Childhood obesity

Childhood obesity is a serious health condition that involves having excess body fat early in life. The extra weight often starts children on the path to other health conditions such as diabetes and high blood pressure. Childhood obesity also can lead to poor self-esteem and depression.

The symptoms of childhood obesity aren't straightforward or simply based on how children look. And various factors can play a part in causing this condition. Some factors may be within a family's ability to change, such as eating and physical activity habits. Many other possible factors can't be changed, such those related to genes and hormones.

You can help manage or prevent childhood obesity by having your whole family regularly eat balanced meals and snacks. It also helps for the whole family to lead an active lifestyle. Steps such as these help protect your child's health now and in the future.

The symptoms of childhood obesity aren't clear-cut. Not all children who carry extra pounds are overweight. Some children have larger than average body frames. And it's typical for children to carry different amounts of body fat at the various stages of development. So you might not know if weight is a concern based on how your child looks.

A measurement called the body mass index (BMI) helps healthcare professionals check for overweight status and obese status. A child's BMI is based on the child's weight and height compared with those of other children the same age and sex using growth charts. Speak with your child's healthcare professional about how your child's BMI fits with other clues of children's health. For instance, growth patterns, eating and activity habits, stress, sleep, and family history also play a key role in health. Other tests also can help your child's healthcare professional figure out if your child's weight might pose health risks.

When to see a doctor

If you're worried that your child is putting on too much weight, talk with your child's healthcare professional. Get a healthcare checkup right away if your child also has any of the following symptoms:

• Headaches that don't go away for a long time.
• High blood pressure.
• Extreme thirst and frequent urination.
• Breathing that starts and stops many times during sleep.
• Poor growth compared with other children of the same sex and age.

Childhood obesity is a complex condition. Various factors can play a part in causing it. These include:

• Genetic and hormonal factors.
• Food access.
• Stress.
• Sleep.
• Social and economic factors.
• Eating and physical activity habits.

Many risk factors make childhood obesity more likely. Some factors that might be within your family's ability to change include the following:

• Eating habits. Frequently eating foods that have lots of added sugar, saturated fat or sodium can cause your child to gain weight. These include fast foods, baked goods and vending machine snacks. Candy and desserts also can cause weight gain. So can sugary drinks such as sodas, fruit juices and sports drinks. These types of foods and drinks are found everywhere, and they're designed to appeal to the taste buds. It's OK to enjoy treats such as these once in a while. Try to eat or drink them slowly and mindfully, paying attention to each bite or sip. And be sure to look at the serving sizes listed on the labels. Try not to have more than those amounts in one sitting.
• Not enough movement. Children who don't get enough daily movement are more likely to gain weight. So encourage your child or teen to get at least 60 minutes of physical activity a day. Too much time spent being inactive also plays a part in weight gain. Examples of being inactive include sitting to watch TV, play video games or use lots of social media. TV and online shows also may feature junk food commercials or ads. If your child is age 2 or older, try to limit leisure screen time not used for schoolwork to no more than two hours a day. If your child is younger than 2, don't let your child have any screen time.
• Mental health factors. Personal stress and family stress can raise a child's risk of obesity. Ongoing stress can cause the body to make high amounts of hormones such as cortisol. High levels of these hormones can cause feelings of increased hunger. They also can trigger cravings for foods that have lots of fat and added sugar. If you think your child has too much stress, talk with your child's healthcare professional. You may be referred to a counselor or another mental healthcare professional who can test your child and offer treatment if needed.
• Certain medicines. Some prescription medicines can raise the risk of obesity. They include prednisone, lithium, amitriptyline, paroxetine (Paxil), gabapentin (Neurontin, Gralise, Horizant), propranolol (Inderal LA, Hemangeol), quetiapine (Seroquel), carbamazepine (Carbatrol, Tegretol, others), medroxyprogesterone (Depo-Provera), olanzapine (Zyprexa) and risperidone (Risperdal). Your child's healthcare professional can review the medicines that your child takes. If a certain medicine might be causing weight gain, the healthcare professional might change the dose or switch medicines.

Some other factors for childhood obesity may be out of a parent's ability to control. They include the following:

• Family factors. If your child comes from a family of people who tend to gain weight easily, your child may be more likely to put on weight.
• Genes and hormones. Sometimes, changes to certain genes can play a part in childhood obesity. So can conditions linked with hormones and many other processes that happen inside the body.
• Social and economic factors. People in some communities have limited resources and limited access to supermarkets. As a result, their main access to foods may be convenience foods that don't spoil quickly. These include frozen meals, crackers and cookies. Access to fresh produce, meats and other proteins, and whole grain foods may be limited. And access to safe places for movement activities and outdoor hobbies also may be limited.

Childhood obesity often causes health concerns and conditions known as complications. These can affect a child's physical, social and mental well-being.

Physical complications

Physical complications of childhood obesity can include:

• Type 2 diabetes. This long-term condition affects the way the body uses sugar, also called glucose. Obesity and an inactive lifestyle raise the risk of type 2 diabetes.
• High cholesterol and high blood pressure. A poor diet can cause one or both of these conditions. High cholesterol and high blood pressure can play a part in the buildup of plaques in the arteries. The buildup can cause arteries to narrow and harden. And that may lead to a heart attack or stroke later in life.
• Joint pain. Extra weight causes more stress on hips and knees. Childhood obesity can cause pain and sometimes injuries in the hips, knees and back.
• Breathing conditions. Asthma is more common in children who are overweight. These children also are more likely to develop obstructive sleep apnea. Obstructive sleep apnea can be a serious condition in which breathing stops and starts many times during sleep.
• Metabolic dysfunction-associated steatotic liver disease. This condition causes fatty deposits to build up in the liver. It usually causes no symptoms. But it can lead to liver scarring and damage. The condition used to be known as nonalcoholic fatty liver disease.

Social and mental health complications

Children who have obesity may get teased or bullied by their peers. As a result, they may lose self-esteem. They also can have a higher risk of depression, anxiety and eating disorders.

To help prevent childhood obesity, take the following steps:

• Set a good example. Make healthy eating and regular physical activity a family affair. That way, everyone benefits and no one feels singled out. It's ideal for your child to get an hour of physical activity a day at least five days a week.
• Offer balanced meals and snacks each day. To serve a balanced meal, think of the space for food on a plate. Fruits and vegetables should take up half of the plate. Grains such as bulgur, brown rice and whole-wheat pasta should take up a quarter of the plate. Proteins such as lean meat, poultry, seafood and lentils should take up the other quarter of the plate. Between meals, offer snacks that have lots of nutrients and little added sugar, saturated fat and sodium. Examples of balanced snacks include yogurt with berries, an apple with nut butter, and whole grain crackers with turkey and avocado. Feel free to get creative when you combine different foods.
• Keep offering new foods. Your child might not like a new food right away. But if you offer it again, your child may learn to enjoy it over time.
• Support a healthy relationship with junk food. Some foods such as fast food, cookies and chips are tasty, but they don't have much nutrition. Many junk foods also have high levels of saturated fat, sodium or added sugar. Sweet drinks and fruit juices also tend to have lots of sugar with little to no nutrition. Explain to your children that they can enjoy these tasty foods on occasion, such as ice cream during a family day out. But help them understand that junk foods don't give the all-day energy that nutritious foods provide. Think about keeping junk foods off the grocery list and out of the home. Doing so could help the family focus on nutritious foods for meals and snacks.
• Limit screen time. Don't let your family watch TV during meals, and have family members put phones and tablets away. Since your child likely will use screens at other times, think about setting a time limit that everyone in the home follows. Encourage children to have fun doing things that don't involve a screen.
• Choose rewards that aren't food. Try not to promise your child snacks for good behavior. Suggest a fun activity reward instead. Examples include playing a game together or taking a trip to the park or the zoo.
• Be sure your child gets enough sleep. Too little sleep may raise the risk of obesity. How much sleep children need depends on their age. For instance, children ages 6 to 12 need about 9 to 12 hours of sleep a day. Teens ages 13 to 18 need about 8 to 10 hours. Try to help your child go to sleep and wake up at the same times each day.
• Breastfeed your baby. Breastfeeding your infant from birth to 6 months old may lower the risk of obesity later in life.

Be sure that your child gets well-child checkups at least once a year too. During this visit, a healthcare professional measures your child's height and weight and figures out your child's BMI. If your child's BMI rises a lot over one year, your child may be at risk of becoming overweight.

Diagnosis involves the steps that a healthcare professional takes to find out if your child has obesity. A healthcare professional calculates your child's BMI and figures out where it falls on a standard growth chart.

Your child's healthcare professional uses the growth chart to find out how your child's weight compares with that of other children of the same sex and age. This is called your child's BMI percentile. For example, a child in the 80th percentile has a higher BMI than 80% of other children of the same sex and age.

Cutoff points on these growth charts mean the following:

• Underweight — BMI 5th percentile or below.
• Healthy weight — BMI between 5th and 84th percentiles.
• Overweight — BMI between 85th and 94th percentiles.
• Obese — BMI 95th percentile or above.
• Severely obese — BMI greater than or equal to 120% of the 95th percentile.

BMI doesn't take into account factors such as being muscular or having a larger than average body frame. What's more, growth patterns vary greatly among children. So, the healthcare professional also factors in your child's growth and development to help find out whether your child's weight is a health concern.

Along with BMI and charting weight on the growth charts, the healthcare professional looks at:

• Your family's history of obesity and weight-related health conditions, such as diabetes.
• Your child's eating habits. This can include what your child eats and how often, and how big the portion sizes are.
• Your child's activity level and amount of screen time.
• Your child's blood pressure.
• Other health conditions your child has or medicines your child takes.
• Mental health history, including bouts of depression, sleep troubles, and whether your child feels isolated, alone or bullied.

Blood tests

Your child's healthcare professional also might do blood tests. These may include:

• A cholesterol test.
• A blood sugar test.
• A liver test.
• Other blood tests to check certain hormone levels or to look for other conditions linked with obesity.

Ask if your child needs to stop eating or drinking for a certain number of hours before a blood test. This is called fasting.

Treatment for childhood obesity is based on factors such as your child's age and whether your child has other health conditions. Treatment usually includes changes in your child's eating habits and physical activity level. The key is to make these healthy changes over time and help your child follow them long term. Sometimes, treatment also includes medicines or weight-loss surgery.

Experts recommend that treatment include a mix of the following:

• A healthcare team's guidance on nutrition and physical activity.
• Skills for building habits as a family to form a healthy lifestyle over time. These habits need to work for the family long term.

In some areas, these treatments are offered in the form of classes that children and parents attend together. Or parents might go to such classes and apply what they've learned at home. When these classes aren't available, your child's healthcare professional may need to work with you to arrange key parts of the treatment plan. These parts include visits with a dietitian and more-regular healthcare visits that are focused on supporting healthy habits and goals.

Your child's healthcare professional likely will set healthy eating and physical activity goals for your family and your child. Any goal for your child's weight is tailored to:

• Your child's age.
• The severity of the obesity.
• Whether your child has obesity-related health conditions.

Remember, success with treatment partly depends on how committed you are to helping your child make long-term healthy changes. Understand that your child is still growing. And be aware that healthy-lifestyle changes can benefit your child and family in ways that the scale may not or cannot show.

Healthy eating

Parents are the ones who buy groceries, cook meals and decide where the food is eaten. Even small changes can make a big difference in your child's health.

• Sit down together for family meals. Make it an event — a time to share news and tell stories. Try not to eat in front of a TV, computer or video game screen. That can lead to fast eating and less awareness of the amount eaten.
• Serve fruits and vegetables. Try to have your child eat at least five fruits and vegetables a day. For instance, aim for two pieces of fruit and three vegetables.
• Cut back on convenience foods. These include cookies, crackers, fast food and prepared meals. They're often high in sugar, fat, sodium and calories.
• Limit sweetened drinks. This includes fruit juice. Sugar-sweetened drinks have little nutrition and lots of calories. They also can make your child feel too full to eat healthier foods.
• Serve appropriate portion sizes. Children don't need as much food as adults do. Start with a small portion. After your child finishes, have your child wait 10 minutes before taking another portion. Let your child eat only until full, even if that means leaving food on the plate. Older children and teens may eat less food when they serve themselves. Also, keep in mind that when you eat out, restaurant portion sizes often are way too large.
• Keep a daily food journal. Write down what your child eats and how much. Show your child this journal. The journal can help your child learn to be more mindful about food choices. You also can teach your child to track physical activity.

Physical activity

A key part of reaching and staying at a healthy weight is physical activity. It burns calories, and strengthens bones and muscles. It also helps children sleep well at night and stay alert during the day. Good habits during childhood help teens stay at healthy weights. Plus, active children are more likely to become fit adults.

To help your child become more active:

• Limit TV time. Children older than age 2 should have no more than two hours a day of leisure screen time. That includes sitting in front of a TV, computer, tablet or smartphone for fun. Children younger than 2 should have no screen time.
• Encourage activity. Children should get at least an hour of physical activity a day. Your child's activity doesn't have to be a structured exercise program. The goal is to get your child moving. Free-play activities such as hide-and-seek, tag and jump rope can be great ways to burn calories and boost fitness. So can dancing, swimming, brisk walking and biking.
• Find activities your child likes. For instance, if your child likes to make art, go on a nature hike to collect leaves and rocks. Your child can use them to make a collage. If your child likes to climb, go to the neighborhood jungle gym or climbing wall. If your child likes to read, then walk or bike to the neighborhood library for a book.
• Encourage more movement and less sitting. You could suggest the following ideas to your child: Stand or walk in place while watching TV. Take the stairs instead of elevators. If school is within a safe walking distance from home, walk or bike instead of riding the bus or in a car. You also could ask if your child would like a wearable device that keeps track steps taken. The device may help your child set fitness goals.

Medications

Your child's healthcare professional may prescribe medicine to help with weight loss if diet and exercise alone aren't enough. Medicines that can help manage childhood obesity need to be used along with healthy eating and more movement. The type of medicine that might be right for your child depends on factors such as your child's age and cause of obesity. Medicines that may boost weight loss include:

• Semaglutide (Wegovy).
• Liraglutide (Saxenda).
• Phentermine and topiramate (Qsymia).
• Phentermine.
• Lisdexamfetamine.

Ask about the side effects of any medicine that your child's healthcare professional recommends.

Surgery or other procedures

Weight-loss surgery might be an option for some teens with severe obesity. Your teen's healthcare professional may recommend the surgery if diet changes and physical activity alone don't help enough. As with any type of surgery, there are risks and possible long-term complications. Talk with your teen's healthcare professional about the pros and cons of weight-loss surgery.

The healthcare professional may recommend surgery if your teen's weight poses a greater health threat than do the risks of surgery. Before weight-loss surgery, it's important to meet with a team of specialists, including:

• An obesity medicine expert.
• A psychologist.
• A registered dietitian.

Surgery may be a treatment option that you support, but your teen needs to decide whether or not to get it. If your teen chooses to get weight-loss surgery, encourage the rest of your family to support the choice.

Weight-loss surgery isn't a miracle cure. It doesn't guarantee that a teen will lose extra weight or be able to keep it off long term. And surgery doesn't replace the need for a healthy diet and regular physical activity.

Parents play a key role in helping children feel loved and in control of their weight. So try to build your child's self-esteem as often as you can. Don't be afraid to bring up the topic of health and fitness. Also, be direct and open when you talk with your child. Try not to judge or be critical.

You can use the following tips:

• Stay upbeat and practical when talking about weight. Harmful comments about your own weight, someone else's weight or your child's weight can hurt your child. That's true even if you mean well with your comments. Harmful talk about weight can lead to poor body image. Instead, focus your talks on healthy eating and positive body image. Make sure that other family members talk with your child in an upbeat way too.
• Tell your child not to skip meals or follow fad diets. Instead, encourage and support healthy eating. Help your child work up to at least an hour of physical activity a day too.
• Find reasons to praise your child's efforts. Celebrate small changes in eating and physical activity. But don't reward your child with food. Choose other ways to mark your child's successes, such as going to the bowling alley or a local park.
• Talk about your child's feelings. Listen to any concerns that your child shares with you about weight or body image. Show that you love your child and that you care about your child's feelings.
• Help your child focus on healthy goals. For example, point out when your child can bike or jog longer than your child used to. Or say how proud you are when your child can run the required number of laps in gym class.
• Be patient. Realize that an intense focus on your child's eating habits and weight can backfire. It can lead a child to overeat even more. It also can raise the risk of an eating disorder. So don't ever shame, blame or shout at your child about weight.
• Put a stop to bullying. If another child bullies your child about weight, take charge of the situation as soon as possible. Talk with the other child's parents. If the bullying happens at school, talk with your child's teachers or principal.

Your child's healthcare professional likely will be first to tell you whether your child's BMI is in the obese range. If your child has complications of obesity, you might be referred to other specialists to help manage these health concerns.

Here's some information to help you get ready for your appointment.

What you can do

When you make the appointment, ask if there's anything your child needs to do ahead of time. For instance, your child may have to stop eating or drinking for a certain number of hours before a test. Before the healthcare checkup, make a list of:

• Your child's symptoms, if any, and when they began.
• Key personal information, including a family medical history and history of obesity.
• All medicines, vitamins or other supplements your child takes, including doses.
• What your child typically eats in a week, and how active your child is.

• Questions to ask your child's healthcare professional.

  Bring a family member or friend along if you can. This person can help you remember all the information you're given.

For childhood obesity, some basic questions to ask your child's healthcare professional include:

• What other health conditions might my child develop?
• What are the treatment choices?
• Are there medicines that might help manage my child's weight and other health conditions?
• How long will treatment take?
• What can I do to help my child lose weight?
• Are there brochures or other printed material I can have? What websites do you recommend?

Feel free to ask other questions.

What to expect from your doctor

Your child's healthcare professional is likely to ask you questions about your child's eating and activity, including:

• What does your child eat in a typical day?
• How much activity does your child get in a typical day?
• What factors do you believe affect your child's weight?
• What diets or treatments, if any, have you tried to help your child lose weight?
• Are you ready to make changes in your family's lifestyle to help your child lose weight?
• What might prevent your child from losing weight?
• How often does the family eat together? Does the child help prepare the food?
• Does your child, or family, eat while watching TV, texting or using a computer?

What you can do in the meantime

If you have days or weeks before your child's appointment, keep a record of what your child eats and how active your child is.