[ Back to HealthHints topic index ] [ Back to HealthHints issue date index ] [ Back to Health ] [ FCS Home ]

HealthHints Newsletter, Texas Cooperative Extension, The Texas A&M University SystemTexas Cancer Council logo

Childhood Overweight: An Epidemic on the Rise

Part 1: Physical Activity for Families

Volume 7, Number 7 - September/October, 2003

Editors: Carol A. Rice, Ph.D., RN, Professor and Extension Health Specialist, and Janet M. Pollard, MPH, Extension Associate-Health

Download PDF version of this newsletter and 7 handouts

Inside HealthHints....

Childhood Overweight: An Epidemic on the Rise

Childhood overweight is currently at an all-time high in the United States (Borra, 2003). The number of children who are overweight has doubled in the last 20-30 years; increases occurring in both children and adolescents, and across all age, race, and gender groups (Torgan, 2002).

Results from the recent National Health and Nutrition Examination Survey (NHANES) 1999-2000 published in the Journal of the American Medical Association indicate that, in addition to the 59 million (31%) adults age 20 and older considered obese...

Thus, about 30% of children and teens nationwide are either overweight or at risk for overweight.

Additionally, over 10% of our younger preschool children ages 2-5 are overweight, up 7% from 1994 (Centers for Disease Control, 2002a).

Statewide, the Texas Medical Association reports...

This issue of HealthHints will be the first in a series on childhood overweight. In these issues of HealthHints, we will give you up front information about the concerns of childhood overweight, and take a look at some guiding principles for fostering a healthy lifestyle. Our primary goal, however, will be to provide you tools and information that will help you guide your clientele in taking first steps toward resolving issues of overweight among children, including issues related to the family as a whole. Though our focus will not be on diseases related to overweight, you can access disease-related information in previous issues of HealthHints at http://fcs.tamu.edu/health/Health_Education_Rural_ Outreach/.

Our focus in this series will be on practical interventions that can be implemented right away, such as plans for...

Throughout this series we will address interventions in areas that have shown the most promise for success (Ritchie et. al., 2001). We will use the seven principles outlined in the grey box below as our guide.

This issue of HealthHints includes a brief overview of the childhood overweight problem and physical activity interventions specifically for individual families. Further issues will address food and nutrition and community intervention
strategies.

Seven Principles to Guide Extension Programs Addressing Childhood Overweight

As we move toward taking action in the area of overweight among children, our focus will be on the following seven principles, which can be our guide in choosing interventions with the most likelihood for success:

  1. Gradually increase physical activity through active play for children and adults.
  2. Decrease sedentary activities including "screen time" (TV, computer, video, etc.) at home to 2 hours or less each day.
  3. Improve diet quality by following the Food Guide Pyramid for serving size and number. Discourage "super-sizing" amounts.
  4. Increase fruit and vegetable intake to amounts recommended by the Food Guide Pyramid.
  5. Limit sweetened beverages including soft drinks, sports drinks, imitation fruit juices, sweetened teas, agua frescas, etc.
  6. Increase family meals together to improve nutrition, communication, and family connections.
  7. Encourage "engaged parenting," in which parents provide children with healthy food choices and opportunities for physical activity and act as role models for these behaviors.

Why be Concerned? A look at the risks -- costs

"Overweight adolescents have a 70 percent chance of becoming overweight or obese adults (Torgan, 2002)."

So, why is overweight of concern? Being overweight puts one at risk for numerous diseases, in addition to costing one socially and economically. It is well documented that overweight children often become overweight adults (The Endocrine Society, 2003). With continued/uncontrolled overweight comes increased risk for disease both now (as children) and into adulthood.

We are now seeing children at young ages exhibiting illnesses once thought to occur only in adults. In fact, overweight children and adolescents have shown an alarming increase in the incidence of type 2 diabetes (the 7th leading cause of death in the U.S. [American Academy of Pediatrics, 2003]), also known as adult-onset diabetes (Torgan, 2002). Type 2 diabetes has increased from 4% in 1990 to approximately 20% in 2000 (American Academy of Pediatrics, 2003). It is more strongly associated with obesity than any other condition (Stevens, 2001).

Additionally, many overweight children also have high cholesterol and blood pressure levels, which are risk factors for heart disease and stroke (Torgan, 2002)." Children who remain overweight into adulthood also increase their risk for certain types of cancers (Nemours, 2001b) and problems of the female reproductive system (e.g., menstrual irregularities, infertility, irregular ovulation, and complications in pregnancy) (Centers for Disease Control, 2002b).

Furthermore, overweight children have a high incidence of orthopedic problems, liver disease, and asthma. One of the more severe problems among overweight children is sleep apnea (interrupted breathing while sleeping), which can lead to learning and memory problems in some cases (Torgan, 2002). Other educational challenges occur when children have trouble staying awake in class.

Added to these concerns about physical health are the social costs for overweight children. According to a recent study in the August 2003 issue of The Archives of Pediatrics & Adolescent Medicine, a journal of the American Medical Association, "few problems in childhood have as significant impact on emotional development as being overweight (American Medical Association, 2000)."

"Overweight adolescents are often socially marginalized and isolated (American Medical Association, 2000)." A new study published in the April 2003 issue of Pediatrics found that "kids who are substantially overweight throughout much of their childhood and adolescence have a higher incidence of depression than those who aren't (Bouchez, 2003)." Additionally, evidence indicates that young adults who are overweight as adolescents face more job discrimination, have less education, earn less money, and marry less frequently than their average weight peers (American Medical Association, 2001). Thus, the mental health consequences for overweight children are far reaching including issues of depression, self-confidence, and self-esteem (Centers for Disease Control, 2002b; Torgan, 2002).

Finally, the economic costs associated with diseases related to overweight in children are staggering. Hospital costs for diseases related to overweight have increased threefold in the past 20 years, increasing from $35 million in 1979 to $127 million in 1999; with discharges for overweight-related diseases among children documented in a recent study as follows:

Factors Contributing to Overweight in Children: Biological, behavioral, environmental

There are a variety of factors -- biological, behavioral, and environmental -- which play a part in the overweight epidemic among children. There is no doubt that genes play a role. A family history of obesity increases a child's chances of weight problems. Additionally, metabolic and endocrine disorders may also contribute to obesity, however, they are the culprits in only about 5% of overweight children (American Academy of Pediatrics, 2000).

While there is no doubt that genetics and some biological disorders play a role, these factors alone cannot account for the huge increases in rates of overweight over the last few decades (Torgan, 2002).

The main culprits of childhood overweight and the greatest areas for prevention, intervention, and treatment of overweight among children are those that fall into categories of behavioral and environmental:

When calories consumed exceed those expended, your child can develop a weight problem. Though this sounds simple, in our society there are many factors contributing to sedentary lifestyles and excessive food consumption patterns. We will take a look at many of these factors in the remainder of this issue and the next as we look at what can be done right now to help children develop healthy lifestyles.

Engaged Parenting: Addressing the needs of parent and child

"Parents and children need to work together in addressing the overweight prevention issue and need effective tools to facilitate this cooperative effort (Borra, et. al., 2003)."

As we seek to help the child, we must first enable the parent. "Parents need to learn how to talk about eating and exercise habits with their children in positive and encouraging ways and to learn how to help their children maintain efforts to get fit (Borra, et. al., 2003)."

The following are some critical factors one current study found important to the success of guiding healthful lifestyles and prevention of overweight:

As we look to guide our clientele in this area, it is important that we seek to address these factors.

Is My Child Overweight? Determining weight status

Is my child overweight? Though the answer to this question may seem obvious to one parent, it may not be so obvious to another. In fact, determining overweight status is more complex than one might think. Height, weight, and age must all be considered in evaluation weight status.

Additionally, some factors of traditional/cultural thought are often challenged. For example, many people hold true that "chubby" babies are the healthiest babies. This is a critical issue in the Hispanic culture (Texas Medical Association, 2003a). Though children will be born into this world in all sizes, a "chubby" baby does not mean that child is the healthiest (Texas Medical Association, 2003a). Healthy babies come in all sizes. It is important not to unintentionally fatten a child to create the appearance of a "chubby" or so-called healthy baby.

Additionally, parents may notice that their child seems overweight, but may also believe that they will "grow out of it." As stated earlier, height, weight, and age must all be considered. If parents are concerned about their child's weight, they should be guided to their family doctor or pediatrician for consultation.

A Look at Our Diverse Population of Children

Overweight is non-discriminating. It affects adults and children from all walks of life. A look at the data on children from the National Center for Health Statistics, however, does indicate some trends/differences among population and age groups. The data on children show:

Additionally, data from other sources indicate that children of low-income families seem to be at greater risk for being overweight (Mei, et. al., 1998; Strauss et. al., 1999)

Body Mass Index (BMI): A Measurement Tool

Assessing overweight

One common measure physicians use to assess overweight is called the Body Mass Index or BMI. "The BMI is more highly correlated with body fat than any other indicator of height and weight (Centers for Disease Control, defining overweight and..., 2003)."

Body Mass Index or BMI is a number that shows body weight adjusted for height. BMI correlates with body fat and is one of many factors used to predict risk for disease. As a person's BMI increases their risk for many diseases increases as well. It is important to note, however, that BMI does not actually measure body fat. In fact, two people can have the same BMI, but a different percentage of body fat. For instance, a body builder may have the same BMI as someone who has more body fat because muscle weighs more than fat and BMI is calculated using weight and height (Centers for Disease Control, 2003b).

BMI can be calculated using pounds and inches as follows:

In children, BMI is used to assess underweight, overweight, and risk for overweight. BMI for children is referred to as BMI-for-age, and is plotted on gender specific charts for children and teens 2-20 years of age (see CDC's National Center for Health Statistics for BMI-for-age charts at http://www.cdc.gov/growthcharts/). These charts are used because children's body fatness changes as they grow (e.g. decreasing during preschool years and increasing through puberty and into adulthood). Additionally, girls and boys differ in body fatness as they mature.

Health care professionals use percentile cutoff points on these charts to identify underweight and overweight children as follows:

Thus, if a child is in the 60th percentile, this means that compared to children of the same gender and age, 60% have a lower BMI (Centers for Disease Control, 2003a). A child at the 60th percentile would be considered in normal weight range for his/her age and gender.

Note: In adults, BMI is designed with ranges indicating weight status as follows:

Assessing Weight and Reporting Behavior Change

An important note for county Extension agents...

Always refer individuals to their physician(s) to assess overweight using the BMI or any other measure. It is important that we do not assess BMIs or other measures of body fatness as this gets into issues of privacy, confidentiality, and legalities regarding human subjects. It is also important to use the term "overweight" rather than obese as we discuss issues of overweight among children.

When seeking to measure and report behavior change for Extension purposes, use intermediate variables such as increased physical activity, decreased sedentary activity during time outside school (less television, video, computer time), improved portion control, increased fruit and vegetable intake, decreased consumption of sweetened beverages, etc. to measure/report behavior changes rather than BMI.

Why Our Kids Aren't Moving: A multi-media generation

"Open your window on a sunny afternoon, and what do you hear? The chirping of singing birds? The yelling of playing children? Odds are these days that you'll hear the birds but not the children. As kids spend more time in front of the television, computer and video screens, their physical activity levels have decreased. And their body weights have increased (Torgan, 2002)."

A sedentary lifestyle contributes greatly to the overweight epidemic in this country. Concerns about the safety of allowing children to play outside, paired with exciting new advances in technology and media are bringing our children indoors. Multi-media, including television watching, video games, and computer games are greatly contributing to increased sedentary lifestyles among children (Dennison, et. al., 2002). "Research has shown that children who consistently spend more than 10 hours per week watching television are more likely to be overweight, aggressive, and slower to learn in school (American Medical Association, 1999c)."

According to recent data, the average American child watches:

Neilson data also showed that the youngest children watched the most hours per week, and these figures did not include the use of videos watched (American Academy of Pediatrics, 1995).

Additionally, according to a recent study, children who have television sets in their bedrooms have a higher risk of overweight (Dennison et. al., 2002). The study showed that 38% of 1-4 year olds, and 54% of 6th and 7th graders had television sets in their bedrooms. Children with access to television in their rooms watched more television overall (almost 5 hours more, often unmonitored by an adult), and were more likely to be overweight (Dennison et. al., 2002).

"Currently, the average American child or adolescent spends > 21 hours per week viewing television. This figure does not include time spent watching movies, listening to music or watching music videos, playing video or computer games, or surfing the Internet for recreational purposes. Time spent with media often displaces involvement in creative, active, or social pursuits (emphasis added) (American Academy of Pediatrics, 1999)."

In addition to the hours of television watched, "American children have viewed 360,000 advertisements on TV before graduating from high school (American Academy of Pediatrics, 1995)." The most frequently advertised category during children's television programs is food -- most often fast food and foods high in sugar content. Research has found that kids choose foods they have seen advertised (Dickey, 2002). Additionally, researchers have reported a correlation between TV, soft drink consumption, and obesity among adolescents (American Medical Association, 2003). Long hours of television watching are linked to diets high in junk food (i.e., foods with little nutritional value) and low in fruits and vegetables (Dickey, 2002).

Finally, as computers have become so prevalent in the home, more and more children are spending time behind the screen with keyboard or joystick (for computer game playing) in hand (Dickey, 2002). Though children's television programming and computer time can be educational and beneficial, it is important to help them balance sedentary activity with a more active lifestyle and healthy eating/snacking practices.

Teaching Good Media Habits: Establishing, monitoring, and modeling good habits

Establishing, monitoring, and modeling good habits is important in all facets of life. Setting the standard for your children by establishing the rules of your home and modeling a healthful lifestyle is a first step in guiding your children to pursue lifelong healthy practices. It is the responsibility of parents and care providers to establish, monitor, and model good habits concerning the use of media. The following recommendations may help families establish good media habits in their homes:

Making a Move on Movement

"Our bodies need calories for daily functions such as breathing, digestion, and daily activities. Weight gain occurs when calories consumed exceed this need. Physical activity plays a key role in energy balance because it uses up calories consumed (Centers for Disease Control, 2003d)."

We know that getting our children moving is important, but where do we begin? How often/long/hard should they exercise? What types of exercise should they do? How can parents motivate their children?

How often/long/hard should children exercise?

The Surgeon General's Call to Action to Prevent and Decrease Overweight and Obesity (December, 2001) recommends adults get at least 30 minutes of moderate physical activity on most days of the week, while children should aim for at least 60 minutes. The 60 minutes can be accumulated throughout the day (e.g., six 10 minute sessions, four 15 minute sessions, two 30 minute sessions, etc.). Physical activity should be built into regular routines and playtime for children and their families. Additionally, physical activity should be done at an intensity that causes the child to breathe hard (mild discomfort), but not to the point of pain. Physical activity should be started gradually among normal, sedentary children. It is a good idea, however, to consult a doctor before beginning physical activity to rule out any medical condition or modification that should be considered.

What types of exercise should children do?

The answer to this question is three-fold...

  1. Children should do any type of activity that causes their body to be in motion.
  2. Children should do activities that are age appropriate.
  3. Children should do activities they enjoy.

This may look different for different families as well as for different members of the same family.

Activities that make the body move...

Children should be involved in a variety of activities that make their bodies move. In fact, a recent study suggests that variety may be a helpful tool in keeping kids motivated (Borra, et. al., 2003). There is no need to go sign your children up for the nearest aerobics class (unless, of course, that is of particular interest to your child). Children can get physical activity through active play, leisure time activities, and even household chores.

Age-appropriate activities...

Parents should always consider age-appropriateness of an activity. For instance, competitive sports are usually considered appropriate beginning between ages 8-12 (Nemours Foundation, 2001a) (See note in box below for special considerations regarding participation in distance running, weight training, or contact sports).

Age-appropriate activities for children ages 2-6, 7-10, and 10 and up can be found in the individual handouts in this issue of HealthHints. Notice there is some cross-over in age- appropriate activities for age 10. Different children will be ready for new activities at different ages. Parents must make decisions based on the developmental level of their children, individually. This is true for all age groups because children develop and mature at different rates.

Activities for enjoyment...

According to the National Park and Recreation Association (NRPA), 75% of Americans live within a 2 mile walking distance from a park (Torgan, 2002).

We can spend so much time taking our children to organized events, that we forget that "active play" and free play can be some of the most beneficial ways to simply enjoy the goodness of feeling the body move while encouraging fitness. Whether guided or free, active play can keep our children just as fit as organized programs and has the added advantage of disguising itself as play/fun rather than athletics/exercise for those who don't have a desire or readiness to participate in organized activities.

Additionally, active play is not limited to any age group or developmental level -- the whole family can participate. Choosing activities that include the whole family can help parents model a physically active lifestyle, support behavior through action among children who are overweight, and increase chances for lifelong activity among all members of the family. Children who see parents who are physically active are more likely to be physically active. In fact, according to the American College of Sports Medicine (ACSM), "research suggests that if both parents are physically active, their children are six times more likely to be physically active than children of inactive parents (Beals, 2003)."

A Note about Distance Running, Weight Training, and Contact Sports:

Distance running -- Distance running of more than 3/4 of a mile at a time should be postponed until adolescence. Even among school-aged children (6th-8th grade), running is usually limited to 3/4 of a mile at a time. It is generally regarded as safe, however, to begin a structured aerobic exercise program from ages 10 on up (Luebbers, 2003; Nemours Foundation, 2001a).

Weight training -- Using free weights or weight training equipment is not recommended unless a child is following an age appropriate program (usually not until age 11-13) and is supervised by a qualified professional (American Medical Association, 1999a; Nemours Foundation, 2003a; Nemours Foundation, 2001a).

Contact sports -- Though contact sports may be appropriate for your children ages 10 and older, safety is of highest importance. When allowing children to participate in contact sports, parents should be well informed about safety equipment and proper injury prevention. It is also important to keep the focus on the child participating rather than the outcome (Nemours Foundation, 2001a).

When helping children make choices about enjoyable activities, also consider what you can do as a family (see handout entitled "Keeping the Fun in Family Fitness" in this issue of HealthHints for ideas). Enjoyment and family participation can both be incentives in motivating your children to continue activity over the lifetime.

Considerations should also be made regarding every child's personal needs and feelings. Fun, success, variety, freedom, family participation, peer support, and enthusiastic leadership encourage and maintain participation; while failure, embarrassment, competition, boredom, regimentation, and injuries discourage further participation (American Academy of Pediatrics, 2001; Rowland, 1990).

"Children who are physically self-conscious or who feel different from their peers may feel uncomfortable about participating in team activities.... Fear of failure or public embarrassment -- as well as fear of letting their parents down -- can also make some children reluctant to play team sports.... Some children, like many adults, may just not be interested in team sports, but they can still maintain an excellent level of fitness by engaging in other activities that don't emphasize competition. As long as your child does not become sedentary, there's no need to worry if [he]/she resists joining organized sports activities (Nemours Foundation, 2003a)."

Encourage your child to take up a lifelong activity, such as cycling, running, martial arts, or hiking. These activities promote fitness on an individual, not competitive level. You could also suggest wrestling, tennis, swimming, or gymnastics teams. In these activities, the sport is individual or one-on-one, but participants can still earn team points (adapted from Nemours Foundation, 2003a).

Activity Charades

Try this activity idea during your next program that includes information on physical activity.

Preparation: Print a list of various physical activities on paper. You can use the list from which this activity is adapted at http://uwadmnweb.uwyo.edu/WINTheRockies/print/physical_activity.pdf. If you make your own list, be sure to include all types of activities from mowing the lawn, vacuuming and gardening, to going down a slide and catching butterflies, to more traditional activities such as shooting a basketball or playing tennis.

Cut apart, fold, and place each activity idea in a container. Have extra pieces of paper for participants to add their own ideas.

Say: People (or children) enjoy different types of physical activity. One person (child) may love gardening, another wants to ride a bike, while still another wants to catch butterflies all day. Any type of activity that gets you and your children moving can help improve health. The key is finding what your children like to do and enjoying physical activity every day.

Do: Pass the container of activity ideas around to participants. Have one person act out the activity idea while the others try to guess what he/she is doing. Allow participants to include their own activity ideas in addition to the suggested list.

The beauty of this activity is that it gives people ideas for how to get active and it allows them to be active during your program. Suggest that participants play activity charades with their children at home.

(Adapted from WIN the Rockies, phys act: whose act..., 2003.)

A Clean Sweep for Fitness: Household Chores

"Physical activity is any bodily movement produced by the skeletal muscles that results in an expenditure of energy.... (Centers for Disease Control, 2003d)." This includes household work.

Though it is important to keep activities enjoyable to motivate fitness across the lifespan, there is no reason you can't activate your children with a few household chores -- they may even come to enjoy some of them. This also provides variety and other sessions of physical activity that can help accumulate to the desired 60 minutes per day.

Like any other type of activity, household work assignments should be kept age appropriate and with safety in mind (particularly when assigning duties such as mowing or edging the lawn).

Some suggestions for active household duties include:

A Family in Motion: Taking it one step at a time

Putting your family in motion can help you and your children prevent overweight and maintain or reduce current weight. Physical activity does not have to be an arduous task. Set limits on sedentary activities and let your family times be active, fun times. Talk with your kids and take it one step at a time. Make decisions as a family about how you will put physical activity in motion in your household. Encourage your child(ren) to be physically active on their own time. Keep the conversation positive and try not to be critical or argumentative. Small steps to small victories can mean a lifetime of good health habits for you and your child(ren), beginning with today, tomorrow, and the next day....

Resources

Other sources of information

The following is a list of resources that may help as you develop programming in the area of childhood overweight:

Acknowledgments
We would like to acknowledge Dr. Debra Reed, Associate Professor and Extension Nutrition Specialist, for her many contributions to this newsletter. It could not have been completed without her thoughtful input in the area of childhood overweight.

References

Download PDF version of this newsletter:

Special Series on Childhood Overweight

[ Back to HealthHints topic index ] [ Back to HealthHints issue date index ] [ Back to Health ] [ FCS Home ]

Family and Consumer Sciences, Texas Cooperative Extension logo

Last updated: January 7, 2008

(Note: Items denoted by this symbol PDF icon are in Adobe Portable Document Format (PDF). You will need the free Adobe Reader in order to view and print PDF files. If you do not have Adobe Reader, you may download the software from the Adobe web site, and install it on your computer.)

Educational programs of Texas Cooperative Extension are open to all people without regard to race, color, sex, disability, religion, age, or national origin.