On Your Health

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How Dangerous is Childhood Obesity?

Baby fat is one thing. Obesity is another.

Childhood obesity is now a disturbing epidemic in the U.S. that affects more than 18 percent of children, making it the most common chronic disease of childhood. The number of children who suffer from childhood obesity has more than tripled since 1980, and it is now becoming a top concern for health officials in the U.S.

In 2016-17, the National Survey of Children’s Health reported that nationwide, 15.8% of children ages 10 to 17 had obesity. The 2017 Youth Risk Behavior Surveillance System found that 14.8% of high school students (grades 9 to 12) nationwide had obesity and 15.6% were overweight. The obesity rate has increased significantly, up from 10.6% in 1999. Because the rates of childhood obesity are rising, more and more children are being diagnosed with dangerous health conditions that are associated with obesity and morbid obesity.

What this means for the future health of children is dire. Diseases that were traditionally reserved for adults and the aging population are now showing up in children - diseases like type 2 diabetes and fatty liver disease.

The good news is that childhood obesity is reversible. Using different methods of diet therapy, physical exercise and even new medical procedures, you can mitigate the damage from childhood obesity to ensure that your child has a healthy future.

How do I know if my child is obese?

If a child is “affected by obesity,” that generally means that their body mass index-for-age percentile is higher than 95 percent; an “overweight” child has a BMI-for-age percentile of more than 85 percent or less than 95 percent.

In layman’s speak, BMI is used to screen for potential weight and health-related issues. Your pediatrician can use various tests like skinfold thickness measurements, diet evaluations, physical activity, family history and other health screenings to see if excess body fat is the problem. The American Academy of Pediatrics recommends the use of BMI to screen for overweight and obesity in children beginning at 2 years old.

A child is defined as “affected by obesity” if their body mass index-for-age (or BMI-for-age) percentile is greater than 95 percent. A child is defined as “overweight” if their BMI-for-age percentile is greater than 85 percent and less than 95 percent.

To determine if your child falls into that category, use this handy BMI-for-age Chart by the Centers for Disease Control. This calculator provides BMI and the corresponding BMI-for-age percentile based on the CDC growth charts for children and teens (ages 2 through 19 years).

Baby fat or something more dangerous?

Dr. Maryam Shambayati, a pediatric gastroenterologist with INTEGRIS Health, says the increase in childhood obesity rates in Oklahoma is concerning.

“We are seeing more patients at a younger age who have more systemic diseases associated with obesity, like fatty liver disease,” Dr. Shambayati says. “Fatty liver disease is the number one cause of liver transplants in America, replacing hepatitis C. We are seeing a rise in fatty liver disease in kids, primarily caused by diet, increased sugar and fat in the diet and sedentary lifestyles.”

Such stress on the liver causes something called NASH, or Non-Alcoholic Steatohepatitis. It is the most severe form of non-alcoholic fatty liver disease and is characterized by the presence of an abnormal accumulation of fat in the liver, according to The NASH Education Program. As NASH evolves, over time it can result in excessive scarring in the liver, an irreversible condition that can lead to liver cirrhosis or liver cancer.

“If we see just fat in the liver, then we can reverse that through good diet, exercise and weight loss,” says Dr. Shambayati. “That’s the only therapy for fatty liver. As of now, there are no FDA-approved drugs to treat fatty liver disease. Scarring, however, is something we cannot reverse.”

Type 2 diabetes is another threat that children with childhood obesity face and doctors are seeing the disease appear in more and more children and at a younger age. “We used to call it ‘adult-onset diabetes.’ But now we see it in children too,” Dr. Shambayati says.

Type 2 diabetes is a chronic condition that affects how the body metabolizes sugar, also known as glucose. Between 2011 and 2012, type 2 diabetes accounted for 23 percent of new diabetes diagnoses in children, according to the CDC. Common symptoms of type 2 diabetes in children include excessive tiredness, the darkening of the folds of the skin in the armpits and neck, thirstiness, frequent urination and slow-healing sores.

Increased reflux is another condition obese children face. The excess fat in the abdominal area can put pressure on the stomach, causing acid to enter the esophagus. Called Barrett’s Esophagus, the condition changes the esophagus to the tissue that resembles the lining of the intestine and carries an increased risk of developing esophageal adenocarcinoma, which is a serious, potentially fatal cancer of the esophagus.

“Anything we can do to prevent the diseases that are caused by obesity and remove those future health risks is good,” says Dr. Shambayati.

Why is childhood obesity on the rise?

Diet remains the top reason for childhood obesity, but eating a healthy diet isn’t as simple as it sounds.

“Part of the reason we see such high rates of childhood obesity in Oklahoma is that so many people live in food deserts,” says Dr. Shambayati. “It’s becoming more and more of a problem in our state. Because so many people do not have access to fresh, healthy food, they rely on packaged food, which is higher in calories and has poor nutritional content.”

According to a report by the Oklahoma Regional Food Bank, out of Oklahoma’s 77 counties, 54 contain food deserts and 76 contain areas of low access to large grocery stores.

A sedentary lifestyle is another big factor in childhood obesity. “Kids are sitting and playing on screens instead of going outside to play,” Dr. Shambayati says. “Families keep their children indoors because they think it’s safer, but it’s doesn’t help with physical activity or their future health.”

Once a child is diagnosed as obese, doctors often also check for vitamin deficiencies. Because packaged food is poor in nutrition, many children lack necessary vitamins like Vitamin D or magnesium. Doctors may also check liver enzymes and cholesterol to see if the child shows signs of fatty liver disease.

How to reverse the trend

“Our first line of defense is lifestyle modification,” says Dr. Shambayati. “One of the easiest first steps are to remove sugar-laden drinks like sodas. We also discuss good food choices. I think this can be hard for parents because oftentimes children who are obese have family members who are obese, and they can get offended.”

Dr. Shambayati says that showing families that a diagnosis of obesity is not a judgment on them or their lifestyle is important to changing habits. She says families should know that doctors are not judging them on their looks or aesthetics but are focusing on how to create the healthiest future for their children. “It is important for people to be aware that obesity can be stigmatizing, but we are trying to prevent future disease,” she says.

New bariatric techniques are in the works that could be used for children who have weight problems, but lifestyle and diet changes are still the most effective treatments.

“It’s easier now to address that. With online services, it’s easier than ever to have fresh vegetables and fruits delivered to your door without having to drive to the store,” Dr. Shambayati says. “Doing things as a family also helps. One easy way to incorporate exercise is to take a walk as a family after dinner, which gets the kids away from the screens for a while and sneaks in exercise too. You don’t have to be super active or running - any exercise is good.”