ERIC Identifier: ED328556
Publication Date: 1990-12-00
Author: Summerfield, Liane M.
Source: ERIC Clearinghouse on Teacher Education Washington DC.
Childhood Obesity. ERIC Digest.
Between 5-25 percent of children and teenagers in the United States
are obese (Dietz, 1983). As with adults, the prevalence of obesity in the
young varies by ethnic group. It is estimated that 5-7 percent of White
and Black children are obese, while 12 percent of Hispanic boys and 19
percent of Hispanic girls are obese (Office of Maternal and Child Health,
Some data indicate that obesity among children is on the increase. The
second National Children and Youth Fitness Study found 6-9 year olds to
have thicker skinfolds than their counterparts in the 1960s (Ross &
Pate, 1987). During the same period, others documented a 54 percent increase
in the prevalence of obesity among 6-11 year olds (Gortmaker, Dietz, Sobol,
& Wehler, 1987).
DEFINING OBESITY IN CHILDREN AND ADOLESCENTS
Obesity is defined as an excessive accumulation of body fat. Obesity
is present when total body weight is more than 25 percent fat in boys and
more than 32 percent fat in girls (Lohman, 1987). Although childhood obesity
is often defined as a weight-for-height in excess of 120 percent of the
ideal, skinfold measures are more accurate determinants of fatness (Dietz,
1983; Lohman, 1987).
A trained technician may obtain skinfold measures relatively easily
in either a school or clinical setting. The triceps alone, triceps and
subscapular, triceps and calf, and calf alone have been used with children
and adolescents. When the triceps and calf are used, a sum of skinfolds
of 10-25mm is considered optimal for boys, and 16-30mm is optimal for girls
THE PROBLEM OF OBESITY
Not all obese infants become obese children, and not all obese children
become obese adults. However, the prevalence of obesity increases with
age among both males and females (Lohman, 1987), and there is a greater
likelihood that obesity beginning even in early childhood will persist
through the life span (Epstein, Wing, Koeske, & Valoski, 1987).
Obesity presents numerous problems for the child. In addition to increasing
the risk of obesity in adulthood, childhood obesity is the leading cause
of pediatric hypertension, is associated with Type II diabetes mellitus,
increases the risk of coronary heart disease, increases stress on the weight-bearing
joints, lowers self-esteem, and affects relationships with peers. Some
authorities feel that social and psychological problems are the most significant
consequences of obesity in children.
CAUSES OF CHILDHOOD OBESITY
As with adult-onset obesity, childhood obesity has multiple causes centering
around an imbalance between energy in (calories obtained from food) and
energy out (calories expended in the basal metabolic rate and physical
activity). Childhood obesity most likely results from an interaction of
nutritional, psychological, familial, and physiological factors.
* THE FAMILY
The risk of becoming obese is greatest among children who have two obese
parents (Dietz, 1983). This may be due to powerful genetic factors or to
parental modeling of both eating and exercise behaviors, indirectly affecting
the child's energy balance. One half of parents of elementary school children
never exercise vigorously (Ross & Pate, 1987).
* LOW-ENERGY EXPENDITURE
The average American child spends several hours each day watching television;
time which in previous years might have been devoted to physical pursuits.
Obesity is greater among children and adolescents who frequently watch
television (Dietz & Gortmaker, 1985), not only because little energy
is expended while viewing but also because of concurrent consumption of
high-calorie snacks. Only about one-third of elementary children have daily
physical education, and fewer than one-fifth have extracurricular physical
activity programs at their schools (Ross & Pate, 1987).
Since not all children who eat non-nutritious foods, watch several hours
of television daily, and are relatively inactive develop obesity, the search
continues for alternative causes. Heredity has recently been shown to influence
fatness, regional fat distribution, and response to overfeeding (Bouchard
et al., 1990). In addition, infants born to overweight mothers have been
found to be less active and to gain more weight by age three months when
compared with infants of normal weight mothers, suggesting a possible inborn
drive to conserve energy (Roberts, Savage, Coward, Chew, & Lucas, 1988).
TREATMENT OF CHILDHOOD OBESITY
Obesity treatment programs for children and adolescents rarely have
weight loss as a goal. Rather, the aim is to slow or halt weight gain so
the child will grow into his or her body weight over a period of months
to years. Dietz (1983) estimates that for every 20 percent excess of ideal
body weight, the child will need one and one-half years of weight maintenance
to attain ideal body weight.
Early and appropriate intervention is particularly valuable. There is
considerable evidence that childhood eating and exercise habits are more
easily modified than adult habits (Wolf, Cohen, Rosenfeld, 1985). Three
forms of intervention include:
* PHYSICAL ACTIVITY
Adopting a formal exercise program, or simply becoming more active,
is valuable to burn fat, increase energy expenditure, and maintain lost
weight. Most studies of children have not shown exercise to be a successful
strategy for weight loss unless coupled with another intervention, such
as nutrition education or behavior modification (Wolf et al., 1985). However,
exercise has additional health benefits. Even when children's body weight
and fatness did not change following 50 minutes of aerobic exercise three
times per week, blood lipid profiles and blood pressure did improve (Becque,
Katch, Rocchini, Marks, & Moorehead, 1988).
* DIET MANAGEMENT
Fasting or extreme caloric restriction is not advisable for children.
Not only is this approach psychologically stressful, but it may adversely
affect growth and the child's perception of "normal" eating. Balanced diets
with moderate caloric restriction, especially reduced dietary fat, have
been used successfully in treating obesity (Dietz, 1983). Nutrition education
may be necessary. Diet management coupled with exercise is an effective
treatment for childhood obesity (Wolf et al., 1985).
* BEHAVIOR MODIFICATION
Many behavioral strategies used with adults have been successfully applied
to children and adolescents: self-monitoring and recording food intake
and physical activity, slowing the rate of eating, limiting the time and
place of eating, and using rewards and incentives for desirable behaviors.
Particularly effective are behaviorally based treatments that include parents
(Epstein et al., 1987). Graves, Meyers, and Clark (1988) used problem-solving
exercises in a parent-child behavioral program and found children in the
problem-solving group, but not those in the behavioral treatment-only group,
significantly reduced percent overweight and maintained reduced weight
for six months. Problem-solving training involved identifying possible
weight-control problems and, as a group, discussing solutions.
PREVENTION OF CHILDHOOD OBESITY
Obesity is easier to prevent than to treat, and prevention focuses in
large measure on parent education. In infancy, parent education should
center on promotion of breastfeeding, recognition of signals of satiety,
and delayed introduction of solid foods. In early childhood, education
should include proper nutrition, selection of low-fat snacks, good exercise/activity
habits, and monitoring of television viewing. In cases where preventive
measures cannot totally overcome the influence of hereditary factors, parent
education should focus on building self-esteem and address psychological
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Becque, M. D., Katch, V. L., Rocchini, A. P., Marks, C. R., & Moorehead,
C. (1988). Coronary risk incidence of obese adolescents: Reduction by exercise
plus diet intervention. Pediatrics, 81(5), 605-612.
Bouchard, C., Tremblay, A., Despres, J-P, Nadeau, A., Lupien, P. J.,
Theriault, G., Dussault, J., Moorjani, S., Pinault, S., and Fournier, G.
(1990). The response to long-term overfeeding in identical twins. The New
England Journal of Medicine, 322(21), 1477-1482.
Dietz, W. H., & Gortmaker, S. L. (1985). Do we fatten our children
at the television set? Obesity and television viewing in children and adolescents.
Pediatrics, 75(5), 807-812.
Dietz, W. H. (1983). Childhood obesity: Susceptibility, cause, and management.
Journal of Pediatrics, 103(5), 676-686.
Epstein, L. H., Wing, R. R., Koeske, R., & Valoski, A. (1987). Long-term
effects of family-based treatment of childhood obesity. Journal of Consulting
and Clinical Psychology, 55(1), 91-95. EJ 352 076.
Gortmaker, S. L., Dietz, W. H., Sobol, A. M., & Wehler, C. A. (1987).
Increasing pediatric obesity in the United States. American Journal of
Diseases of Children, 141, 535-540.
Graves, T., Meyers, A. W., & Clark, L. (1988). An evaluation of
parental problem-solving training in the behavioral treatment of childhood
obesity. Journal of Consulting and Clinical Psychology, 56(2), 246-250.
EJ 373 116.
Lohman, T. G. (1987). The use of skinfolds to estimate body fatness
on children and youth. Journal of Physical Education, Recreation &
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Office of Maternal and Child Health. (1989). Child health USA '89. Washington,
DC: U.S. Department of Health and Human Services, National Maternal and
Child Health Clearinghouse. ED 314 421
Roberts, S. B., Savage, J., Coward, W. A., Chew, B., & Lucas, A.
(1988). Energy expenditure and intake in infants born to lean and overweight
mothers. The New England Journal of Medicine, 318, 461-466.
Ross, J. G., & Pate, R. R. (1987). The National Children and Youth
Fitness Study II: A summary of findings. Journal of Physical Education,
Recreation and Dance, 58(9), 51-56. EJ 364 411.
Wolf, M. C., Cohen, K. R., & Rosenfeld, J. G. (1985). School-based
interventions for obesity: Current approaches and future prospects. Psychology
in the Schools, 22, 187-200. EJ 318 072.