Back in the good old days, kids played outside for hours, enjoyed bike riding with their neighborhood friends, ate home-cooked dinners and snacked on locally grown fruits. Fast forward to the present time. Today kids play inside on video games for hours, face time with their friends, eat fast food or pizza for dinner and snack on chips and ice cream bars. The result? Children with adult diseases such as diabetes, heart disease, and non-alcoholic fatty liver disease. The impact of the changes in the American lifestyle is huge – in wellness, health care cost, and mental health.
Arguably, all of these diseases that children are experiencing are a direct result of the climbing statistics of overweight and obesity. The Centers for Disease Control (CDC) estimates that 1 in 6 children and teens are overweight or obese in the United States. To complicate matters, the National Health and Nutrition Examination Study (NHANES) data showed that parents of overweight or obese children believe that their children “look just right.” Our perceptions of weight status seem to be evolving in a negative direction.
Weight status is determined by body mass index (BMI), a ratio of weight to height in adults. BMI in children and teens is determined by a ratio of weight to age. Not only is BMI calculated differently in children and teens than it is for adults, but it is also interpreted differently as well. Children of different ages have different BMI numbers for a healthy weight status. This is noted in the table below:How has the statistics changed over the years? Dramatically. Approximately 17% of American children aged 2-19 years are considered obese. That is 12.7 million kids. The incidence is higher in Hispanics (22.4%) and non-Hispanic blacks (20.2%), compared to non-Hispanic whites (14.6%) and non-Hispanic Asians (8.6%).
Why are kids heavier? The causes are multi-factorial, including the basics of less physical activity and more calories eaten. Add in variables such as popular sedentary activities (the internet, video games, smart phones, cable television, streaming videos), two working parents, increased homework load, convenience foods, high amounts of sugary drinks and snacks, families eating on the go, and genetics… It’s no wonder that children and teens are heavier than ever before.
National level programs attempt to combat pediatric obesity – Let’s Move! By Michelle Obama, Play 60 from the National Football League, Healthy Children from the American Academy of Pediatrics, as well as government programs through USDA and NIH. Local schools and pediatricians are uniting to provide awareness, education and solutions to the growing obesity problem in children and teens.
Type 2 Diabetes
In the past, children were diagnosed with type 1 diabetes and adults with type 2 diabetes. Now, that is not always true. Type 1 diabetes (formally called insulin dependent diabetes mellitus) occurs when insulin is no longer produced by the pancreas, causing a rise in blood sugar levels. Type 2 diabetes (formally called non-insulin dependent diabetes mellitus) involves insulin resistance at the cellular level. Type 2 diabetes can be managed by diet, exercise and weight reduction, but may require oral medications, or even insulin injections.
The number of children with type 2 diabetes has risen dramatically, and parallel to the rise in obesity. According to the American Diabetes Association, in 2008-2009 type 2 diabetes affected over 5800 children under the age of 20 years, not including the suspected large number of undiagnosed cases. It is estimated that 1 in 4 adults with type 2 diabetes are unaware they have the disease. This could be the case with kids as well.
Risk factors for childhood type 2 diabetes include obesity, family history, and ethnicity. Symptoms of pediatric type 2 diabetes include fatigue, increased thirst or hunger, frequent urination, frequent infections or poor wound healing, and blurry vision. Acanthosis nigracans, a darkening of the skin in the armpits or neck, irregular menstrual periods, or excess hair and acne in girls, are some less common side effects of insulin resistance.
- Prevention – maintaining a healthy weight, healthy eating, regular physical activity!
High levels of blood fats such as cholesterol and triglycerides fall under the term, “hyperlipidemia.” Once tested and seen only in adults, this condition is on the rise in children today. Ten percent of teens have been found to have elevated serum cholesterol, according to the National Cholesterol Education Program. Hyperlipidemia is a risk factor for the eventual development of cardiovascular diseases, such as coronary artery disease (clogging of the arteries that pump blood to the heart muscle), myocardial infarction (heart attack), and cerebrovascular accident (stroke). Heart disease remains the #1 cause of death in the United States.Hyperlipidemia has been shown to be correlated with diets high in total fat, saturated fat, and trans fats, as well as obesity. Diets that are low in fiber and monounsaturated fat also contribute to hyperlipidemia. Treatment in children is almost always diet and exercise before medications are introduced. Encouraging intake of fruits, vegetables and whole grains, and at least 60 minutes of physical activity through play and exercise, is the first line of treatment.
High blood pressure, or hypertension, has been a silent disease among adults for decades. The Journal of the American Medical Association published a study stating that 3.6% of children have verified hypertension, as well as 3.4% with pre-hypertension.
- Normal blood pressure: 120 / 80
- Pre-Hypertension: 120 – 139 / 80 – 89
- Hypertension: Greater than 140 / 90
Adult hypertension is deemed a “silent killer” because has no signs or symptoms. While hypertensive-related deaths do not appear to be an issue in the pediatric or adolescent population, the damage to targeted organs is happening – cardiac tissue, eye complications, and even subtle cognitive changes. The primary concern with children is the association of high blood pressure with obesity, the rising numbers in recent decades, and the long-term effects of a lifelong chronic condition.
Non-alcoholic fatty liver disease (NAFLD) is also associated with obesity and unhealthy lifestyles. Fat deposits accumulate in the liver tissue, interfering with vital liver functions. NAFLD is the most common chronic liver condition in American children. Estimates state that 10% of American children and 38% of obese American children have NAFLD. Furthermore, it affects 1% of preschoolers and 17% of teens.
Children with NAFLD may be asymptomatic, or present with fatigue, constipation, abdominal pain and enlarged livers. Blood tests of elevated liver enzyme function, and possible imaging tests such as CT scan or ultrasound, are important diagnostic tools.
Research published by the American Association for the Study of Liver Diseases showed that modest, gradual weight reduction through healthy diet and exercise can reduce liver steatosis and inflammation. Dietary intervention for pediatric NAFLD includes reduced calories, reduced fat and sugar, and eventual weight reduction.
Excess weight on developing bones, joints, muscles and connecting tissues can have significant repercussions. The American Academy of Orthopedic Surgeons has stated that weight has a direct and serious impact on the muscular-skeletal health of children. Too much weight can damage growth plates, cause early-onset arthritis, a higher risk for bone fractures, Blount’s disease (severe bowing of the legs), foot disorders and generalized pain.
Developmental coordination disorders, which appear as clumsiness and gross or fine motor skill problems, are often coexisting with obesity in children. Problems with gross motor skills may reduce a child’s willingness to exercise and play, leading to more weight gain. The prevalence of these muscular-skeletal weight-related complications in children and teens is unclear.
Obstructive sleep apnea is a disorder in which breathing is interrupted during sleep, causing inability to sleep, inability to stay asleep, and frequent awakening. One study published in the American Family Physician journal estimated that 3-12% of children suffer from sleep apnea, which can drastically affect their daytime mood, behavior, and activity. Sleep apnea is more common in obese adults and children.
Symptoms of sleep apnea in children may include:
- Choking or drooling
- Trouble getting up in the morning
- Night sweats
- Behavioral disorders (irritability, depression)
- Problems at school (trouble concentrating, forgetfulness)
- Sluggishness or sleepiness (often misinterpreted as laziness in the classroom)
- Teeth grinding
- Restlessness in bed
- Pauses or absence of breathing
- Unusual sleeping positions (sleeping on the hands and knees or with the neck hyperextended)
Many children with sleep apnea have enlarged tonsils or adenoids, and surgical intervention is required. For the obese child with sleep apnea, treatment would include weight reduction through healthy diet and physical activity.
Keep our kids healthy –
- Healthy weight is paramount!
- Eat healthy
- Exercise daily
- Be good examples of a healthy lifestyle
- Teach kids to take care of their bodies
Dr. Jennifer Bowers is a Registered Dietitian with 25 years of experience in clinical nutrition and health promotion. Dr. Bowers earned her PhD in Nutritional Sciences from the University of Arizona and owns a private practice in Tucson.