While obesity rates appear to be increasing across all age groups in the U.S., nowhere is this more evident than in the pediatric population. According to the American Obesity Association, 15.3% of all children ages 6 to 11 were considered clinically obese in 2001, a 219% increase from 1980.
In adolescents (ages 12 to 19), the obesity rate has grown at an even more alarming rate, increasing to 15.5% in 2001, up dramatically from 5% only 20 years ago.
The reasons for the dramatic jump in childhood obesity in the United States over the past quarter-century are varied and complex. Several issues have led to this situation, ranging from societal factors such as having less time to prepare food at home (which generates a need for quick and convenient - but not necessarily healthy - meals) and pervasive marketing strategies (which target children and adolescents more than any other age group) to a lack of regular physical exercise (in 1999, the Centers for Disease Control estimated that only 29% of all high school students attended a physical education class daily).
Perhaps the biggest contributor to the increase in childhood obesity is the consumption of fast food. According to the National Restaurant Association, the number of fast-food restaurants in the U.S. more than doubled between 1972 and 1995. A 2004 study published in the journal Pediatrics estimated that on a typical day, nearly one-third of all American children ages 4 to 19 eat fast food, and that fast-food consumption among children has increased more than 500% since 1970.
Can childhood obesity be stopped, and if so, how? These are questions health care providers, policy-makers and politicians must grapple with over the next few decades. A series of recent studies suggests childhood obesity is not a condition that can be cured overnight, and that it will likely continue to get worse before it gets better. Fortunately, these studies also provide a wide range of solutions that, if implemented, can slow down or perhaps even reverse this frightening trend. Many of these solutions begin with making simple changes at home.
Eating as a Family = Eating Better
Earlier this year, researchers published an analysis of the health records of more than 14,000 children who participated in the "Growing Up Today" study, an offshoot of a national study of nurses. In this analysis, published in the May issue of Obesity Research, the authors explored the relationship between family dinners and the incidence of overweight or obesity in adolescents. Data were collected from 1996 to 1999; each child was asked to fill out a questionnaire that assessed, among other things, if they ate dinner with other family members "never or some days," "most days" or "every day."
At baseline, 84% of the children reported they ate dinner with their families every day or on most days. These children were 15% less likely to be overweight compared to those who never or only sometimes ate dinner with another family member. In addition, the more frequently children ate dinner with their families, the less likely they were to be overweight.
The researchers noted that while increased family dinners may not necessarily prevent an adolescent from becoming overweight, at the very least, such meals will improve the quality of food a teenager eats and may provide additional benefits.
Benefits of Family Meals: More Than Just Eating Healthy Food
Previous research has shown that the rate at which a family eats evening meals together is a strong indicator of how likely a teenage child is to smoke, drink, or use illegal drugs, and whether that child is likely to perform better academically. The results of a national telephone survey, published in September, revealed the positive impact regular family dinners can have on a teenager's life, nutritionally and otherwise.
The survey was conducted by the National Center on Addiction and Substance Abuse. Researchers interviewed 1,000 teens ages 12-17, along with 829 parents of teenagers. The survey consisted of a series of questions related to the frequency at which teenagers and their parents ate dinner together; the quality of family dinners (including factors such as the length of the dinner, whether the family talked much during dinner, and whether the television was on during dinner); incidence of substance abuse; and academic performance
Fifty-eight percent of teens reported having dinner with their family at least five times a week. Compared with teens who ate three family dinners per week, those who ate five or more were: 2.42 times less likely to smoke cigarettes; 1.73 times less likely to drink alcohol; 2.92 times less likely to try marijuana; 2.71 times more likely to report low levels of stress and tension at home; 41% more likely to confide in their parents with a serious problem; and 38% more likely get mostly A's and B's in school.
"Given the importance of frequent family dinners and the powerful impact parental engagement has in preventing teen substance abuse, families should work to identify and overcome the barriers to frequent family dining," concluded the authors.
Weight Gain in Teens: Exploring the Fried Food Connection
In the October issue of Pediatrics, another team of investigators analyzed a different set of data from the Growing Up Today study, paying particular attention to the consumption of fried foods away from home. The study surveyed the eating habits, physical activity levels and other variables of more than 14,000 adolescents for a three-year period.
At the beginning of the study, 3.5% of the girls reported eating between four and seven servings of fried food away from home per week, as did 6% of the boys. By the end of the study period, the percentage of children eating out more than four times per week had more than doubled, to 7.5% for girls and 12.7% for boys. Children who consumed more fast food also consumed more processed meat, red meat, whole dairy products, and sugar-sweetened beverages, and ate fewer fruits, vegetables, and low-fat dairy products.
Small but potentially significant alterations in body mass index also were noted. After adjusting for other factors, the researchers found that the average BMI was 19.1 for children who ate fast food away from home never or less than once a week; 19.2 for those who ate fast food one to three times per week; and 19.3 for children who ate fast food away from home four to seven times per week. "Although the effect may seem small," the authors wrote, "it is of practical significance because it is the effect of one year of intake of fried foods away from home. Our study suggests that doing this year after year accumulates to larger weight gains that are clinically significant."
All in the Family: How Parents Can Make a Difference
As with most traits, a person's eating habits are formed early in life. One of the biggest influences on a child's eating habits is the type of food provided by his or her parents. A 2003 survey found that parents act as role models for their children; if parents make health-conscious decisions in terms of their own eating habits, their children are more likely to do so as well.
Of course, while parents are the first line of defense for maintaining their children's health against overweight and obesity, health care providers play an important role. Doctors can create wellness plans to improve a child's diet, and help set goals for weight loss and activity levels in children at risk of becoming obese. They also can adjust these plans as children get older, to ensure their nutritional needs are being met.
By working together, parents and health care practitioners can help turn back the rising tide of childhood obesity. The changes doctors and parents can make toward the health of America's children may not be immediately apparent, but in the coming decades, they will make a tremendous impact on the health of the American population. On the other hand, if not addressed soon, the problems caused by obesity - like the average American's waistline - will simply keep expanding.