Childhood Obesity Awareness Month

More than one in six children in the U.S. have obesity, and the rate of children with obesity is now three times higher than it was in the 1970s. To prevent obesity among children, we must first understand the complex factors that can lead to childhood obesity and which populations are most impacted.

Children with Medicaid are more than twice as likely to have obesity as children with private insurance.¹ During the COVID-19 pandemic, school closures and disruptions in daily routines and access to food disproportionately impacted obesity among boys, children of color, and children in lower-income households.² While these statistics are staggering, it’s important to note at the outset that the typical way overweight and obesity are measured, body mass index, is a less reliable measurement at the individual level, particularly for those of color — more on that in a bit.

Children who are obese are more likely to experience several long-term health issues, such as obesity persisting into adulthood, diabetes, heart disease and many others. To complicate things more, weight stigma, which is based on misconceptions and misunderstandings that obesity is solely due to unhealthy choices, can occur with friends, family, and health care providers and further perpetuate challenges with unhealthy weight, mental health, and parent or caregiver distress.³

Several important factors to understand drive children with obesity: 1) social and environmental factors, 2) genetic factors, and 3) demographic factors.

• Social and environmental factors: Two key environmental factors are 1) consistent access to and ability to afford healthy food options and 2) safe spaces to play and be active. Communities with limited access to healthy foods (sometimes called food deserts or food swamps) make healthy eating habits much harder, particularly when individuals do not own a car or public transportation options are limited. And while the ties between food insecurity4 and childhood obesity are mixed; food insecurity is associated with childhood obesity in early childhood and for children who experience recurring food insecurity.5 Additionally, having a safe space to play and be active is critical to ensuring children get the physical activity they need. If there are barriers to being active, such as unsafe public spaces or playgrounds, busy boulevards or highways obstructing access to parks and playgrounds, or highly polluted neighborhoods, these environments can impact how physically active children can be.
• Genetic factors: Just as important as environmental factors are the genetic factors that impact a child’s weight. Genes can impact obesity in various ways, including appetite, satiety (feeling full), metabolism, craving food, body-fat distribution, and the tendency to eat to cope with stress. Hundreds of different genes have been found to impact overweight and obesity, and research has found that genes can account for 25% or more of a person’s predisposition to being overweight.⁶
• Demographic factors: Obesity can vary across children and youth age, race and ethnic identity, and socioeconomic status, which can create a complex relationship between these characteristics. Children of color are at higher risk for obesity, which may stem from several factors, including studies showing the impacts of racial discrimination on obesity.⁷ Additionally, how we measure obesity through body mass index has harmful impacts, primarily racial bias, and the American Medical Association has announced that body mass index (BMI) alone is an imperfect measure.⁸

The solution to this complex problem can too often be narrowed down to causes that are within the child or person’s control, such as dietary choices, amount of exercise, or willingness to change, without factoring in the complex combination of environmental, genetic, and social factors.

So, what solutions are there?

At the policy and system level, improvements to access and quality of healthy foods can make sweeping improvements across children’s populations. For example, a study on the impacts of the Healthy, Hunger-Free Kids Act of 2010, which improved access and nutritional standards for food in schools, showed that it substantially improved childhood obesity among children in low-income households.⁹ There are many opportunities to promote outdoor play among children, including sidewalks, bike paths, and playgrounds, all of which invite activity across the income spectrum, but will only be successful if there is also a deliberate investment in promoting safety in communities.¹⁰

In the health care setting, providers can focus on addressing obesity in children by going beyond the mantra of eating less and moving more. What’s more effective is getting to know the child, building a trusting relationship, and identifying goals that resonate with the family. Goals should focus on the many steps that can lead to changes in obesity, such as trying healthier foods, rather than a change in a number (BMI or weight) alone. Obesity medicine is also moving toward a better synergy between medicine and food: health care providers in Colorado and across the country are promoting a Food as Medicine model, paired with lifestyle medicine, for a more comprehensive obesity treatment plan.¹¹ Additionally, understanding and helping address social factors that impede medical goals will go a long way. If a family has interpersonal violence in the home, challenges with stable housing, or food insecurity, thinking about changes in eating habits or physical activity are not going to be at the top of that family’s list of goals or priorities. At Colorado Access, we are committed to partnering with organizations to support access to health-related social needs and working closely with partners to align our common goals.

Lastly, and importantly, weight stigma exists, and providers can play a leading role in recognizing and reducing it so that any patient and family’s feelings of blame are replaced by the much more impactful patient-to-provider relationship-building and guidance founded in science.¹²

 Sources

1. org/medicaid/issue-brief/obesity-rates-among-children-a-closer-look-at-implications-for-children-covered-by-medicaid
2. com/journals/jamapediatrics/fullarticle/2815511
3. nlm.nih.gov/pmc/articles/PMC8147499/
4. Feeding American describes food insecurity as “when people don’t have enough to eat and don’t know where their next meal will come from.” There are validated questions like VitalSigns that
5. aap.org/pediatrics/article/150/1/e2021055571/188267/Food-Insecurity-and-Childhood-Obesity-A-Systematic?autologincheck=redirected
6. harvard.edu/staying-healthy/why-people-become-overweight
7. edu/about/news-publications/news/2023/july/racial-discrimination-childhood-obesity.html
8. ama-assn.org/delivering-care/public-health/ama-use-bmi-alone-imperfect-clinical-measure
9. org/doi/10.1377/hlthaff.2020.00133
10. org/sites/activelivingresearch.org/files/ALR_Brief_SafePlaygrounds_0.pdf
11. org/content/forefront/food-vital-ingredient-transforming-obesity-care
12. harvard.edu/event/childhood-obesity-science-and-solutions
13. Special thanks to Eve Kutchman, exercise physiologist and Food as Medicine leader at Children’s Hospital Colorado, for her insights into childhood obesity treatment that informed this blog post.