A Growing Concern: Childhood Obesity Rates Continue Increasing
From the Eat 5 a Day initiative to increase fruit and vegetable consumption to First Lady Michelle Obama’s Let’s Move campaign, many efforts have been made to curb the growing incidence of childhood obesity. But a troubling new study suggests a lot more work needs to be done. Researchers at the Duke Clinical Research Institute have found that childhood obesity prevalence rates have not declined as earlier reports had initially suggested. Instead, they continue to increase, with the largest increases being in cases of severe obesity.
Claudia Borzutzky, MD, medical director of the EMPOWER Weight Management Clinic at Children’s Hospital Los Angeles, spoke to us about the concerns this new study raises and how physicians and researchers can better tackle issues related to childhood obesity.
What are the most concerning aspects of the results of this study?
There are many concerning aspects of the results of this study. The first is that, contrary to some analyses performed in the last several years, looking at data comparing prevalence in 1999-2000 to 2013-14, the rates of being overweight (i.e., BMI>85th percentile) have increased overall in both girls and boys, including the youngest group analyzed, the 2 to 5 year olds. The second is that racial and ethnic disparities, particularly for children and adolescents with low- or moderate-risk obesity, continue to persist. The third is that the overall rate of severe obesity (those kids whose BMI is greater than 120% of the 95th percentile) has increased significantly over that time.
What are some of the limitations of this study?
The biggest limitation to this study, as acknowledged by its authors, is that the number of subjects in the class 2 (moderate-risk) and 3 (high-risk) obesity groupings, which can be taken together as representative of “severe obesity”, was small, particularly for the younger age groups. The smaller the number, the more difficult it is to say that the results are meaningful.
How do you think current efforts can be improved? What issues need to be tackled to reduce prevalence rates of childhood obesity?
We have significant work to do at a societal level. In order for pediatric obesity rates to improve, we must tackle this problem from every angle:
1) Our federal, state, and local governments, as well as the food industry, must take ownership of this problem; and the most obesogenic foods and beverages should be priced and taxed in a progressive manner, rather than subsidized as many currently are.
2) Similarly, government at all levels will need to invest in our physical infrastructure, so children have access – free of cost – to green places to play in.
3) School systems will need to better integrate physical education into their curricula at all grade levels.
4) There needs to be better support for pregnant women, including access to adequate nutrition and education. New mothers also need access to paid and longer maternity leaves, so that they can focus on their own health and nutrition as well as that of their children. We know that even the intra-uterine environment that babies start out in will influence their future weight-related health.
5) Clinical care of the obese is just the tip of the iceberg in addressing this problem; support of research to determine best practices for pediatric weight management, safety of weight loss surgery for young people, and third-party payer support of comprehensive obesity treatment programs, will be crucial as well.
Sarah Armstrong, MD, director of the Duke Healthy Lifestyles Program (who was not involved in the study) suggests “we may need to be more disruptive in our thinking about how we change the environment around children”. What do you think about this suggestion?
I absolutely agree. As she notes, despite significant focus on this issue for the last decade or so, we have not made tangible progress – at least not according to the data presented in this new study. We must begin to think outside the box in ways that can improve our health, population-wide.
What efforts are being undertaken here at CHLA to address issues of childhood obesity?
At CHLA, the Diabetes and Obesity Program is committed to making efforts, both at home as well as out in the community, to help prevent and treat childhood obesity. We’ve started a weekly CHLA Farmers’ Market, in order to promote and increase the access for our patients and staff to fresh fruits, nuts and vegetables. We also run the Kids N Fitness program, an evidence-based, classroom-style weight management program for children and their families. We have implemented various community-based programs, including one centered in a faith-based organization and another in a community health center, to help prevent and address obesity closer to peoples’ homes. And with the generous support of the UniHealth Foundation, we have our comprehensive, multidisciplinary weight management program, the EMPOWER (Energy Management for Personalized Weight Reduction) clinic.
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