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  • J Family Med Prim Care
  • v.4(2); Apr-Jun 2015

Childhood obesity: causes and consequences

Krushnapriya sahoo.

1 Phd Scholar, Department of Human Development and Family Studies, Maharana Pratap University of Agriculture and Technology, Udaipur, Rajasthan, India

Bishnupriya Sahoo

2 Senior Resident, Department of Pediatrics, Vardhmann Medical College and Safdarjung Hospital, New Delhi, India

Ashok Kumar Choudhury

3 Assistant Professor, Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India

Nighat Yasin Sofi

4 Research Scientist, Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, India

Raman Kumar

5 CMO In Charge Emergency, Department of Clinical Research, Institute of Liver and Biliary Sciences, New Delhi, India

Ajeet Singh Bhadoria

6 Epidemiologist and Public Health Specialist, Department of Clinical Research, Institute of Liver and Biliary Sciences, New Delhi, India

Childhood obesity has reached epidemic levels in developed as well as in developing countries. Overweight and obesity in childhood are known to have significant impact on both physical and psychological health. Overweight and obese children are likely to stay obese into adulthood and more likely to develop non-communicable diseases like diabetes and cardiovascular diseases at a younger age. The mechanism of obesity development is not fully understood and it is believed to be a disorder with multiple causes. Environmental factors, lifestyle preferences, and cultural environment play pivotal roles in the rising prevalence of obesity worldwide. In general, overweight and obesity are assumed to be the results of an increase in caloric and fat intake. On the other hand, there are supporting evidence that excessive sugar intake by soft drink, increased portion size, and steady decline in physical activity have been playing major roles in the rising rates of obesity all around the world. Childhood obesity can profoundly affect children's physical health, social, and emotional well-being, and self esteem. It is also associated with poor academic performance and a lower quality of life experienced by the child. Many co-morbid conditions like metabolic, cardiovascular, orthopedic, neurological, hepatic, pulmonary, and renal disorders are also seen in association with childhood obesity.

Introduction

The world is undergoing a rapid epidemiological and nutritional transition characterized by persistent nutritional deficiencies, as evidenced by the prevalence of stunting, anemia, and iron and zinc deficiencies. Concomitantly, there is a progressive rise in the prevalence of obesity, diabetes and other nutrition related chronic diseases (NRCDs) like obesity, diabetes, cardiovascular disease, and some forms of cancer. Obesity has reached epidemic levels in developed countries. The highest prevalence rates of childhood obesity have been observed in developed countries; however, its prevalence is increasing in developing countries as well.[ 1 ] Females are more likely to be obese as compared to males, owing to inherent hormonal differences.[ 2 ]

It is emerging convincingly that the genesis of Type 2 Diabetes and Coronary Heart Disease begins in childhood, with childhood obesity serving as an important factor.[ 3 ] There has been a phenomenal rise in proportions of children having obesity in the last 4 decades, especially in the developed world. Studies emerging from different parts of India within last decade are also indicative of similar trend.[ 4 , 5 , 6 , 7 , 8 , 9 ] This view has been challenged over recent years and we presently consider these as different forms of the global malnutrition problem. This new conceptualization leads us to simultaneously address the root causes of nutritional deficiencies which in turn will contribute to the control of under nutrition and the prevention of obesity, diabetes, and other NRCDs. This summary provides a public health overview of selected key issues related to the prevention of obesity and chronic diseases with a life-course perspective of nutrition and child growth.

Childhood obesity is one of the most serious public health challenges of the 21 st century. The problem is global and is steadily affecting many low and middle income countries, particularly in urban settings. The prevalence has increased at an alarming rate. Globally in 2010, the number of overweight children under the age of five is estimated to be over 42 million. Close to 35 million of these are living in developing countries.

Definition of Childhood Obesity

Although definition of obesity and overweight has changed over time, it can be defined as an excess of body fat (BF). There is no consensus on a cut-off point for excess fatness of overweight or obesity in children and adolescents. A study by conducted by Williams et al . (1992), on 3,320 children in the age-group of 5–18 years classified children as fat if their percentage of body fat was at least 25% for males and 30% for females, respectively.[ 10 ] The Center for Disease Control and Prevention defined overweight as at or above the 95 th percentile of body mass index (BMI) for age and “at risk for overweight” as between 85 th to 95 th percentile of BMI for age.[ 11 , 12 ] European researchers classified overweight as at or above 85 th percentile and obesity as at or above 95 th percentile of BMI.[ 13 ]

An Indian research study has defined overweight and obesity as overweight (between ≥85 th and <95 th percentile) and obesity (≥95 th percentile).[ 14 ] Another study has followed World Health Organization 2007 growth reference for defining overweight and obesity.[ 15 ]

There are also several methods to measure the percentage of body fat. In research, techniques include underwater weighing (densitometry), multi-frequency bioelectrical impedance analysis (BIA), and magnetic resonance imaging (MRI). In the clinical environment, techniques such as BMI, waist circumference, and skin-fold thickness have been used extensively. Although, these methods are less accurate than research methods, they are satisfactory to identify risk. While BMI seems appropriate for differentiating adults, it may not be as useful in children because of their changing body shape as they progress through normal growth. In addition, BMI fails to distinguish between fat and fat-free mass (muscle and bone) and may exaggerate obesity in large muscular children. Furthermore, maturation pattern differs between genders and different ethnic groups. Studies that used BMI to identify overweight and obese children based on percentage of body fat have found high specificity (95–100%), but low sensitivity (36–66%) for this system of classification.[ 16 ] While health consequences of obesity are related to excess fatness, the ideal method of classification should be based on direct measurement of fatness. Although methods such as densitometry can be used in research practice, they are not feasible for clinical settings. For large population-based studies and clinical situations, bioelectrical impedance analysis (BIA) is widely used. Waist circumference seems to be more accurate for children because it targets central obesity, which is a risk factor for type II diabetes and coronary heart disease.

Causes of Childhood Obesity

It is widely accepted that increase in obesity results from an imbalance between energy intake and expenditure, with an increase in positive energy balance being closely associated with the lifestyle adopted and the dietary intake preferences. However, there is increasing evidence indicating that an individual's genetic background is important in determining obesity risk. Research has made important contributions to our understanding of the factors associated with obesity. The ecological model, as described by Davison et al ., suggests that child risk factors for obesity include dietary intake, physical activity, and sedentary behavior.[ 17 ] The impact of such risk factors is moderated by factors such as age, gender. Family characteristics parenting style, parents’ lifestyles also play a role. Environmental factors such as school policies, demographics, and parents’ work-related demands further influence eating and activity behaviors.

Genetics are one of the biggest factors examined as a cause of obesity. Some studies have found that BMI is 25–40% heritable.[ 18 ] However, genetic susceptibility often needs to be coupled with contributing environmental and behavioral factors in order to affect weight.[ 19 ] The genetic factor accounts for less than 5% of cases of childhood obesity.[ 18 ] Therefore, while genetics can play a role in the development of obesity, it is not the cause of the dramatic increase in childhood obesity.

Basal metabolic rate has also been studied as a possible cause of obesity. Basal metabolic rate, or metabolism, is the body's expenditure of energy for normal resting functions. Basal metabolic rate is accountable for 60% of total energy expenditure in sedentary adults. It has been hypothesized that obese individuals have lower basal metabolic rates. However, differences in basal metabolic rates are not likely to be responsible for the rising rates of obesity.[ 18 ]

Review of the literature investigates factors behind poor diet and offers numerous insights into how parental factors may impact on obesity in children.[ 20 ] They note that children learn by modeling parents’ and peers’ preferences, intake and willingness to try new foods. Availability of, and repeated exposure to, healthy foods is key to developing preferences and can overcome dislike of foods. Mealtime structure is important with evidence suggesting that families who eat together consume more healthy foods. Furthermore, eating out or watching TV while eating is associated with a higher intake of fat. Parental feeding style is also significant. The author's found that authoritative feeding (determining which foods are offered, allowing the child to choose, and providing rationale for healthy options) is associated with positive cognitions about healthy foods and healthier intake. Interestingly authoritarian restriction of “junk-food” is associated with increased desire for unhealthy food and higher weight.[ 21 ]

Government and social policies could also potentially promote healthy behavior. Research indicates taste, followed by hunger and price, is the most important factor in adolescents snack choices.[ 22 ] Other studies demonstrate that adolescents associate junk food with pleasure, independence, and convenience, whereas liking healthy food is considered odd.[ 23 ] This suggests investment is required in changing meanings of food, and social perceptions of eating behavior. As proposed by the National Taskforce on Obesity (2005), fiscal policies such as taxing unhealthy options, providing incentives for the distribution of inexpensive healthy food, and investing in convenient recreational facilities or the esthetic quality of neighborhoods can enhance healthy eating and physical activity.[ 24 ]

Dietary factors have been studied extensively for its possible contributions to the rising rates of obesity. The dietary factors that have been examined include fast food consumption, sugary beverages, snack foods, and portion sizes.

Fast food Consumption: Increased fast food consumption has been linked with obesity in the recent years. Many families, especially those with two parents working outside the home, opt for these places as they are often favored by their children and are both convenient and inexpensive.[ 25 ] Foods served at fast food restaurants tend to contain a high number of calories with low nutritional values. A study conducted examined the eating habits of lean and overweight adolescents at fast food restaurants.[ 26 ] Researchers found that both groups consumed more calories eating fast food than they would typically in a home setting but the lean group compensated for the higher caloric intake by adjusting their caloric intake before or after the fast food meal in anticipation or compensation for the excess calories consumed during the fast food meal. Though many studies have shown weight gain with regular consumption of fast food, it is difficult to establish a causal relationship between fast food and obesity.

Sugary beverages

A study examining children aged 9–14 from 1996–1998, found that consumption of sugary beverages increased BMI by small amounts over the years.[ 18 ] Sugary drinks are another factor that has been examined as a potential contributing factor to obesity. Sugary drinks are often thought of as being limited to soda, but juice and other sweetened beverages fall into this category. Many studies have examined the link between sugary drink consumption and weight and it has been continually found to be a contributing factor to being overweight.[ 18 ] Sugary drinks are less filling than food and can be consumed quicker, which results in a higher caloric intake.[ 19 ]

Snack foods

Another factor that has been studied as a possible contributing factor of childhood obesity is the consumption of snack foods. Snack foods include foods such as chips, baked goods, and candy. Many studies have been conducted to examine whether these foods have contributed to the increase in childhood obesity. While snacking has been shown to increase overall caloric intake, no studies have been able to find a link between snacking and overweight.[ 18 ]

Portion size

Portion sizes have increased drastically in the past decade. Consuming large portions, in addition to frequent snacking on highly caloric foods, contribute to an excessive caloric intake. This energy imbalance can cause weight gain, and consequently obesity.[ 18 ]

Activity level

One of the factors that is most significantly linked to obesity is a sedentary lifestyle. Each additional hour of television per day increased the prevalence of obesity by 2%.[ 18 ] Television viewing among young children and adolescents has increased dramatically in recent years.[ 18 , 27 ] The increased amount of time spent in sedentary behaviors has decreased the amount of time spent in physical activity. Research which indicates the number of hours children spend watching TV correlates with their consumption of the most advertised goods, including sweetened cereals, sweets, sweetened beverages, and salty snacks.[ 22 ] Despite difficulties in empirically assessing the media impact, other research discussed emphasizes that advertising effects should not be underestimated. Media effects have been found for adolescent aggression and smoking and formation of unrealistic body ideals. Regulation of marketing for unhealthy foods is recommended, as is media advocacy to promote healthy eating.

Environmental factors

While extensive television viewing and the use of other electronic media has contributed to the sedentary lifestyles, other environmental factors have reduced the opportunities for physical activity. Opportunities to be physically active and safe environments to be active in have decreased in the recent years. The majority of children in the past walked or rode their bike to school. A study conducted in 2002 found that 53% of parents drove their children to school.[ 18 ] Of these parents, 66% said they drove their children to school since their homes were too far away from the school. Other reasons parents gave for driving their children to school included no safe walking route, fear of child predators, and out of convenience for the child.[ 18 ] Children who live in unsafe areas or who do not have access to safe, well-lit walking routes have fewer opportunities to be physically active.[ 18 ]

Socio-cultural factors

Socio-cultural factors have also been found to influence the development of obesity. Our society tends to use food as a reward, as a means to control others, and as part of socializing.[ 28 ] These uses of food can encourage the development of unhealthy relationships with food, thereby increasing the risk of developing obesity.

Family factors

Family factors have also been associated with the increase of cases of obesity. The types of food available in the house and the food preferences of family members can influence the foods that children eat. In addition, family mealtimes can influence the type of food consumed and the amount thereof. Lastly, family habits, whether they are sedentary or physically active, influence the child.[ 28 ] Studies have shown that having an overweight mother and living in a single parent household are associated with overweight and childhood obesity.[ 29 ]

Psychological factors

Depression and anxiety.

A recent review concluded that the majority of studies find a prospective relationship between eating disturbances and depression.[ 30 ] However, this relationship is not unidirectional; depression may be both a cause and a consequence of obesity.[ 31 ] Additionally, in a clinical sample of obese adolescents, a higher life-time prevalence of anxiety disorders was reported compared to non-obese controls.[ 32 ] Although some studies demonstrate no significant relationship between increased BMI and increased anxiety symptoms.[ 33 ] Thus, the relationship between obesity and anxiety may not be unidirectional and is certainly not conclusive.

Self-esteem

Research findings comparing overweight/obese children with normal-weight children in regards to self-esteem have been mixed.[ 34 ] Some studies have found that obese children have lower self-esteem while others do not.[ 35 , 36 , 37 ] There is some consensus in the literature that the global approach to self-esteem measurement with children who are overweight/obese is misleading as the physical and social domains of self-esteem seem to be where these children are most vulnerable.[ 38 ]

Body dissatisfaction

Research has consistently found that body satisfaction is higher in males than females at all ages.[ 39 ] Gender differences may reflect the westernized cultural ideals of beauty in that thinness is the only culturally defined ideal for females, while males are encouraged to be both lean and muscular. Thus, there is a linear relationship between body dissatisfaction and increasing BMI for girls; while for boys a U-shaped relationship suggests that boys with BMIs at the low and high extremes experience high levels of body dissatisfaction.[ 40 , 41 ]

Eating disorder symptoms

Traits associated with eating disorders appear to be common in adolescent obese populations, particularly for girls.[ 42 ] A number of studies have shown higher prevalence of eating-related pathology (i.e. Anorexia, Bulimia Nervosa, and impulse regulation) in obese children/youth.[ 43 , 44 ]

Emotional problems

In one of the few studies to investigate the psychological impact of being overweight/obese in children, a review of 10 published studies over a 10-year period (1995-2005) with sample sizes greater than 50 revealed that all participants reported some level of psychosocial impact as a result of their weight status.[ 45 ] Being younger, female, and with an increased perceived lack of control over eating seemed to heighten the psychosocial consequences.

Consequences of childhood obesity

Childhood obesity can profoundly affect children's physical health, social, and emotional well-being, and self esteem. It is also associated with poor academic performance and a lower quality of life experienced by the child. These potential consequences are further examined in the following sections.

Medical consequences

Childhood obesity has been linked to numerous medical conditions. These conditions include, but are not limited to, fatty liver disease, sleep apnea, Type 2 diabetes, asthma, hepatic steatosis (fatty liver disease), cardiovascular disease, high cholesterol, cholelithiasis (gallstones), glucose intolerance and insulin resistance, skin conditions, menstrual abnormalities, impaired balance, and orthopedic problems.[ 25 , 46 ] Until recently, many of the above health conditions had only been found in adults; now they are extremely prevalent in obese children. Although most of the physical health conditions associated with childhood obesity are preventable and can disappear when a child or adolescent reaches a healthy weight, some continue to have negative consequences throughout adulthood.[ 46 ] In the worst cases, some of these health conditions can even result in death. Below, three of the more common health problems associated with childhood obesity are discussed, diabetes, sleep apnea, and cardiovascular disease.

Socio-emotional consequences

In addition to being implicated in numerous medical concerns, childhood obesity affects children's and adolescent's social and emotional health. Obesity has been described as being “one of the most stigmatizing and least socially acceptable conditions in childhood.”[ 38 ] Overweight and obese children are often teased and/or bullied for their weight. They also face numerous other hardships including negative stereotypes, discrimination, and social marginalization.[ 46 ] Discrimination against obese individuals has been found in children as young as 2 years old.[ 28 ] Obese children are often excluded from activities, particularly competitive activities that require physical activity. It is often difficult for overweight children to participate in physical activities as they tend to be slower than their peers and contend with shortness of breath.[ 25 ] These negative social problems contribute to low self esteem, low self confidence, and a negative body image in children and can also affect academic performance.[ 46 ] All of the above-mentioned negative effects of overweight and obesity can be devastating to children and adolescents.

The social consequences of obesity may contribute to continuing difficulty in weight management. Overweight children tend to protect themselves from negative comments and attitudes by retreating to safe places, such as their homes, where they may seek food as a comfort. In addition, children who are overweight tend to have fewer friends than normal weight children, which results in less social interaction and play, and more time spent in sedentary activities.[ 25 ] As aforementioned, physical activity is often more difficult for overweight and obese children as they tend to get shortness of breath and often have a hard time keeping up with their peers. This in turn inevitably results in weight gain, as the amount of calories consumed exceeds the amount of energy burned.[ 25 ]

Academic consequences

Childhood obesity has also been found to negatively affect school performance. A research study concluded that overweight and obese children were four times more likely to report having problems at school than their normal weight peers.[ 38 ] They are also more likely to miss school more frequently, especially those with chronic health conditions such as diabetes and asthma, which can also affect academic performance.

The growing issue of childhood obesity can be slowed, if society focuses on the causes. There are many components that play into childhood obesity, some being more crucial than others. A combined diet and physical activity intervention conducted in the community with a school component is more effective at preventing obesity or overweight. Moreover, if parents enforce a healthier lifestyle at home, many obesity problems could be avoided. What children learn at home about eating healthy, exercising and making the right nutritional choices will eventually spill over into other aspects of their life. This will have the biggest influence on the choices kids make when selecting foods to consume at school and fast-food restaurants and choosing to be active. Focusing on these causes may, over time, decrease childhood obesity and lead to a healthier society as a whole.

Source of Support: Nil.

Conflict of Interest: None declared.

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  • 1 Division of Endocrinology, Diabetes and Metabolism, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, United States
  • 2 Division of Adolescent Medicine, Department of Pediatrics, Medical College of Wisconsin Affiliated Hospitals, Milwaukee, WI, United States
  • 3 Division of Adolescent Medicine, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, United States

Obesity is a complex condition that interweaves biological, developmental, environmental, behavioral, and genetic factors; it is a significant public health problem. The most common cause of obesity throughout childhood and adolescence is an inequity in energy balance; that is, excess caloric intake without appropriate caloric expenditure. Adiposity rebound (AR) in early childhood is a risk factor for obesity in adolescence and adulthood. The increasing prevalence of childhood and adolescent obesity is associated with a rise in comorbidities previously identified in the adult population, such as Type 2 Diabetes Mellitus, Hypertension, Non-alcoholic Fatty Liver disease (NAFLD), Obstructive Sleep Apnea (OSA), and Dyslipidemia. Due to the lack of a single treatment option to address obesity, clinicians have generally relied on counseling dietary changes and exercise. Due to psychosocial issues that may accompany adolescence regarding body habitus, this approach can have negative results. Teens can develop unhealthy eating habits that result in Bulimia Nervosa (BN), Binge- Eating Disorder (BED), or Night eating syndrome (NES). Others can develop Anorexia Nervosa (AN) as they attempt to restrict their diet and overshoot their goal of “being healthy.” To date, lifestyle interventions have shown only modest effects on weight loss. Emerging findings from basic science as well as interventional drug trials utilizing GLP-1 agonists have demonstrated success in effective weight loss in obese adults, adolescents, and pediatric patients. However, there is limited data on the efficacy and safety of other weight-loss medications in children and adolescents. Nearly 6% of adolescents in the United States are severely obese and bariatric surgery as a treatment consideration will be discussed. In summary, this paper will overview the pathophysiology, clinical, and psychological implications, and treatment options available for obese pediatric and adolescent patients.

Introduction

Obesity is a complex issue that affects children across all age groups ( 1 – 3 ). One-third of children and adolescents in the United States are classified as either overweight or obese. There is no single element causing this epidemic, but obesity is due to complex interactions between biological, developmental, behavioral, genetic, and environmental factors ( 4 ). The role of epigenetics and the gut microbiome, as well as intrauterine and intergenerational effects, have recently emerged as contributing factors to the obesity epidemic ( 5 , 6 ). Other factors including small for gestational age (SGA) status at birth, formula rather than breast feeding in infancy, and early introduction of protein in infant's dietary intake have been reportedly associated with weight gain that can persist later in life ( 6 – 8 ). The rising prevalence of childhood obesity poses a significant public health challenge by increasing the burden of chronic non-communicable diseases ( 1 , 9 ).

Obesity increases the risk of developing early puberty in children ( 10 ), menstrual irregularities in adolescent girls ( 1 , 11 ), sleep disorders such as obstructive sleep apnea (OSA) ( 1 , 12 ), cardiovascular risk factors that include Prediabetes, Type 2 Diabetes, High Cholesterol levels, Hypertension, NAFLD, and Metabolic syndrome ( 1 , 2 ). Additionally, obese children and adolescents can suffer from psychological issues such as depression, anxiety, poor self-esteem, body image and peer relationships, and eating disorders ( 13 , 14 ).

So far, interventions for overweight/obesity prevention have mainly focused on behavioral changes in an individual such as increasing daily physical exercise or improving quality of diet with restricting excess calorie intake ( 1 , 15 , 16 ). However, these efforts have had limited results. In addition to behavioral and dietary recommendations, changes in the community-based environment such as promotion of healthy food choices by taxing unhealthy foods ( 17 ), improving lunch food quality and increasing daily physical activity at school and childcare centers, are extra measures that are needed ( 16 ). These interventions may include a ban on unhealthy food advertisements aimed at children as well as access to playgrounds and green spaces where families can feel their children can safely recreate. Also, this will limit screen time for adolescents as well as younger children.

However, even with the above changes, pharmacotherapy and/or bariatric surgery will likely remain a necessary option for those youth with morbid obesity ( 1 ). This review summarizes our current understanding of the factors associated with obesity, the physiological and psychological effects of obesity on children and adolescents, and intervention strategies that may prevent future concomitant issues.

Definition of Childhood Obesity

Body mass index (BMI) is an inexpensive method to assess body fat and is derived from a formula derived from height and weight in children over 2 years of age ( 1 , 18 , 19 ). Although more sophisticated methods exist that can determine body fat directly, they are costly and not readily available. These methods include measuring skinfold thickness with a caliper, Bioelectrical impedance, Hydro densitometry, Dual-energy X-ray Absorptiometry (DEXA), and Air Displacement Plethysmography ( 2 ).

BMI provides a reasonable estimate of body fat indirectly in the healthy pediatric population and studies have shown that BMI correlates with body fat and future health risks ( 18 ). Unlike in adults, Z-scores or percentiles are used to represent BMI in children and vary with the age and sex of the child. BMI Z-score cut off points of >1.0, >2.0, and >3.0 are recommended by the World Health Organization (WHO) to define at risk of overweight, overweight and obesity, respectively ( 19 ). However, in terms of percentiles, overweight is applied when BMI is >85th percentile <95th percentile, whereas obesity is BMI > 95th percentile ( 20 – 22 ). Although BMI Z-scores can be converted to BMI percentiles, the percentiles need to be rounded and can misclassify some normal-weight children in the under or overweight category ( 19 ). Therefore, to prevent these inaccuracies and for easier understanding, it is recommended that the BMI Z-scores in children should be used in research whereas BMI percentiles are best used in the clinical settings ( 20 ).

As BMI does not directly measure body fat, it is an excellent screening method, but should not be used solely for diagnostic purposes ( 23 ). Using 85th percentile as a cut off point for healthy weight may miss an opportunity to obtain crucial information on diet, physical activity, and family history. Once this information is obtained, it may allow the provider an opportunity to offer appropriate anticipatory guidance to the families.

Pathophysiology of Obesity

The pathophysiology of obesity is complex that results from a combination of individual and societal factors. At the individual level, biological, and physiological factors in the presence of ones' own genetic risk influence eating behaviors and tendency to gain weight ( 1 ). Societal factors include influence of the family, community and socio-economic resources that further shape these behaviors ( Figure 1 ) ( 3 , 24 ).

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Figure 1 . Multidimensional factors contributing to child and adolescent obesity.

Biological Factors

There is a complex architecture of neural and hormonal regulatory control, the Gut-Brain axis, which plays a significant role in hunger and satiety ( Figure 2 ). Sensory stimulation (smell, sight, and taste), gastrointestinal signals (peptides, neural signals), and circulating hormones further contribute to food intake ( 25 – 27 ).

www.frontiersin.org

Figure 2 . Pictorial representation of the Hunger-Satiety pathway a and the various hormones b involved in the pathway. a, Y1/Y5R and MC3/4 are second order neuro receptors which are responsible in either the hunger or satiety pathway. Neurons in the ARC include: NPY, Neuropeptide Y; AgRP, Agouti-Related Peptide; POMC, Pro-Opiomelanocortin; CART, Cocaine-and Amphetamine-regulated Transcript; α-MSH, α-Melanocyte Stimulating Hormone. b, PYY, Peptide YY; PP, Pancreatic Polypeptide; GLP-1, Glucagon-Like Peptide- I; OMX, Oxyntomodulin.

The hypothalamus is the crucial region in the brain that regulates appetite and is controlled by key hormones. Ghrelin, a hunger-stimulating (orexigenic) hormone, is mainly released from the stomach. On the other hand, leptin is primarily secreted from adipose tissue and serves as a signal for the brain regarding the body's energy stores and functions as an appetite -suppressing (anorexigenic) hormone. Several other appetite-suppressing (anorexigenic) hormones are released from the pancreas and gut in response to food intake and reach the hypothalamus through the brain-blood barrier (BBB) ( 28 – 32 ). These anorexigenic and orexigenic hormones regulate energy balance by stimulating hunger and satiety by expression of various signaling pathways in the arcuate nucleus (ARC) of the hypothalamus ( Figure 2 ) ( 28 , 33 ). Dysregulation of appetite due to blunted suppression or loss of caloric sensing signals can result in obesity and its morbidities ( 34 ).

Emotional dysfunction due to psychiatric disorders can cause stress and an abnormal sleep-wake cycles. These modifications in biological rhythms can result in increased appetite, mainly due to ghrelin, and can contribute to emotional eating ( 35 ).

Recently, the role of changes in the gut microbiome with increased weight gain through several pathways has been described in literature ( 36 , 37 ). The human gut serves as a host to trillions of microorganisms, referred to as gut microbiota. The dominant gut microbial phyla are Firmicutes, Bacteroidetes, Actinobacteria, Proteobacteria, Fusobacteria, and Verrucomicrobia, with Firmicutes and Bacteroidetes representing 90% of human gut microbiota ( 5 , 38 ). The microbes in the gut have a symbiotic relationship within their human host and provide a nutrient-rich environment. Gut microbiota can be affected by various factors that include gestational age at birth, mode of infant delivery, type of neonatal and infant feeding, introduction of solid food, feeding practices and external factors like antibiotic use ( 5 , 38 ). Also, the maturation of the bacterial phyla that occurs from birth to adulthood ( 39 ), is influenced by genetics, environment, diet, lifestyle, and gut physiology and stabilizes in adulthood ( 5 , 39 , 40 ). Gut microbiota is unique to each individual and plays a specific role in maintaining structural integrity, and the mucosal barrier of the gut, nutrient metabolism, immune response, and protection against pathogens ( 5 , 37 , 38 ). In addition, the microbiota ferments the indigestible food and synthesizes other essential micronutrients as well as short chain fatty acids (SCFAs') ( 40 , 41 ). Dysbiosis or imbalance of the gut microbiota, in particularly the role of SCFA has been linked with the patho-physiology of obesity ( 36 , 38 , 41 , 42 ). SCFAs' are produced by anaerobic fermentation of dietary fiber and indigestible starch and play a role in mammalian energy metabolism by influencing gut-brain communication axis. Emerging evidence has shown that increased ratio of Firmicutes to Bacteroidetes causes increased energy extraction of calories from diets and is evidenced by increased production of short chain fatty acids (SCFAs') ( 43 – 45 ). However, this relationship is not affirmed yet, as a negative relationship between SCFA levels and obesity has also been reported ( 46 ). Due to the conflicting data, additional randomized control trials are needed to clarify the role of SCFA's in obese and non-obese individuals.

The gut microbiota also has a bidirectional interaction with the liver, and various additional factors such as diet, genetics, and the environment play a key role in this relationship. The Gut- Liver Axis is interconnected at various levels that include the mucus barrier, epithelial barrier, and gut microbiome and are essential to maintain normal homeostasis ( 47 ). Increased intestinal mucosal permeability can disrupt the gut-liver axis, which releases various inflammatory markers, activates an innate immune response in the liver, and results in a spectrum of liver diseases that include hepatic steatosis, non-alcoholic steatohepatitis (NASH), cirrhosis, and hepatocellular carcinoma (HCC) ( 48 , 49 ).

Other medical conditions, including type 2 Diabetes Mellitus, Metabolic Syndrome, eating disorders as well as psychological conditions such as anxiety and depression are associated with the gut microbiome ( 50 – 53 ).

Genetic Factors

Genetic causes of obesity can either be monogenic or polygenic types. Monogenic obesity is rare, mainly due to mutations in genes within the leptin/melanocortin pathway in the hypothalamus that is essential for the regulation of food intake/satiety, body weight, and energy metabolism ( 54 ). Leptin regulates eating behaviors, the onset of puberty, and T-cell immunity ( 55 ). About 3% of obese children have mutations in the leptin ( LEP ) gene and the leptin receptor (LEPR) and can also present with delayed puberty and immune dysfunction ( 55 , 56 ). Obesity caused by other genetic mutations in the leptin-melanocortin pathway include proopiomelanocortin (POMC) and melanocortin receptor 4 (MC4R), brain-derived neurotrophic factor (BDNF), and the tyrosine kinase receptor B (NTRK2) genes ( 57 , 58 ). Patients with monogenic forms generally present during early childhood (by 2 years old) with severe obesity and abnormal feeding behaviors ( 59 ). Other genetic causes of severe obesity are Prader Willi Syndrome (PWS), Alström syndrome, Bardet Biedl syndrome. Patients with these syndromes present with additional characteristics, including cognitive impairment, dysmorphic features, and organ-specific developmental abnormalities ( 60 ). Individuals who present with obesity, developmental delay, dysmorphic features, and organ dysfunction should receive a genetics referral for further evaluation.

Polygenic obesity is the more common form of obesity, caused by the combined effect of multiple genetic variants. It is the result of the interplay between genetic susceptibility and the environment, also known as the Gene-Environment Interaction (GEI) ( 61 – 64 ). Genome-wide association studies (GWAS) have identified gene variants [single nucleotide polymorphism (SNPs)] for body mass index (BMI) that likely act synergistically to affect body weight ( 65 ). Studies have identified genetic variants in several genes that may contribute to excessive weight gain by increasing hunger and food intake ( 66 – 68 ). When the genotype of an individual confers risk for obesity, exposure to an obesogenic environment may promote a state of energy imbalance due to behaviors that contribute to conserving rather than expending energy ( 69 , 70 ). Research studies have shown that obese individuals have a genetic variation that can influence their actions, such as increased food intake, lack of physical activity, a decreased metabolism, as well as an increased tendency to store body fat ( 63 , 66 , 67 , 69 , 70 ).

Recently the role of epigenetic factors in the development of obesity has emerged ( 71 ). The epigenetic phenomenon may alter gene expression without changing the underlying DNA sequence. In effect, epigenetic changes may result in the addition of chemical tags known as methyl groups, to the individual's chromosomes. This alteration can result in a phenomenon where critical genes are primed to on and off regulate. Complex physiological and psychological adjustment occur during infancy and can thereafter set the stage for health vs. disease. Developmental origins of health and disease (DOHaD) shows that early life environment can impact the risk of chronic diseases later in life due to fetal programming secondary to epigenetic changes ( 72 ). Maternal nutrition during the prenatal or early postnatal period may trigger these epigenetic changes and increase the risk for chronic conditions such as obesity, metabolic and cardiovascular disease due to epigenetic modifications that may persist and cause intergenerational effect on the health children and adults ( 58 , 73 , 74 ). Similarly, adverse childhood experiences (ACE) have been linked to a broad range of negative outcomes through epigenetic mechanisms ( 75 ) and promote unhealthy eating behaviors ( 76 , 77 ). Other factors such as diet, physical activity, environmental and psychosocial stressors can cause epigenetic changes and place an individual at risk for weight gain ( 78 ).

Developmental Factors

Eating behaviors evolve over the first few years of life. Young children learn to eat through their direct experience with food and observing others eating around them ( 79 ). During infancy, feeding defines the relationship of security and trust between a child and the parent. Early childhood eating behaviors shift to more self-directed control due to rapid physical, cognitive, communicative, and social development ( 80 ). Parents or caregivers determine the type of food that is made available to the infant and young child. However, due to economic limitations and parents having decreased time to prepare nutritious meals, consumption of processed and cheaper energy-dense foods have occurred in Western countries. Additionally, feeding practices often include providing large or super-sized portions of palatable foods and encouraging children to finish the complete meal (clean their plate even if they do not choose to), as seen across many cultures ( 81 , 82 ). Also, a segment of parents are overly concerned with dietary intake and may pressurize their child to eat what they perceive as a healthy diet, which can lead to unintended consequences ( 83 ). Parents' excessive restriction of food choices may result in poor self-regulation of energy intake by their child or adolescent. This action may inadvertently promote overconsumption of highly palatable restricted foods when available to the child or adolescent outside of parental control with resultant excessive weight gain ( 84 , 85 ).

During middle childhood, children start achieving greater independence, experience broader social networks, and expand their ability to develop more control over their food choices. Changes that occur in the setting of a new environment such as daycare or school allow exposure to different food options, limited physical activity, and often increased sedentary behaviors associated with school schedules ( 24 ). As the transition to adolescence occurs, physical and psychosocial development significantly affect food choices and eating patterns ( 25 ). During the teenage years, more independence and interaction with peers can impact the selection of fast foods that are calorically dense. Moreover, during the adolescent years, more sedentary behaviors such as video and computer use can limit physical exercise. Adolescence is also a period in development with an enhanced focus on appearance, body weight, and other psychological concerns ( 86 , 87 ).

Environmental Factors

Environmental changes within the past few decades, particularly easy access to high-calorie fast foods, increased consumption of sugary beverages, and sedentary lifestyles, are linked with rising obesity ( 88 ). The easy availability of high caloric fast foods, and super-sized portions, are increasingly common choices as individuals prefer these highly palatable and often less expensive foods over fruits and vegetables ( 89 ). The quality of lunches and snacks served in schools and childcare centers has been an area of debate and concern. Children and adolescents consume one-third to one-half of meals in the above settings. Despite policies in place at schools, encouraging foods, beverages, and snacks that are deemed healthier options, the effectiveness of these policies in improving children's dietary habits or change in obesity rate has not yet been seen ( 90 ). This is likely due to the fact that such policies primarily focus on improving dietary quality but not quantity which can impact the overweight or obese youth ( 91 ). Policies to implement taxes on sugary beverages are in effect in a few states in the US ( 92 ) as sugar and sugary beverages are associated with increased weight gain ( 2 , 3 ). This has resulted in reduction in sales of sugary drinks in these states, but the sales of these types of drinks has risen in neighboring states that did not implement the tax ( 93 ). Due to advancements in technology, children are spending increased time on electronic devices, limiting exercise options. Technology advancement is also disrupting the sleep-wake cycle, causing poor sleeping habits, and altered eating patterns ( 94 ). A study published on Canadian children showed that the access to and night-time use of electronic devices causes decreased sleep duration, resulting in excess body weight, inferior diet quality, and lower physical activity levels ( 95 ).

Infant nutrition has gained significant popularity in relation to causing overweight/obesity and other diseases later in life. Breast feeding is frequently discussed as providing protection against developing overweight/obesity in children ( 8 ). Considerable heterogeneity has been observed in studies and conducting randomized clinical trials between breast feeding vs. formula feeding is not feasible ( 8 ). Children fed with a low protein formula like breast milk are shown to have normal weight gain in early childhood as compared to those that are fed formulas with a high protein load ( 96 ). A recent Canadian childbirth cohort study showed that breast feeding within first year of life was inversely associated with weight gain and increased BMI ( 97 ). The effect was stronger if the child was exclusively breast fed directly vs. expressed breast milk or addition of formula or solid food ( 97 ). Also, due to the concern of poor growth in preterm or SGA infants, additional calories are often given for nutritional support in the form of macronutrient supplements. Most of these infants demonstrate “catch up growth.” In fact, there have been reports that in some children the extra nutritional support can increase the risk for overweight/obesity later in life. The association, however, is inconsistent. Recently a systemic review done on randomized controlled trials comparing the studies done in preterm and SGA infants with feeds with and without macronutrient supplements showed that macronutrient supplements may increase weight and length in toddlers but did not show a significant increase in the BMI during childhood ( 98 ). Increased growth velocity due to early introduction of formula milk and protein in infants' diet, may influence the obesity pathways, and can impact fetal programming for metabolic disease later in life ( 99 ).

General pediatricians caring for children with overweight/obesity, generally recommend endocrine testing as parents often believe that there may be an underlying cause for this condition and urge their primary providers to check for conditions such as thyroid abnormalities. Endocrine etiologies for obesity are rarely identified and patients with underlying endocrine disorders causing excessive weight gain usually are accompanied by attenuated growth patterns, such that a patient continues to gain weight with a decline in linear height ( 100 ). Various endocrine etiologies that one could consider in a patient with excessive weight gain in the setting of slow linear growth: severe hypothyroidism, growth hormone deficiency, and Cushing's disease/syndrome ( 58 , 100 ).

Clinical-Physiology of Pediatric Obesity

It is a well-known fact that early AR(increased BMI) before the age of 5 years is a risk factor for adult obesity, obesity-related comorbidities, and metabolic syndrome ( 101 – 103 ). Typically, body mass index (BMI) declines to a minimum in children before it starts increasing again into adulthood, also known as AR. Usually, AR happens between 5 and 7 years of age, but if it occurs before the age of 5 years is considered early AR. Early AR is a marker for higher risk for obesity-related comorbidities. These obesity-related health comorbidities include cardiovascular risk factors (hypertension, dyslipidemia, prediabetes, and type 2 diabetes), hormonal issues, orthopedic problems, sleep apnea, asthma, and fatty liver disease ( Figure 3 ) ( 9 ).

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Figure 3 . Obesity related co-morbidities a in children and adolescents. a, NAFLD, Non-Alcoholic Fatty Liver Disease; SCFE, Slipped Capital Femoral Epiphysis; PCOS, Polycystic Ovary Syndrome; OSA, Obstructive Sleep Apnea.

Clinical Comorbidities of Obesity in Children

Growth and puberty.

Excess weight gain in children can influence growth and pubertal development ( 10 ). Childhood obesity can cause prepubertal acceleration of linear growth velocity and advanced bone age in boys and girls ( 104 ). Hyperinsulinemia is a normal physiological state during puberty, but children with obesity can have abnormally high insulin levels ( 105 ). Leptin resistance also occurs in obese individuals who have higher leptin levels produced by their adipose tissue ( 55 , 106 ). The insulin and leptin levels can act on receptors that impact the growth plates with a resultant bone age advancement ( 55 ).

Adequate nutrition is essential for the typical timing and tempo of pubertal onset. Excessive weight gain can initiate early puberty, due to altered hormonal parameters ( 10 ). Obese children may present with premature adrenarche, thelarche, or precocious puberty (PP) ( 107 ). The association of early pubertal changes with obesity is consistent in girls, and is well-reported; however, data is sparse in boys ( 108 ). One US study conducted in racially diverse boys showed obese boys had delayed puberty, whereas overweight boys had early puberty as compared to normal-weight boys ( 109 ). Obese girls with PP have high leptin levels ( 110 , 111 ). Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) is a cross-sectional study and suggested an indirect relationship between elevated leptin levels, early puberty, and cardiometabolic and inflammatory markers in obese girls ( 112 ). Additionally, obese girls with premature adrenarche carry a higher risk for developing polycystic ovary syndrome (PCOS) in the future ( 113 , 114 ).

Sleep Disorders

Obesity is an independent risk factor for obstructive sleep apnea (OSA) in children and adolescents ( 12 , 115 ). Children with OSA have less deleterious consequences in terms of cardiovascular stress of metabolic syndrome when compared to adolescents and adults ( 116 , 117 ). In children, abnormal behaviors and neurocognitive dysfunction are the most critical and frequent end-organ morbidities associated with OSA ( 12 ). However, in adolescents, obesity and OSA can independently cause oxidative systemic stress and inflammation ( 118 , 119 ), and when this occurs concurrently, it can result in more severe metabolic dysfunction and cardiovascular outcomes later in life ( 120 ).

Other Comorbidities

Obesity is related to a clinical spectrum of liver abnormalities such as NAFLD ( 121 ); the most important cause of liver disease in children ( 122 – 124 ). NAFLD includes steatosis (increased liver fat without inflammation) and NASH (increased liver fat with inflammation and hepatic injury). While in some adults NAFLD can progress to an end-stage liver disease requiring liver transplant ( 125 , 126 ), the risk of progression during childhood is less well-defined ( 127 ). NAFLD is closely associated with metabolic syndrome including central obesity, insulin resistance, type 2 diabetes, dyslipidemia, and hypertension ( 128 ).

Obese children are also at risk for slipped capital femoral epiphysis (SCFE) ( 129 ), and sedentary lifestyle behaviors may have a negative influence on the brain structure and executive functioning, although the direction of causality is not clear ( 130 , 131 ).

Clinical Comorbidities of Obesity in Adolescents

Menstrual irregularities and pcos.

At the onset of puberty, physiologically, sex steroids can cause appropriate weight gain and body composition changes that should not affect normal menstruation ( 132 , 133 ). However, excessive weight gain in adolescent girls can result in irregular menstrual cycles and puts them at risk for PCOS due to increased androgen levels. Additionally, they can have excessive body hair (hirsutism), polycystic ovaries, and can suffer from distorted body images ( 134 , 135 ). Adolescent girls with PCOS also have an inherent risk for insulin resistance irrespective of their weight. However, weight gain further exacerbates their existing state of insulin resistance and increases the risk for obesity-related comorbidities such as metabolic syndrome, and type 2 diabetes. Although the diagnosis of PCOS can be challenging at this age due to an overlap with predictable pubertal changes, early intervention (appropriate weight loss and use of hormonal methods) can help restore menstrual cyclicity and future concerns related to childbearing ( 11 ).

Metabolic Syndrome and Sleep Disorders

Metabolic syndrome (MS) is a group of cardiovascular risk factors characterized by acanthosis nigricans, prediabetes, hypertension, dyslipidemia, and non-alcoholic steatohepatitis (NASH), that occurs from insulin resistance caused by obesity ( 136 ). Diagnosis of MS in adults requires at least three out of the five risk factors: increased central adiposity, hypertension, hyperglycemia, hypertriglyceridemia, or low HDL level. Definitions to diagnose MS are controversial in younger age groups, and many definitions have been proposed ( 136 ). This is due to the complex physiology of growth and development during puberty, which causes significant overlap between MS and features of normal growth. However, childhood obesity is associated with an inflammatory state even before puberty ( 137 ). In obese children and adolescents, hyperinsulinemia during puberty ( 138 , 139 ) and unhealthy sleep behaviors increase MS's risk and severity ( 140 ). Even though there is no consensus on diagnosis regarding MS in this age group, when dealing with obese children and adolescents, clinicians should screen them for MS risk factors and sleep behaviors and provide recommendations for weight management.

Social Psychology of Pediatric Obesity in Children and Adolescents

Obese children and adolescents may experience psychosocial sequelae, including depression, bullying, social isolation, diminished self-esteem, behavioral problems, dissatisfaction with body image, and reduced quality of life ( 13 , 141 ). Compared with normal-weight counterparts, overweight/obesity is one of the most common reasons children and adolescents are bullied at school ( 142 ). The consequence of stigma, bullying, and teasing related to childhood obesity are pervasive and can have severe implications for emotional and physical health and performance that can persist later in life ( 13 ).

In adolescents, psychological outcomes associated with obesity are multifactorial and have a bidirectional relationship ( Figure 4 ). Obese adolescents due to their physique may have a higher likelihood of psychosocial health issues, including depression, body image/dissatisfaction, lower self-esteem, peer victimization/bullying, and interpersonal relationship difficulties. They may also demonstrate reduced resilience to challenging situations compared to their non-obese/overweight counterparts ( 9 , 143 – 146 ). Body image dissatisfaction has been associated with further weight gain but can also be related to the development of a mental health disorder or an eating disorder (ED) or disorder eating habits (DEH). Mental health disorders such as depression are associated with poor eating habits, a sedentary lifestyle, and altered sleep patterns. ED or DEH that include anorexia nervosa (AN), bulimia nervosa (BN), binge-eating disorder (BED) or night eating syndrome (NES) may be related to an individual's overvaluation of their body shape and weight or can result during the treatment for obesity ( 147 – 150 ). The management of obesity can place a patient at risk of AN if there is a rigid focus on caloric intake or if a patient overcorrects and initiates obsessive self-directed dieting. Healthcare providers who primarily care for obese patients, usually give the advice to diet to lose weight and then maintain it. However, strict dieting (hypocaloric diet), which some patients may later engage in can lead to an eating disorder such as anorexia nervosa ( 151 ). This behavior leads to a poor relationship with food, and therefore, adolescents perseverate on their weight and numbers ( 152 ).

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Figure 4 . Bidirectional relationship of different psychological outcomes of obesity.

Providers may not recognize DEHs when a morbidly obese patient loses the same weight as a healthy weight individual ( 149 ). It may appear as a positive result with families and others praising the individual without realizing that this youth may be engaging in destructive behaviors related to weight control. Therefore, it is essential to screen regarding the process of how weight loss was achieved ( 144 , 150 ).

Support and attention to underlying psychological concerns can positively affect treatment, overall well-being, and reduce the risk of adult obesity ( 150 ). The diagram above represents the complexity of the different psychological issues which can impact the clinical care of the obese adolescent.

Eating family meals together can improve overall dietary intake due to enhanced food choices mirrored by parents. It has also may serve as a support to individuals with DEHs if there is less attention to weight and a greater focus on appropriate, sustainable eating habits ( 148 ).

Prevention and Anticipatory Guidance

It is essential to recognize and provide preventive measures for obesity during early childhood and adolescence ( 100 , 153 , 154 ). It is well-established that early AR is a risk factor for adult obesity ( 66 – 68 ). Therefore, health care providers caring for the pediatric population need to focus on measures such as BMI but provide anticipatory guidance regarding nutritional counseling without stigmatizing or judging parents for their children's overweight/obesity ( 155 ). Although health care providers continue to pursue effective strategies to address the obesity epidemic; ironically, they frequently exhibit weight bias and stigmatizing behaviors. Research has demonstrated that the language that health care providers use when discussing a patient's body weight can reinforce stigma, reduce motivation for weight loss, and potentially cause avoidance of routine preventive care ( 155 ). In adolescents, rather than motivating positive changes, stigmatizing language regarding weight may negatively impact a teen and result in binge eating, decreased physical activity, social isolation, avoidance of health care services, and increased weight gain ( 156 , 157 ). Effective provider-patient communication using motivational interviewing techniques are useful to encourage positive behavior changes ( 155 , 158 ).

Anticipatory guidance includes educating the families on healthy eating habits and identifying unhealthy eating practices, encouraging increased activity, limiting sedentary activities such as screen time. Lifestyle behaviors in children and adolescents are influenced by many sectors of our society, including the family ( Figure 1 ) ( 3 , 24 ). Therefore, rather than treating obesity in isolation as an individual problem, it is crucial to approach this problem by focusing on the family unit. Family-based multi-component weight loss behavioral treatment is the gold standard for treating childhood obesity, and it is having been found useful in those between 2 and 6 years old ( 150 , 159 ). Additionally, empowering the parents to play an equal role in developing and implementing an intervention for weight management has shown promising results in improving the rate of obesity by decreasing screen time, promoting healthy eating, and increasing support for children's physical activity ( 160 , 161 ).

When dietary/lifestyle modifications have failed, the next option is a structured weight -management program with a multidisciplinary approach ( 15 ). The best outcomes are associated with an interdisciplinary team comprising a physician, dietician, and psychologist generally 1–2 times a week ( 15 , 162 ). However, this treatment approach is not effective in patients with severe obesity ( 122 ). Although healthier lifestyle recommendations for weight loss are the current cornerstone for obesity management, they often fail. As clinicians can attest, these behavioral and dietary changes are hard to achieve, and all too often is not effective in patients with severe obesity. Failure to maintain substantial weight loss over the long term is due to poor adherence to the prescribed lifestyle changes as well as physiological responses that resist weight loss ( 163 ). American TV hosts a reality show called “The Biggest Loser” that centers on overweight and obese contestants attempting to lose weight for a cash prize. Contestants from “The Biggest Loser” competition, had metabolic adaptation (MA) after drastic weight loss, regained more than they lost weight after 6 years due to a significant slow resting metabolic rate ( 164 ). MA is a physiological response which is a reduced basal metabolic rate seen in individuals who are losing or have lost weight. In MA, the body alters how efficient it is at turning the food eaten into energy; it is a natural defense mechanism against starvation and is a response to caloric restriction. Plasma leptin levels decrease substantially during caloric restriction, suggesting a role of this hormone in the drop of energy expenditure ( 165 ).

Pharmacological Management

The role of pharmacological therapy in the treatment of obesity in children and adolescents is limited.

Orlistat is the only FDA approved medication for weight loss in 12-18-year-olds but has unpleasant side effects ( 166 ). Another medicine, Metformin, has been used in children with signs of insulin resistance, may have some impact on weight, but is not FDA approved ( 167 ). The combination of phentermine/topiramate (Qsymia) has been FDA approved for weight loss in obese individuals 18 years and older. In studies, there has been about 9–10% weight loss over 2 years. However, caution must be taken in females as it can lead to congenital disabilities, especially with use in the first trimester of pregnancy ( 167 ).

GLP-1 agonists have demonstrated great success in effective weight loss and are approved by the FDA for adult obesity ( 168 – 170 ). A randomized control clinical trial recently published showed a significant weight loss in those using liraglutide (3.0 mg)/day plus lifestyle therapy group compared to placebo plus lifestyle therapy in children between the ages of 12–18 years ( 171 ).

Recently during the EASL conference, academic researchers and industry partners presented novel interventions targeting different gut- liver axis levels that include intestinal content, intestinal microbiome, intestinal mucosa, and peritoneal cavity ( 47 ). The focus for these therapeutic interventions within the gut-liver axis was broad and ranged anywhere from newer drugs protecting the intestinal mucus lining, restoring the intestinal barriers and improvement in the gut microbiome. One of the treatment options was Hydrogel technology which was shown to be effective toward weight loss in patients with metabolic syndrome. Hydrogel technology include fibers and high viscosity polysaccharides that absorb water in the stomach and increasing the volume, thereby improving satiety ( 47 ). Also, a clinical trial done in obese pregnant mothers using Docosahexaenoic acid (DHA) showed that the mothers' who got DHA had children with lower adiposity at 2 and 4 years of age ( 172 ). Recently the role of probiotics in combating obesity has emerged. Probiotics are shown to alter the gut microbiome that improves intestinal digestive and absorptive functions of the nutrients. Intervention including probiotics may be a possible solution to manage pediatric obesity ( 173 , 174 ). Additionally, the role of Vitamin E for treating the comorbidities of obesity such as diabetes, hyperlipidemia, NASH, and cardiovascular risk, has been recently described ( 175 , 176 ). Vitamin E is a lipid- soluble compound and contains both tocopherols and tocotrienols. Tocopherols have lipid-soluble antioxidants properties that interact with cellular lipids and protects them from oxidation damage ( 177 ). In metabolic disease, certain crucial pathways are influenced by Vitamin E and some studies have summarized the role of Vitamin E regarding the treatment of obesity, metabolic, and cardiovascular disease ( 178 ). Hence, adequate supplementation of Vitamin E as an appropriate strategy to help in the treatment of the prevention of obesity and its associated comorbidities has been suggested. Nonetheless, some clinical trials have shown contradictory results with Vitamin E supplementation ( 177 ). Although Vitamin E has been recognized as an antioxidant that protects from oxidative damage, however, a full understanding of its mechanism of action is still lacking.

Bariatric Surgery

Bariatric surgery has gained popularity since the early 2000s in the management of severe obesity. If performed earlier, there are better outcomes for reducing weight and resolving obesity-related comorbidities in adults ( 179 – 182 ). Currently, the indication for bariatric in adolescents; those who have a BMI >35 with at least one severe comorbidity (Type 2 Diabetes, severe OSA, pseudotumor cerebri or severe steatohepatitis); or BMI of 40 or more with other comorbidities (hypertension, hyperlipidemia, mild OSA, insulin resistance or glucose intolerance or impaired quality of life due to weight). Before considering bariatric surgery, these patients must have completed most of their linear growth and participated in a structured weight-loss program for 6 months ( 159 , 181 , 183 ). The American Society for Metabolic and Bariatric Surgery (AMBS) outlines the multidisciplinary approach that must be taken before a patient undergoing bariatric surgery. In addition to a qualified bariatric surgeon, the patient must have a pediatrician or provider specialized in adolescent medicine, endocrinology, gastroenterology and nutrition, registered dietician, mental health provider, and exercise specialist ( 181 ). A mental health provider is essential as those with depression due to obesity or vice versa may have persistent mental health needs even after weight loss surgery ( 184 ).

Roux-en-Y Gastric Bypass (RYGB), laparoscopic Sleeve Gastrectomy (LSG), and Gastric Banding are the options available. RYGB and LSG currently approved for children under 18 years of age ( 166 , 181 , 185 ). At present, gastric banding is not an FDA recommended procedure in the US for those under 18y/o. One study showed some improvements in BMI and severity of comorbidities but had multiple repeat surgeries and did not believe a suitable option for obese adolescents ( 186 ).

Compared to LSG, RYGB has better outcomes for excess weight loss and resolution of obesity-related comorbidities as shown in studies and clinical trials ( 183 , 184 , 187 ). Overall, LSG is a safer choice and may be advocated for more often ( 179 – 181 ). The effect on the Gut-Brain axis after Bariatric surgery is still inconclusive, especially in adolescents, as the number of procedures performed is lower than in adults. Those who underwent RYGB had increased fasting and post-prandial PYY and GLP-1, which could have contributed to the rapid weight loss ( 185 ); this effect was seen less often in patients with gastric banding ( 185 ). Another study in adult patients showed higher bile acid (BA) subtype levels and suggested a possible BA's role in the surgical weight loss response after LSG ( 188 ). Adolescents have lower surgical complication rates than their adult counterparts, hence considering bariatric surgery earlier rather than waiting until adulthood has been entertained ( 180 ). Complications after surgery include nutritional imbalance in iron, calcium, Vitamin D, and B12 and should be monitored closely ( 180 , 181 , 185 ). Although 5-year data for gastric bypass in very obese teens is promising, lifetime outcome is still unknown, and the psychosocial factors associated with adolescent adherence post-surgery are also challenging and uncertain.

Obesity in childhood and adolescence is not amenable to a single easily modified factor. Biological, cultural, and environmental factors such as readily available high-density food choices impact youth eating behaviors. Media devices and associated screen time make physical activity a less optimal choice for children and adolescents. This review serves as a reminder that the time for action is now. The need for interventions to change the obesogenic environment by instituting policies around the food industry and in the schools needs to be clarified. In clinical trials GLP-1 agonists are shown to be effective in weight loss in children but are not yet FDA approved. Discovery of therapies to modify the gut microbiota as treatment for overweigh/obesity through use of probiotics or fecal transplantation would be revolutionary. For the present, ongoing clinical research efforts in concert with pharmacotherapeutic and multidisciplinary lifestyle programs hold promise.

Author Contributions

AK, SL, and MJ contributed to the conception and design of the study. All authors contributed to the manuscript revision, read, and approved the submitted version.

Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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Keywords: obesity, childhood, review (article), behavior, adolescent

Citation: Kansra AR, Lakkunarajah S and Jay MS (2021) Childhood and Adolescent Obesity: A Review. Front. Pediatr. 8:581461. doi: 10.3389/fped.2020.581461

Received: 08 July 2020; Accepted: 23 November 2020; Published: 12 January 2021.

Reviewed by:

Copyright © 2021 Kansra, Lakkunarajah and Jay. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Alvina R. Kansra, akansra@mcw.edu

This article is part of the Research Topic

Pediatric Obesity: From the Spectrum of Clinical-Physiology, Social-Psychology, and Translational Research

  • Patient Care & Health Information
  • Diseases & Conditions
  • Childhood obesity

Childhood obesity is a serious medical condition that affects children and adolescents. It's particularly troubling because the extra pounds often start children on the path to health problems that were once considered adult problems — diabetes, high blood pressure and high cholesterol. Childhood obesity can also lead to poor self-esteem and depression.

One of the best strategies to reduce childhood obesity is to improve the eating and exercise habits of your entire family. Treating and preventing childhood obesity helps protect your child's health now and in the future.

Not all children carrying extra pounds are overweight. Some children have larger than average body frames. And children normally carry different amounts of body fat at the various stages of development. So you might not know by how your child looks if weight is a health concern.

The body mass index (BMI), which provides a guideline of weight in relation to height, is the accepted measure of overweight and obesity. Your child's doctor can use growth charts, the BMI and, if necessary, other tests to help you figure out if your child's weight could pose health problems.

When to see a doctor

If you're worried that your child is putting on too much weight, talk to his or her doctor. The doctor will consider your child's history of growth and development, your family's weight-for-height history, and where your child lands on the growth charts. This can help determine if your child's weight is in an unhealthy range.

Lifestyle issues — too little activity and too many calories from food and drinks — are the main contributors to childhood obesity. But genetic and hormonal factors might play a role as well.

Risk factors

Many factors — usually working in combination — increase your child's risk of becoming overweight:

  • Diet. Regularly eating high-calorie foods, such as fast foods, baked goods and vending machine snacks, can cause your child to gain weight. Candy and desserts also can cause weight gain, and more and more evidence points to sugary drinks, including fruit juices and sports drinks, as culprits in obesity in some people.
  • Lack of exercise. Children who don't exercise much are more likely to gain weight because they don't burn as many calories. Too much time spent in sedentary activities, such as watching television or playing video games, also contributes to the problem. TV shows also often feature ads for unhealthy foods.
  • Family factors. If your child comes from a family of overweight people, he or she may be more likely to put on weight. This is especially true in an environment where high-calorie foods are always available and physical activity isn't encouraged.
  • Psychological factors. Personal, parental and family stress can increase a child's risk of obesity. Some children overeat to cope with problems or to deal with emotions, such as stress, or to fight boredom. Their parents might have similar tendencies.
  • Socioeconomic factors. People in some communities have limited resources and limited access to supermarkets. As a result, they might buy convenience foods that don't spoil quickly, such as frozen meals, crackers and cookies. Also, people who live in lower income neighborhoods might not have access to a safe place to exercise.
  • Certain medications. Some prescription drugs can increase the risk of developing obesity. They include prednisone, lithium, amitriptyline, paroxetine (Paxil), gabapentin (Neurontin, Gralise, Horizant) and propranolol (Inderal, Hemangeol).

Complications

Childhood obesity often causes complications in a child's physical, social and emotional well-being.

Physical complications

Physical complications of childhood obesity may include:

  • Type 2 diabetes. This chronic condition affects the way your child's body uses sugar (glucose). Obesity and a sedentary lifestyle increase the risk of type 2 diabetes.
  • High cholesterol and high blood pressure. A poor diet can cause your child to develop one or both of these conditions. These factors can contribute to the buildup of plaques in the arteries, which can cause arteries to narrow and harden, possibly leading to a heart attack or stroke later in life.
  • Joint pain. Extra weight causes extra stress on hips and knees. Childhood obesity can cause pain and sometimes injuries in the hips, knees and back.
  • Breathing problems. Asthma is more common in children who are overweight. These children are also more likely to develop obstructive sleep apnea, a potentially serious disorder in which a child's breathing repeatedly stops and starts during sleep.
  • Nonalcoholic fatty liver disease (NAFLD). This disorder, which usually causes no symptoms, causes fatty deposits to build up in the liver. NAFLD can lead to scarring and liver damage.

Social and emotional complications

Children who have obesity may experience teasing or bullying by their peers. This can result in a loss of self-esteem and an increased risk of depression and anxiety.

To help prevent excess weight gain in your child, you can:

  • Set a good example. Make healthy eating and regular physical activity a family affair. Everyone will benefit and no one will feel singled out.
  • Have healthy snacks available. Options include air-popped popcorn without butter, fruits with low-fat yogurt, baby carrots with hummus, or whole-grain cereal with low-fat milk.
  • Offer new foods multiple times. Don't be discouraged if your child doesn't immediately like a new food. It usually takes multiple exposures to a food to gain acceptance.
  • Choose nonfood rewards. Promising candy for good behavior is a bad idea.
  • Be sure your child gets enough sleep. Some studies indicate that too little sleep may increase the risk of obesity. Sleep deprivation can cause hormonal imbalances that lead to increased appetite.

Also, be sure your child sees the doctor for well-child checkups at least once a year. During this visit, the doctor measures your child's height and weight and calculates his or her BMI . A significant increase in your child's BMI percentile rank over one year may be a possible sign that your child is at risk of becoming overweight.

  • Helping your child who is overweight. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/weight-management/helping-your-child-who-is-overweight. Oct. 14, 2020.
  • Childhood obesity causes and consequences. Centers for Disease Control and Prevention. https://www.cdc.gov/obesity/childhood/causes.html. Accessed Oct. 14, 2020.
  • Kliegman RM, et al. Overweight and obesity. In: Nelson Textbook of Pediatrics. 21st ed. Elsevier; 2020. https://www.clinicalkey.com. Accessed Oct. 14, 2020.
  • Hay WW, et al., eds. Normal childhood nutrition and its disorders. In: Current Diagnosis & Treatment: Pediatrics. 25th ed. McGraw Hill; 2020. https://accessmedicine.mhmedical.com. Accessed Oct. 20, 2020.
  • Skelton JA. Management of childhood obesity in the primary care setting. https://www.uptodate.com/contents/search. Accessed Oct. 14, 2020.
  • Klish WJ, et al. Definition, epidemiology and etiology of obesity in children and adolescents. https://www.uptodate.com/contents/search. Accessed Oct. 14, 2020.
  • Polfuss ML, et al. Childhood obesity: Evidence-based guidelines for clinical practice — Part one. Journal of Pediatric Health Care. 2020; doi:10.1016/j.pedhc.2019.12.003.
  • Davis RL, et al. Childhood obesity: Evidence-based guidelines for clinical practice — Part two. Journal of Pediatric Health Care. 2020; doi:10.1016/j.pedhc.2020.07.011.
  • Mayo Clinic Children's Center Pediatric Weight Management Clinic

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Childhood Obesity: Causes and Effects

Introduction, feasible solution, concluding thoughts.

It is impossible to deny that good health is one of the most significant phenomena for people. When some health issues affect an individual, he or she suffers from compromised well-being, denoting that it is impossible to live fully-fledged lives. That is why it is of importance for people to take care of their health, and one should draw attention to this activity as early as possible. The rationale behind this statement is that problems that develop during childhood are more likely to result in adverse consequences in the future. This description refers to childhood obesity, which is a dangerous and widespread phenomenon. According to the World Health Organization (2021), this term stands for “an abnormal or excessive fat accumulation that may impair health” (para. 2). Body mass index (BMI) is typically measured to assess whether a young individual has weight issues. In particular, children of 5-19 years old are considered having obesity if their weight is higher than two standard deviations above the accepted average value (World Health Organization, 2021). This explanation and the statistical value above ensure that the problem is severe and requires specific attention.

Simultaneously, additional statistical data proves that the issue is widespread. According to the Centers for Disease Control and Prevention (CDC, 2022), 19.7% (14.7 million) of children and adolescents in the USA suffered from the issue in 2017-2020. This statistical value demonstrates that it is impossible to overestimate the need to prevent the problem. Thus, childhood obesity has many causes and effects, which denotes that parents and teachers should make children with obesity engage in regular physical exercise in school and at home to solve the problem.

A comprehensive approach should be utilized to determine what causes lead to childhood obesity. According to a scholarly and peer-reviewed article by Deal et al. (2020), there are many risk factors, and one can classify them into three groups based on the periods when they occur. These are prenatal, neonatal and infancy, as well as childhood and adolescence stages. Firstly, a child can be subject to obesity for a number of reasons, including parents’ obesity, exposure to antibiotics, maternal smoking, and diabetes (Deal et al., 2020). This information demonstrates that children’s health is formed until they have come into being.

Secondly, the first months of life can also contribute to the problem under analysis. Weight gain can occur if birth weight is over four kilograms, antibiotics are used for a long period, or a diet is full of added sugars (Deal et al., 2020). Thirdly, it is reasonable to consider the processes during childhood and adolescence since they can be impactful. In particular, these causes can be social, physical, and nutritional. Among social factors, poverty is the most influential one because it stipulates that children live in physically and emotionally disadvantaged conditions that promote obesity (Deal et al., 2020). Additional causes are more specific and include food insecurity and family stressors. As for physical factors, it is challenging to determine which one is the most impactful. This statement denotes that high screen time, poor sleep, and insufficient exercise contribute to the spread of the problem (Deal et al., 2020). Finally, an excessive intake of fat and sugar is a significant nutritional cause (Deal et al., 2020). This information reveals that many processes and phenomena result in the fact that a child suffers from excessive weight.

In addition to that, I can incorporate a few examples from my experience that prove the statements above. I know a guy who has not engaged in any sports activity during his life. Now, he suffers from being overweight and tries to solve the issue. Another example refers to my neighbors who gave birth to their daughter a few years ago. The family is in compromised economic conditions, which denotes that they do not have sufficient money to follow healthy diets. This scenario results in the fact that their child started gaining weight and currently suffers from the problem.

Other scholars utilize a narrower approach to find a cause of childhood obesity. In particular, Han et al. (2020) conducted a scientific study to determine whether proximity to fast food could lead to childhood obesity. According to the authors, they have found credible evidence demonstrating that obesity rates were higher among those children who lived closer to fast food locations (Han et al., 2020). Some critics can state that this suggestion is not appropriate because fast food restaurants are widespread almost in every state, but it is challenging to argue with facts. This finding is significant because it demonstrates that environmental factors can be critical in causing the problem under analysis. The authors stipulate that children tend to attend such locations on their way home from school. It is not reasonable to underestimate this evidence because it reveals that fast-food chains and various franchises are harmful to children and, therefore, dangerous for the future of the entire nation.

The information above has represented different approaches to defining the causes of childhood obesity. On the one hand, Deal et al. (2020) relied on a comprehensive analysis and identified multiple risk factors that contribute to the problem collectively. On the other hand, Han et al. (2020) stated that a single aspect could be a significant cause. Even though the study by Han et al. (2020) offered valuable and credible conclusions, it seems that a comprehensive approach is more appropriate. Childhood obesity is a complicated problem, and it is challenging to believe that limiting children’s access to fast-food restaurants can completely solve the issue. This strategy can reduce the prevalence, but harmful food can come from other sources. That is why it is challenging to deny that many essential aspects contribute to the spread of childhood obesity.

Since a significant part of the US population suffers from the health issue under review, it is reasonable to look at what effects it brings. The focus on potential consequences is needed because it can demonstrate whether urgent responses are required to protect people. As for childhood obesity, it is possible to divide its effects into two groups. They are physical and psychological causes, and each of the groups should receive sufficient attention.

On the one hand, physical consequences are more evident and straightforward. Since an organism is forced to deal with excessive weight, some of its processes witness additional challenges that lead to specific problems. According to Deal et al. (2020), adverse effects impact neurological, pulmonary, cardiovascular, gastrointestinal, renal, endocrine, reproductive, and musculoskeletal systems performance. Thus, specific consequences are versatile, and they include hypertension, coronary artery disease, type 2 diabetes mellitus, asthma, orthopedic disorders, stroke, and certain cancers (Deal et al., 2020). This information demonstrates that it is impossible to underestimate the role that obesity plays for every child who deals with it. Since many systems are impacted negatively, children with an excessive weight typically request medical services more often. This state of affairs results in a higher financial burden for their parents. Moreover, Deal et al. (2020) indicate that childhood obesity can result in health issues that will finally lead to adult mortality. Thus, various scholars and healthcare professionals highlight the danger of physical consequences that can be brought by the issue under analysis.

On the other hand, childhood obesity can result in psychological or mental consequences. The given condition makes children understand that they are different from others and limits their abilities. For example, it is not a rare occasion when children with obesity have difficulties finding friends. That is why it is not surprising that many mental health issues arise as consequences. In particular, they are depression, stress, eating disorders, low self-esteem, and poor health (Chu et al., 2019). It is impossible to deny that these conditions harmfully impact young individuals and their development. If a child deals with depression at school, it is likely that this person will be subject to harmful effects of the same mental condition being an adult. In fact, many psychological problems find their origin in childhood, which justifies the fact that many scholars draw their attention to these phenomena. Children with obesity are suitable subjects for such studies because these individuals are subject to various harmful effects.

Simultaneously, examples from my life can help understand why the issue is a big problem. I know a few children with this condition, and all of them feel depressed and isolated. As for adults, they can also experience some difficulties having romantic relationships. Among people with obesity whom I know, each individual has other health problems that have emerged because of their extra weight. That is why it is impossible to underestimate the negative effects of the phenomenon.

This information demonstrates that childhood obesity is associated with multiple adverse consequences. Since the problem is associated with excessive weight, it is not surprising that significant physical health problems are prevalent. Obesity creates many difficulties, meaning that people and their organisms are forced to spend more energy dealing with this body condition. That is why it is not a rare case that children with obesity are subject to multiple comorbidities. Simultaneously, it is not reasonable to ignore subtle consequences that refer to psychological issues. Mental health problems are also important because they can significantly affect children’s development. Depression, anxiety, difficulties finding friends, and even social isolation are sometimes closely linked to childhood obesity. It is now impossible to state which group of effects is more significant or harmful because all of them negatively affect children and their well-being. The impact even becomes higher when multiple issues influence a single child.

The information above demonstrates that a timely and appropriate response is required. Since the selected problem affects many children, various stakeholders should find a solution to the issue. Thus, parents, teachers, and other involved individuals should join efforts to determine what specific intervention can protect children’s health. According to the available scientific data, subjecting young individuals to regular physical exercises can be considered a feasible solution.

One should admit that it is possible to use different methods to implement the suggested intervention, and school-based exercises seem a suitable option since children and adolescents spend much time at school. Consequently, they can use it profitably and engage in the sports activity. Duncombe et al. (2022) have conducted a systematic review and meta-analysis to assess the effectiveness of high-intensity interval training (HIIT) programs in combating childhood obesity. That is why the researchers have located and analyzed 54 credible studies that, in turn, focused on the impact of physical exercise on various health outcomes. In particular, Duncombe et al. (2022) have focused on the effects of running, cycling, jumping, throwing, and other activities and identified that they contributed to various improved consequences. In particular, they are reduced waist circumference, body fat percentage, and body mass index (Duncombe et al., 2022). Teachers should be actively involved in this intervention, meaning that physical education lesson plans should be changed to ensure that children with obesity are engaged in those activities that can address their condition.

This intervention should be implemented at a state level, which denotes that state health departments should develop exercise guidelines for schools. These recommendations should specify what exercises are appropriate for children based on their abilities. Thus, teachers can rely on these guidelines to ensure that the suggested interventions are suitable for children and provide the latter with positive impacts that can lead to losing weight.

Simultaneously, schools are not the only environments that are suitable to address the problem under analysis. Children and adolescents also spend much time at home with their parents, and it is reasonable to ensure that the latter participate in addressing the problem. According to Bülbül (2020), it is useful to subject children with obesity to various exercise types, including aerobic exercise, muscle strengthening, bone strengthening, and extension. Specific exercises include running, cycling, weightlifting, walking, team sports, and gymnastics (Bülbül, 2020). Since these activities do not require specific skills and specialized equipment, young individuals can easily do them at home or outdoors.

The only requirement is that children should allocate 20-60 minutes a few times a week to exercise regularly. However, one should state separately that young individuals are unlikely to engage in systematic exercises because they do not have sufficient motivation. That is why parents should control their children and ensure that they practice regularly. This statement denotes that state health departments should create exercise plans and distribute them among teachers and parents. In this case, adults will join their efforts to help children lose weight. Consequently, the responsibility is placed on adults since they should better understand the importance of this intervention and deliver this information to their sons and daughters.

The identified evidence demonstrates that there are many interventions that can help reduce the prevalence of childhood obesity. On the one hand, school-based responses are effective because children and adolescents spend much time in these establishments. That is why physical education lessons should be restructured to ensure that students with the given condition engage in appropriate activities that help them lose weight. On the other hand, home-based interventions are also required to solve the problem. Parents are expected to make their children participate in regular exercises at home and outdoors. However, one cannot state which approach is the most effective. That is why it could be better to ensure that a versatile approach is utilized, meaning that home and school-based interventions are used simultaneously. As has been mentioned, specific exercise plans will provide these adults with recommendations on how they can make reasonable contributions to solving the problem. It is possible to expect that if children engage in physical exercise in school and at home, better outcomes can be reached.

The report has comprehensively analyzed the issue of childhood obesity and made a few reasonable conclusions based on scientific evidence. It has been found that versatile behaviors and conditions can be considered contributing factors, while the condition leads to multiple adverse effects. Thus, the paper has devoted a sufficient section of the paper to discussing a feasible solution. According to the available literature, a suitable and effective option is to make children with obesity involved in regular physical exercise. This intervention requires the efforts of many stakeholders, including parents and school teachers, because it can be implemented in school and home-based environments. In practice, such interventions can be practiced in physical education lessons, at home, and outdoors. Suitable activities include cycling, running, jumping, team sports, walking, and weightlifting. It is challenging to state which approach or which activity is the most effective. That is why a reasonable strategy is to solve the problem comprehensively.

Bülbül S. (2020). Exercise in the treatment of childhood obesity . Turk Pediatri Arsivi , 55 (1), 2-10.

Centers for Disease Control and Prevention. (2022). Childhood obesity facts . 

Chu, D. T., Nguyet, N. T. M., Nga, V. T., Lien, N. V. T., Vo, D. D., Lien, N., Ngoc, V. T. N., Son, L. H., Le., D.-H., Nga, V. B., Tu, P. V., To, T. V., Ha., L. S., Tao, Y., & Pham, V. H. (2019). An update on obesity: Mental consequences and psychological interventions. Diabetes & Metabolic Syndrome: Clinical Research & Reviews, 13 (1), 155-160.

Deal, B. J., Huffman, M. D., Binns, H., & Stone, N. J. (2020). Perspective: Childhood obesity requires new strategies for prevention. Advances in Nutrition, 11 (5), 1071-1078.

Duncombe, S. L., Barker, A. R., Bond, B., Earle, R., Varley-Campbell, J., Vlachopoulos, D., Walker, J. L., Weston, K. L., & Stylianou, M. (2022). School-based high-intensity interval training programs in children and adolescents: A systematic review and meta-analysis. PloS ONE , 17 (5), e0266427.

Han, J., Schwartz, A. E., & Elbel, B. (2020). Does proximity to fast food cause childhood obesity? Evidence from public housing . Regional Science and Urban Economics, 84 , 103565.

World Health Organization. (2021). Obesity and overweight .

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StarsInsider

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Childhood obesity: what are the causes and how you can fight it

Posted: December 20, 2023 | Last updated: December 20, 2023

<p>Childhood obesity rates are rising and global figures don't make for easy reading. The <a href="https://www.starsinsider.com/health/426605/the-history-of-the-world-health-organization" rel="noopener">World Health Organization</a> (WHO) estimates that over 124 million children and teenagers around the world are obese, resulting in a host of health concerns for the next generation. </p> <p>Click on to learn about the causes of childhood obesity and get some tips to combat it. </p><p>You may also like:<a href="https://www.starsinsider.com/n/67818?utm_source=msn.com&utm_medium=display&utm_campaign=referral_description&utm_content=514640v2en-en"> 10 countries with exceptionally beautiful women </a></p>

Childhood obesity rates are rising and global figures don't make for easy reading. The World Health Organization (WHO) estimates that over 124 million children and teenagers around the world are obese, resulting in a host of health concerns for the next generation. 

Click on to learn about the causes of childhood obesity and get some tips to combat it. 

You may also like: 10 countries with exceptionally beautiful women

The leader of a study on childhood obesity and professor at Duke University, Asheley Skinner, says that the jump in cases of obesity in children aged two to five (9% to 14%) is alarming. Skinner said they were the highest rates of obesity for that age group since the study began in 1999.<p><a href="https://www.msn.com/en-us/community/channel/vid-7xx8mnucu55yw63we9va2gwr7uihbxwc68fxqp25x6tg4ftibpra?cvid=94631541bc0f4f89bfd59158d696ad7e">Follow us and access great exclusive content every day</a></p>

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The facts presented mentioned that efforts to warn the American population had a positive impact over the years but haven't been enough to curb the growth of cases.<p><a href="https://www.msn.com/en-us/community/channel/vid-7xx8mnucu55yw63we9va2gwr7uihbxwc68fxqp25x6tg4ftibpra?cvid=94631541bc0f4f89bfd59158d696ad7e">Follow us and access great exclusive content every day</a></p>

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For the study, Skinner's team examined data from American national health and nutrition surveys, analyzing children's height and weight statistics from 1999 until 2016.<p><a href="https://www.msn.com/en-us/community/channel/vid-7xx8mnucu55yw63we9va2gwr7uihbxwc68fxqp25x6tg4ftibpra?cvid=94631541bc0f4f89bfd59158d696ad7e">Follow us and access great exclusive content every day</a></p>

Methodology

In the beginning, around 29% of children were overweight and another 20% obese. But by the end of the study, numbers showed around 35% of children were overweight and another 26% were obese.<p>You may also like:<a href="https://www.starsinsider.com/n/224764?utm_source=msn.com&utm_medium=display&utm_campaign=referral_description&utm_content=514640v1en-us"> Random everyday things you'll be shocked to learn have names</a></p>

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<p>The study showed that white American and Asian-American children had significantly lower obesity rates than other groups, such as African Americans and Hispanic Americans.</p><p><a href="https://www.msn.com/en-us/community/channel/vid-7xx8mnucu55yw63we9va2gwr7uihbxwc68fxqp25x6tg4ftibpra?cvid=94631541bc0f4f89bfd59158d696ad7e">Follow us and access great exclusive content every day</a></p>

Most effected

The study showed that white American and Asian-American children had significantly lower obesity rates than other groups, such as African Americans and Hispanic Americans.

In October 2017, the WHO had already warned of the alarming figure of 124 million obese children and teenagers.<p>You may also like:<a href="https://www.starsinsider.com/n/250904?utm_source=msn.com&utm_medium=display&utm_campaign=referral_description&utm_content=514640v1en-us"> High IQ: these are the world's smartest countries</a></p>

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According to Majid Ezzati, the study leader, 90% of cases can be explained by modern changes in diet and lifestyle.<p><a href="https://www.msn.com/en-us/community/channel/vid-7xx8mnucu55yw63we9va2gwr7uihbxwc68fxqp25x6tg4ftibpra?cvid=94631541bc0f4f89bfd59158d696ad7e">Follow us and access great exclusive content every day</a></p>

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The WHO survey notes that population growth accounts for 10% of that growth.<p><a href="https://www.msn.com/en-us/community/channel/vid-7xx8mnucu55yw63we9va2gwr7uihbxwc68fxqp25x6tg4ftibpra?cvid=94631541bc0f4f89bfd59158d696ad7e">Follow us and access great exclusive content every day</a></p>

Omnipresent

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One of the main reasons the WHO cites is lack of exercise and bad diet.<p><a href="https://www.msn.com/en-us/community/channel/vid-7xx8mnucu55yw63we9va2gwr7uihbxwc68fxqp25x6tg4ftibpra?cvid=94631541bc0f4f89bfd59158d696ad7e">Follow us and access great exclusive content every day</a></p>

Advertising

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In 2016, the WHO appealed to governments around the world to tax drinks with high sugar content as a way of combating obesity and other problems.<p><a href="https://www.msn.com/en-us/community/channel/vid-7xx8mnucu55yw63we9va2gwr7uihbxwc68fxqp25x6tg4ftibpra?cvid=94631541bc0f4f89bfd59158d696ad7e">Follow us and access great exclusive content every day</a></p>

Urgent appeal

The WHO estimates that a fiscal policy to raise the price of sugary drinks by at least 20% would result in a reduction of consumption of these products.<p>You may also like:<a href="https://www.starsinsider.com/n/283869?utm_source=msn.com&utm_medium=display&utm_campaign=referral_description&utm_content=514640v1en-us"> American foods that are banned around the world</a></p>

Consumption

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To reverse the trend, the WHO insists that health authorities should better inform people about healthy eating. For exampling, encouraging them to eat fruit and vegetables.<p><a href="https://www.msn.com/en-us/community/channel/vid-7xx8mnucu55yw63we9va2gwr7uihbxwc68fxqp25x6tg4ftibpra?cvid=94631541bc0f4f89bfd59158d696ad7e">Follow us and access great exclusive content every day</a></p>

Recommendation

Another suggestion is to choose wholegrain foods instead of processed foods. Avoid biscuits, cookies, and microwave meals, which are high in sugar, sodium, and fat.<p>You may also like:<a href="https://www.starsinsider.com/n/317674?utm_source=msn.com&utm_medium=display&utm_campaign=referral_description&utm_content=514640v1en-us"> Stars who took method acting to extremes </a></p>

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Reducing how often you eat out is also recommended, especially when it's in fast food restaurants.<p><a href="https://www.msn.com/en-us/community/channel/vid-7xx8mnucu55yw63we9va2gwr7uihbxwc68fxqp25x6tg4ftibpra?cvid=94631541bc0f4f89bfd59158d696ad7e">Follow us and access great exclusive content every day</a></p>

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As well as burning calories, physical exercise strengthens muscles and bones, improves mood, and helps with fatigue. Physical exercise can be organized (team sports, or dance class, for example) or as easy as going to play in the park.<p><a href="https://www.msn.com/en-us/community/channel/vid-7xx8mnucu55yw63we9va2gwr7uihbxwc68fxqp25x6tg4ftibpra?cvid=94631541bc0f4f89bfd59158d696ad7e">Follow us and access great exclusive content every day</a></p>

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<p>The CDC (Centers for Disease Control and Prevention) added that use of medication and sleep patterns should be taken into account.</p><p><a href="https://www.msn.com/en-us/community/channel/vid-7xx8mnucu55yw63we9va2gwr7uihbxwc68fxqp25x6tg4ftibpra?cvid=94631541bc0f4f89bfd59158d696ad7e">Follow us and access great exclusive content every day</a></p>

Other factors

The CDC (Centers for Disease Control and Prevention) added that use of medication and sleep patterns should be taken into account.

For serious cases of childhood obesity related with other conditions, medication can be prescribed. But these treatments should never substitute healthy habits.<p>You may also like:<a href="https://www.starsinsider.com/n/415169?utm_source=msn.com&utm_medium=display&utm_campaign=referral_description&utm_content=514640v1en-us"> Why you're washing your hair wrong (and what to do about it)</a></p>

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Pharmacological treatment is only recommended for young people with disorders like thyroid problems or high cholesterol.<p><a href="https://www.msn.com/en-us/community/channel/vid-7xx8mnucu55yw63we9va2gwr7uihbxwc68fxqp25x6tg4ftibpra?cvid=94631541bc0f4f89bfd59158d696ad7e">Follow us and access great exclusive content every day</a></p>

Immediate risks

Childhood obesity can effect the body in many ways. The CDC warns that overweight children are more vulnerable to high blood pressure and high cholesterol, which can lead to cardiovascular disease.

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<p>The CDC also warns that obese kids may display breathing problems like asthma or sleep apnea.</p> <p>Kids can develop problems later on such as muscular discomfort as well as liver problems, gallstones, and heartburn.</p><p><a href="https://www.msn.com/en-us/community/channel/vid-7xx8mnucu55yw63we9va2gwr7uihbxwc68fxqp25x6tg4ftibpra?cvid=94631541bc0f4f89bfd59158d696ad7e">Follow us and access great exclusive content every day</a></p>

The CDC also warns that obese kids may display breathing problems like asthma or sleep apnea.

Kids can develop problems later on such as muscular discomfort as well as liver problems, gallstones, and heartburn.

<p>The CDC also notes the psychological side. Overweight children are more vulnerable to anxiety and depression.</p> <p>They are also more vulnerable to low self-esteem as well as bullying and other problems.</p><p>You may also like:<a href="https://www.starsinsider.com/n/438306?utm_source=msn.com&utm_medium=display&utm_campaign=referral_description&utm_content=514640v1en-us"> Amber Tamblyn, David Cross share how couples therapy helped both on- and off-screen</a></p>

The CDC also notes the psychological side. Overweight children are more vulnerable to anxiety and depression.

They are also more vulnerable to low self-esteem as well as bullying and other problems.

You may also like: Amber Tamblyn, David Cross share how couples therapy helped both on- and off-screen

<p>Adulthood obesity is linked to numerous serious illnesses, such as heart disease, type 2 diabetes and cancer, according to the CDC.</p> <p>Sources: (WHO) (PBS)</p> <p>See also: <a href="https://www.starsinsider.com/lifestyle/154870/how-to-strengthen-your-immune-system">How to strengthen your immune system</a></p><p><a href="https://www.msn.com/en-us/community/channel/vid-7xx8mnucu55yw63we9va2gwr7uihbxwc68fxqp25x6tg4ftibpra?cvid=94631541bc0f4f89bfd59158d696ad7e">Follow us and access great exclusive content every day</a></p>

Future risks

Adulthood obesity is linked to numerous serious illnesses, such as heart disease, type 2 diabetes and cancer, according to the CDC.

Sources: (WHO) (PBS)

See also: How to strengthen your immune system

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Causes and Effects of Obesity Essay

Introduction, laziness as the main cause of obesity, social effects of obesity, effects of obesity: health complications.

Bibliography

Maintaining good body weight is highly recommended by medical doctors as a way of promoting a healthy status of the body. This is to say that there is allowed body weight, which a person is supposed to maintain. Extreme deviations from this weight expose a person to several health complications.

While being underweight is not encouraged, cases of people who are overweight and increasing effects of this condition have raised concerns over the need of addressing the issue of obesity in the society today, where statistics are rising day and night. What is obesity? This refers to a medical condition in which a person’s body has high accumulation of body fat to the level of being fatal or a cause of serious health complications. Additionally, obesity is highly associated with one’s body mass index, abbreviated as BMI.

This denotes the value obtained when a person’s weight in kilograms is divided by the square of their height in meters (Burniat 3). According to medical experts, obesity occurs when the BMI exceeds 30kg/m 2 . While this is the case, people who have a BMI of between 25 and 29 and considered to be overweight. Obesity has a wide-range of negative effects, which may be a threat to the life of a person.

The fist effect of obesity is that it encourages laziness in the society. It is doubtless that obese people find it hard and strenuous to move from one point to the other because of accumulated fats. As a result, most of these people lead a sedentary lifestyle, which is usually characterized by minimal or no movement. In such scenarios, victims prefer being helped doing basic activities, including moving from one point to another.

Moreover, laziness makes one to be inactive and unproductive. For example, a student who is obese may find it hard to attend to his or her homework and class assignments, thus affecting performance. With regard to physical exercises, obese people perceive exercises as punishment, which is not meant for them (Korbonits 265). As a result, they do not accept simple activities like jogging because of their inability to move.

In line with this, obese people cannot participate in games like soccer, athletics, and rugby among others. Based on this sedentary lifestyle, obese people spend a lot of their time watching television, movies, and playing video games, which worsen the situation.

The main effect of obesity is health complications. Research indicates that most of the killer diseases like diabetes, heart diseases, and high blood pressure are largely associated with obesity. In the United States, obesity-related complications cost the nation approximately 150 billion USD and result into 0.3 million premature deaths annually.

When there is increase in body fat, it means that the body requires more nutrients and oxygen to support body tissues (Burniat 223). Since these elements can only be transported by the blood to various parts of the body, the workload of the heart is increased.

This increase in the workload of the heart exerts pressure on blood vessels, leading to high blood pressure. An increase in the heart rate may also be dangerous due to the inability of the body to supply required blood to various parts. Moreover, obesity causes diabetes, especially among adults as the body may become resistant to insulin. This resistance may lead to a high level of blood sugar, which is fatal.

Besides health complications, obesity causes an array of psychological effects, including inferiority complex among victims. Obese people suffer from depression, emanating from negative self-esteem and societal rejection. In some cases, people who become obese lose their friends and may get disapproval from teachers and other personalities (Korbonits 265). This is mainly based on the assumption that people become obese due to lack of self-discipline. In extreme cases, obese people may not be considered for promotion at workplaces, because of the negative perception held against them.

Due to inferiority complex, obese people avoid being in public and prefer being alone. This is because they imagine how the world sees them and may also find it hard being involved in public activities because of their sizes.

This further makes them to consider themselves unattractive based on their deviation from what is considered as the normal body size and shape. Regardless of how obese people are treated, they always believe that they are being undermined because of their body size.

In summary, obesity is a major cause of premature deaths in the United States and around the world. This health condition occurs when there is excess accumulation of body fat, caused by unhealthy lifestyles. Obesity is largely associated with several killer diseases like high blood pressure, diabetes, and diseases of the heart.

These diseases drain world economies since most of them are fatal and expensive to manage. Additionally, obesity promotes sedentary life where victims minimize movement by adopting an inactive lifestyle. Moreover, obese victims suffer psychologically because of societal rejection. In general, obesity has a wide-range of negative effects, which may be a threat to the life of a person.

Burniat, Walter. Child and Adolescent Obesity: Causes and Consequences, Prevention and Management . United Kingdom: Cambridge University Press, 2002. Print.

Korbonits, Márta. Obesity and Metabolism . Switzerland: Karger Publishers, 2008. Print.

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Angela Chao, CEO of Foremost Group and Mitch McConnell's sister-in-law, dies in car accident

essay on childhood obesity causes and effects

The CEO of Foremost Group, Angela Chao, died in a car accident, according to several media publications.

"Angela Chao was a formidable executive and shipping industry leader, as well as a proud and loving daughter, sister, aunt, wife and mother," reads the Foremost Group statement published by Hellenic Shipping News .

In a tweet , the U.S. Coast Guard Academy called Chao a "trailblazer in the maritime industry."

Life of Angela Chao

Chao was the youngest daughter of Foremost Group's founder and honorary chairman, Dr. James S.C. Chao, the sister of Elaine Chao, former Secretary of Transportation , and the sister-in-law of Senator Mitch McConnell.

According to Chao's website , she was a Harvard graduate, earning both her undergraduate and graduate degrees there. She is also a published author on topics of economics, international trade and finance, and education.

Her case study on “Ocean Carriers,” which she wrote while attending Harvard Business School, is a part of the required curriculum for first-year business students at the school, says the Foremost Group statement.

Her company, Foremost Group, is an American shipping company based in New York.

According to Hellenic Shipping News, it "charters out some of the world’s largest and most eco-friendly ships to blue-chip clients who use the vessels to transport dry bulk products to markets around the world."

The Maritime Executive states Chao is survived by her father and her five sisters.

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COMMENTS

  1. Childhood obesity: causes and consequences

    Childhood obesity can profoundly affect children's physical health, social, and emotional well-being, and self esteem. It is also associated with poor academic performance and a lower quality of life experienced by the child.

  2. Childhood Obesity: Causes & Prevention

    Policy Why is childhood obesity a problem? The facts about childhood obesity are clear. Childhood obesity in the United States is a serious public health problem. According to the CDC, 1 in 5 children and adolescents in the United States has obesity. Children who have obesity are more likely to carry the condition over into adulthood.

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    95%. Children who are Black or Hispanic or live in low-income neighborhoods are at almost twice the risk for obesity as non-Hispanic white youth (CDC, n.d.-a). Later in life, these children will face increased risk for diabetes, cancer, and heart disease (CDC, n.d.-b). But

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    1 Obesity during childhood is likely to continue into adulthood and is associated with cardiometabolic and psychosocial comorbidity as well as premature mortality. 2 , 3 , 4 The provision of effective and compassionate care, tailored to the child and family, is vital.

  6. Frontiers

    Obesity increases the risk of developing early puberty in children ( 10 ), menstrual irregularities in adolescent girls ( 1, 11 ), sleep disorders such as obstructive sleep apnea (OSA) ( 1, 12 ), cardiovascular risk factors that include Prediabetes, Type 2 Diabetes, High Cholesterol levels, Hypertension, NAFLD, and Metabolic syndrome ( 1, 2 ).

  7. Childhood obesity

    Lifestyle issues — too little activity and too many calories from food and drinks — are the main contributors to childhood obesity. But genetic and hormonal factors might play a role as well. Risk factors Many factors — usually working in combination — increase your child's risk of becoming overweight: Diet.

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    It is important that adolescents meet the recommended amount of exercise for their age. If an adolescent's time is spending sitting, watching television, and a lack of sleep also contributes weight gain. Too much weight gain from this lack of physical activity is what is causing the rate of obesity to quadruple.

  14. Childhood Obesity: Causes and Effects

    Introduction It is impossible to deny that good health is one of the most significant phenomena for people. When some health issues affect an individual, he or she suffers from compromised well-being, denoting that it is impossible to live fully-fledged lives.

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    1 Obesity in America 2 pages / 704 words Introduction Obesity is defined as having a body mass index (BMI) of 30 or higher. In America, the prevalence of obesity has been steadily increasing over the past few decades, with currently around 42% of the population being classified as obese. Addressing this issue is... Obesity Childhood Obesity 2

  16. The Main Causes of Childhood Obesity: Child's Environment

    Published: Feb 9, 2022 Throughout recent years obesity has been a very important topic in our society. It has continued to rise at high rates especially among children. This causes us to ask what are the causes of childhood obesity? There are many different elements which can contribute to the causes of childhood obesity.

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    1 Obesity during childhood is likely to continue into adulthood and is associated with cardiometabolic and psychosocial comorbidity as well as premature mortality.

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  20. Causes and Effects of Obesity

    Besides health complications, obesity causes an array of psychological effects, including inferiority complex among victims. Obese people suffer from depression, emanating from negative self-esteem and societal rejection. In some cases, people who become obese lose their friends and may get disapproval from teachers and other personalities ...

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