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Dr. Gregory Weiss provides perspective on a recent study in Pediatrics describing the increased incidence of childhood obesity in the US and what it might mean for clinicians moving forward.
Obesity rates continue to rise across the globe and, although adult obesity gets a lot of press due to the pressing nature of the comorbid diseases that go along with it, the rates of childhood obesity are on the rise as well.
In fact, Solveig Cunningham, PhD, and colleagues at Emory University have found that the incidence of childhood obesity is higher, is occurring at younger ages, and is more severe than 12 years ago.1
This trend is deeply concerning as such severe and early onset obesity may be associated with significant health consequences as the children grow. The scope of the obesity problem in the United States is daunting. Further, the prevalence of childhood obesity in the US is among the highest in the world.2
The authors of this study hoped to better define the problem by investigating temporal changes in childhood obesity rates as well as severity in comparison to historic data. They feel that, with a clear perspective on the magnitude of the problem, an assessment can be made about how well prevention efforts have worked and areas where they can be improved upon.1
Cunningham and colleagues obtained data from the National Center for Education Statistics (NCES) including ages and body mass index (BMI) information. Using these data children were separated into age cohorts and obesity prevalence as the percentage of children with obesity at a given point in time was determined.1
The authors found that children born in the first decade of this century had a higher chance of being obese and were obese a younger age than children born in the late 1980’s and 1990’s.1 This was despite aggressive public health campaigns aimed at preventing obesity. They also found that as many as 40% of current high school students could be categorized as overweight before leaving primary school.1 As with many other health problems, childhood obesity affects minority and low socioeconomic populations disproportionately. In this study Non-Black Hispanic kindergartners were 29 percent more likely to be obese by the fifth grade compared to the same children 12 years earlier.1 Children in economically disadvantaged groups saw a 15% increase in obesity in primary school.1
“These worrying data indicate that the childhood obesity epidemic in the United States continues to grow and get more serious,” said Venkat Narayan, MD, coauthor of the study.
“We urgently need an aggressive national strategy for interdisciplinary research and public health to stem the tide of childhood obesity and its consequences in the US and worldwide,” Narayan added.1
A single overriding message is born from these data, efforts at combating childhood obesity have fallen short or failed outright. While high profile initiatives like the Let’s Move! Campaign and the Health, Hunger-Free Kids Act have tried to make a difference since 2010, they have had no impact whatsoever on population-level obesity.1 The authors call for public health policies that address the heterogeneity of the incidence of obesity in schools. For instance, while the highest and lowest socioeconomic households were the most likely to have obese children, boys were more likely than girls in primary school to develop obesity.1 A one size fits all plan will not work.
“For decades, we have seen the number of children with obesity increasing, in spite of extensive efforts from many parents and policymakers to improve children’s nutrition, physical activity and living environments,” Cunningham noted. “Have these efforts worked? Is obesity finally receding? Our findings indicate that no, obesity must continue to be a public health priority.”
This is not solely about negative outcomes down the road. Obese children are at higher risk for diabetes, depression, anxiety, and a host of social disadvantages when compared to normal weight children. The authors suggest the development of programs and policies aimed at a younger audience even preschool children.1 Clearly, we are not reaching children early enough to make a difference. Recognizing disparities in access to clinical care and advice as well as the availability of healthy food should be areas of focus while surveillance continues in an effort to measure our successes and failures. Finally, we must learn from the initiatives that have failed. Clever slogans and media campaigns cannot take the place of sound guidance and the provision of choices for every child in every neighborhood.