When one considers the emerging trends within the segment of the population of newborns to young adults, the prevalence of obesity and overweight status has steadily increased within the last few decades. In some U.S. demographic subgroups, like non-Hispanic whites and those of higher socioeconomic status, the rates have plateaued recently.
A LOOK AT TRENDS IN OBESITY
Pertaining to the current trends facing the pediatric population, obesity has been an issue for the past several decades. Obesity is measured by estimating the Body Mass Index (BMI), which is calculated by dividing the weight of the patient in kilograms by the height in meters squared. The BMI does not measure body fat mass directly, but is a rough estimate. The child’s weight status is determined using the age/sex specific percentiles for BMI. Charts published by the Centers for Disease Control (CDC) are available for ages between two to 19-years-old. Overweight is defined as BMI at or above the 85th percentile and lower than the 95th percentile. Obesity is defined as BMI at or above the 95th percentile for the children of same age and sex. In the U.S., the prevalence of overweight and obesity in children and adolescents is 32 percent. In a prospective pre-birth cohort, the prevalence of overweight and obesity among black and Hispanic children at 7-years-old was almost double that of white children. About 19-20 percent of black children and eight to 10 percent of Hispanic children from the ages of two to five years are obese. These children are likely to remain obese during their childhood and adolescence. The obesity rates have decreased in 19 of the 43 states studied, while 3 states have increased and 21 states remain the same.
The work published by the Department of Population Medicine at the Harvard Medical School and the Harvard Pilgrim Healthcare Institute states there is growing evidence that the risk factors in the pre-natal period and early childhood are crucial to the development, thus the prevention of obesity and its consequences. Adverse experiences like intra-uterine exposure to maternal smoking, excessive weight gain during the intra-uterine period, and elevated glucose levels are some associated factors. In the early childhood period rapid weight gain in the infant, poor feeding practices like early introduction of cereals, excessive TV watching, and short sleep duration may increase the short and long term risk for obesity. The racial, ethnic, and socio-economic disparities across most of the known risk factors for childhood obesity from the prenatal period through to childhood has also been demonstrated by research publications.
During the past several decades, research including the seminal Cochrane review emphasizes the impression that a strategy engaging a family based intervention to achieve weight loss rather than child focused program is more effective, and has less chance of having rebound weight gain. Evidence also suggests that the best times to intervene with optimizing efficiency and effectiveness to prevent obesity is during infancy and early childhood, when behaviors are easily modifiable and physiologic characteristics are plastic. In addition, the parents have the access to primary care providers, child care, and agents of early childhood education. Since habits and tastes develop early in children it is important to implement a healthy life style initiative, establishing a behavioral pattern to choose a blend of healthy foods, recreation activities, and good sleeping habits. For those organizations providing outpatient services, opportunity exists to identify individuals who are at risk and intervene appropriately, utilizing the concept of maternal-child heath integration of service and minimize the long term consequences of obesity.
CREDITS
story by RANJIT J. SILVA, MD, FAAP
ABOUT THE AUTHOR: Dr. Ranjit Silva is a Polk County Medical Association member and a board-certified pediatrician with the Children’s Division of Gessler Clinic in Winter Haven.