Cause and Effect in Childhood Obesity

Childhood obesity has reached epidemic proportions in the United States. As a result, children are at increased risk for myriad preventable acute and chronic medical problems—many of which are associated with increased morbidity and mortality. In addition, childhood obesity has serious psychosocial consequences, such as low self-esteem, lower quality of life, and depression. The multifaceted causes and solutions to this pervasive health issue are discussed in the present review, as are pertinent health policy issues. Osteopathic physicians and other healthcare providers can play an important role in patient and family education, direct care, and advocacy.

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Many social and environmental factors have negatively influenced the physical activity and eating behaviors of US children and adolescents. Financial and time pressures force many families to minimize food costs and meal preparation time, resulting in increased consumption of prepackaged convenience foods that are high in calories and fat.1 In fact, fast-food restaurants are often concentrated in neighborhoods containing schools and therefore young customers.2 Children are also the target of junk food advertisements.3 As a result of these and many other factors, childhood obesity has reached epidemic proportions.

Since the 1970s, the rate of obesity more than doubled among US children aged 2 to 5 years,1,4 and recent data from studies conducted by the Centers for Disease Control and Prevention (CDC)5-7 indicate that this increased prevalence of obesity applies to all ethnicities in this age group. Meanwhile, the number of obese children has tripled among youth aged 6 to 11 years and doubled among those aged 12 to 16 years.1,4 According to the Institute of Medicine, more than 9 million children and young adults older than 6 years are overweight or obese.1

Childhood obesity increases the risk of multiple acute and chronic medical problems as well as psychological issues, all of which can persist into adulthood and adversely affect quality of life. Obese children can suffer from orthopedic complications, including abnormal bone growth, degenerative disease, and pain.8,9 They are also more likely to have low self-esteem, leading to depression and suicidal ideation, and to engage in substance abuse.10 One study11 suggested that obese children may have a similar quality of life as children with cancer. Health issues related to obesity are also linked with decreased life expectancy.1

The estimated 9 million overweight children—including 4.5 million obese children—are at higher risk for type 2 diabetes mellitus, heart disease, cancer, asthma and other pulmonary diseases, high cholesterol, elevated blood pressure, stroke, and other chronic illnesses.12 Compared with children at a normal weight, overweight children are 70% to 80% more likely to be overweight in adulthood.13

Based on current trends, diabetes will occur in an estimated one in three children (30% of boys and 40% of girls) born in 2000.1,14 Type 2 diabetes mellitus accounted for 8% to 45% of new pediatric cases of diabetes according to case reports published in the 1990s, compared with less than 4% before 1990.1 In fact, overweight increases lifetime risk of type 2 diabetes mellitus, potentially reversing trends of increased life expectancy.1

If these trends continue, adolescents with type 2 diabetes mellitus may have heart disease at as early as 30 or 40 years of age.15 In the past 3 decades, the annual cost of managing obesity-related diseases among children and adolescents increased more than threefold, from $35 million in 1979-1981 to $127 million in 1997-1999.16 However, the CDC estimates that a 10% weight loss could decrease an overweight person’s lifetime medical costs by $2200 to $5300.17

The present review explores the factors that contribute to childhood obesity and presents options for prevention through education, regulation, and the increased involvement of osteopathic physicians and other healthcare providers.