth: approaches to the prevention and management of childhood obesity: a scientific statement from the American Heart Association. Circulation. 2018;138(11):e142-e159.
17. U.S. Preventive Services Task Force' Grossman DC, Bibbins-Domingo K, Curry SJ, et al. Screening for obesity in children and adolescents: US Preventive Services Task Force Recommendation Statement. JAMA. 2017;317(23):2417-2426.
18. Styne DM, Arslanian SA, Connor EL, et al. Pediatric obesity—assessment, treatment, and prevention: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2017;102(3):709-757.
19. Steinbeck KS, Lister NB, Gow ML, Baur LA. Treatment of adolescent obesity. Nat Rev Endocrinol. 2018;14(6):331-344.
20. Srivastava G, Fox CK, Kelly AS, et al. Clinical considerations regarding the use of obesity pharmacotherapy in adolescents with obesity. Obesity (Silver Spring). 2019;27(2):190-204.
21. Pandita A, Sharma D, Pandita D, et al. Childhood obesity: prevention is better than cure. Diabetes Metab Syndr Obes. 2016;9:83-89.
22. Sanyaolu A, Okorie C, Qi X, et al. Childhood and adolescent obesity in the United States: a public health concern. Glob Pediatr Health. 2019;6:2333794X19891305.
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What Causes Childhood Obesity?
There is no one reason why children become obese. Causes include a combination of environmental and behavioral factors. Today’s environment encourages fast-food eating, consumption of sugary drinks, and large portion sizes. Children also participate in less physical activity because of increased use of computers, phones, and television.
Genetics may also play a role. It has been shown that children with obese parents are more likely to be obese as well. But genes alone do not determine if a child will be affected by obesity.
What Can I Do if My Child Is Obese?
Lifestyle modification is key in helping a child lose weight. It is important to get the whole family involved in the child’s weight loss. Healthy eating habits should be incorporated. The entire family should practice healthy eating. Meals should be eaten together at the dinner table. Avoid other activities, such as watching television, when eating. Avoid foods high in calories, sugars, and fat. Try to limit fast-food eating.
Encourage regular physical activity. It is recommended that children get at least 60 minutes of physical activity each day. Nonacademic screen time should also be limited to less than 2 hours per day.
Can I Prevent My Child From Becoming Obese?
The same strategies used to treat childhood obesity are also used to prevent obesity. Again, these include healthy eating habits and encouraging physical exercise. It is also important to have the whole family involved, thereby providing support for the child.
Where Can I Go to Learn More About Childhood Obesity?
Visit the Obesity Action Coalition (OAC) website section on childhood obesity to learn more about this condition. www.obesityaction.org/get-educated/understanding-childhood-obesity/.
You can also visit the CDC website to learn more about tips to help children maintain a healthy weight: www.cdc.gov/healthyweight/children/index.html.