Obesity is a health problem that has increasingly affected children of all ages. Children are typically considered to be overweight or obese if they are heavier than 95 percent of peers of the same age and height.

Children who are overweight or obese may experience many health problems and are at higher risk of being diagnosed with potentially life-threatening or debilitating conditions later in life, including type 2 diabetes, high blood pressure, high cholesterol, heart disease, osteoarthritis and several types of cancer.

The percentage of children ages 6 to 11 years who are overweight has more than doubled in recent decades (from 7 to 19 percent) and the rate of overweight adolescents ages 12 to 19 years has more than tripled (from 5 to 17 percent), according to the U.S. Centers for Disease Control and Prevention (CDC). The good news is that these rates have not risen in the past decade, federal data revealed in 2008.

The substantial rise in obesity rates appears to be the result of several factors, including a more sedentary lifestyle coupled with increased consumption of fatty and sugary foods. Genetics also plays a role, as genes help determine a child's body type and how the body stores and burns fat. Inadequate sleep may also be a factor.

Children who are overweight or obese can experience many different symptoms. These may include problems with bones or joints, or shortness of breath during exercise or sports. They also may experience related health problems, such as high blood pressure and high cholesterol levels.

A physician can determine if a child is overweight or obese. A common standard for measuring obesity is the body mass index (BMI), which uses a person's height and weight to estimate body fat. The physician will also ask about a child's family history, eating habits and patterns of physical activity.

Changes to diet and exercise are common ways to treat and prevent childhood obesity.

Obesity is a major health problem for people of all ages. About two-thirds of all Americans are overweight or obese, according to the U.S. Centers for Disease Control and Prevention (CDC), and a growing proportion are children or adolescents.

The CDC has found that the percentage of children ages 6 to 11 years who are overweight has more than doubled in the past 20-plus years (from 7 to 19 percent) and the rate of overweight adolescents ages 12 to 19 years has more than tripled (from 5 to 17 percent). The percentage of children under age 5 who are overweight also appears to be on the rise. However, these rates may have hit a plateau because they have not risen since 1999, CDC data revealed in 2008.

The substantial rise in obesity rates appears to be the result of several factors, including increased consumption of fatty and sugary foods coupled with a more sedentary lifestyle. Health experts are concerned because obesity is the leading controllable risk factor of many diseases, including type 2 diabetes, high blood pressure, high cholesterol, osteoarthritis and several types of cancer (e.g., breast, gallbladder, prostate). It is estimated that 61 percent of overweight youths have at least one additional risk factor for heart disease, according to the CDC.

The CDC reviewed the discharge records of hospitals nationwide from 1979 to 1999, specifically of children ranging in age from 6 to 17 years and analyzed the results for all obesity-related illnesses. The researchers found that the incidence of:

• Diabetes had nearly doubled
• Obesity and gallbladder disease tripled
• Sleep apnea increased five-fold

The CDC found that these illnesses in children combined to create hospital costs that have tripled as a direct result of childhood obesity. In addition to the high cost of health care for these children, there is an even greater cost in human life. For the general population, it is estimated that 300,000 deaths each year are directly related to obesity, according the CDC.

This makes obesity-related deaths second only to those related to smoking. Deaths due to poor diet and physical inactivity rose by 33 percent during a recent 10-year period and may soon surpass tobacco as the leading cause of death, according to the CDC.

Children grow at different rates and times, often making it difficult to determine whether or not they are overweight. Children are typically considered to be overweight or obese if they are heavier than 95 percent of peers of the same age and height (pursuant to the body mass index or BMI). Children may be at risk for becoming overweight if their BMI is between 85 and 95 percent.

Efforts to help children lose weight typically may not pay off right away. It is important to display patience with children who are trying to lose weight, and to focus initially more on the child’s efforts and less on results. It is also crucial for parents to communicate love and acceptance of their child, regardless of the child's weight. Children's self-esteem is often based on how parents feel about them.

Breastfeeding young children may help prevent them from gaining excessive amounts of weight later in life. Research indicates that babies who are breastfed are better able to regulate food intake and to follow body cues that indicate hunger and fullness.

Overeating, poor diet and lack of exercise explain most of the increase in childhood obesity. Genetics also plays a role, as genes help determine a child’s body type and how the body stores and burns fat. Obesity is more common in Hispanics and black Americans than in some other racial and ethnic groups. Poverty may play a role as well because sweets and sodas are often cheaper than fresh fruits and vegetables.

Overweight parents are more likely to have an overweight child, and children who are heavy are more likely to grow up to be obese adults. The probability of an obese child remaining obese into adulthood is 20 percent for obese 4-year-olds and 80 percent for those who are obese in adolescence, according to the American Academy of Pediatrics.

Obese children face a higher risk of metabolic syndrome. This condition includes controllable risk factors for heart disease, many of which are also risk factors for diabetes, including excess blood fats (hyperlipidemia), high blood glucose, high blood pressure and excess body weight. The American Heart Association (AHA) reports that about 1 million American children between 12 and 19 years old, or about 4.2 percent, have metabolic syndrome. About 73 percent of the 1 million children were classified as overweight, and the remaining had all the risk factors for becoming overweight.

Many of the factors behind childhood obesity involve eating habits, such as:

• Increased portion sizes
• Diet high in cholesterol and saturated fats
• Diet high in processed starches and sugars
• Diet low in fiber, fruit and vegetables
• Increased consumption of soft drinks
• Increased consumption of fast food
• Consuming more fats, sugars and soft drinks while in school

Children are also exercising less today than in years past. Computers, video games and television have replaced outdoor play for millions of children. Several studies have shown that fewer than half of the nation's schoolchildren participate in daily physical activity. The American Dietetic Association suggests parents involve children in meal planning, portion control and also become a positive role model for good nutrition and exercise.

Other factors associated with obesity include:

• Lack of muscle mass. Muscle burns calories at a higher rate than other tissues, which helps manage weight. The sedentary lifestyle of many children is a major contributing factor for a lack of muscle mass.
  
  
• Medications. Some medications, such as certain antidepressants and antihistamines, may cause a child to gain unintended weight.
  
  
• Psychological factors. Some children eat out of boredom, sadness, stress or anger.
  
  
• Chronic diseases. Disorders including insulin resistance, hypothyroidism, polycystic ovary syndrome and Cushing's syndrome have been shown to contribute to obesity.
  
  
• Vitamin deficiencies. Filling up on non-nutritious foods not only adds extra calories that can promote weight gain, it also puts children at risk for vitamin deficiencies.
  
  
• Inadequate sleep. Studies in recent years have increasingly indicated that insufficient sleep may promote obesity in children and adults, perhaps by altering hormones in a way that leads to overeating.

Children who are overweight or obese can experience many symptoms. These may include problems with bones or joints, shortness of breath during exercise or sports, and signs of early maturity such as precocious puberty, irregular menstrual cycles and excessive growth of body hair.

In addition, obesity may cause a variety of related health conditions, such as:

• High blood pressure.
  
  
• Insulin resistance, metabolic syndrome and diabetes.
  
  
• Acanthosis nigricans. A skin disorder associated with insulin resistance. People with acanthosis nigricans may have dark, velvety patches, especially in the folds of the skin, such as in the neck, armpits, abdomen, breasts and groin.
  
  
• Polycystic ovary syndrome (PCOS). A female reproductive disorder involving excessive amounts of male hormones. Girls with PCOS may have menstrual irregularities, skin tags, acne, hirsuitism (coarse hair in a male pattern, such as on the face, chest and abdomen) and hair loss.
  
  
• Hyperlipidemia. Unhealthy levels of cholesterol and other blood fats.
  
  
• Liver problems.
  
  
• Sleep apnea.
  
  
• Pseudotumor cerebri. A rare condition, not always related to obesity, that presents with increased intracranial pressure, leading to headaches that may cause blindness.

Children who are overweight may also suffer from poor self-esteem as a result of being teased, bullied or rejected by others. As they grow older, these children may be more likely to suffer from depression, eating disorders and substance abuse problems.

A physician can determine if a child is overweight or obese. A common standard for measuring obesity is the body mass index (BMI). The formula uses a person's height and weight to estimate body fat. Children who are above the 95^th percentile for BMI for their age are considered overweight. Those who score between the 85^th and 95^th percentile are considered at risk of becoming overweight.

The office visit will likely include a physical examination and medical history. This will include questions about a history of:

• Family members who have weight problems or who are obese
  
  
• Birth weight under 5 pounds (2 kilograms) or over 10 pounds (4.5 kilograms)
  
  
• High blood sugar, high blood pressure, unhealthy cholesterol levels or high levels of triglycerides

The physician will also ask about a child's eating habits and patterns of activity. If the physician determines that the child is overweight or obese, the patient may be referred to a dietitian for further advice. Dietitians can help establish a healthy weight management program for children.

Changes in diet and adding exercise into daily activities are common ways to treat and prevent childhood obesity. Even modest weight loss and a modest increase in daily activity can reap dramatic results. However, because children are still developing, some experts do not recommend extensive weight loss for them unless obesity is severe or involves complications.

Parents can play a major role in helping to reduce the risk of their child becoming obese. Parents are urged to speak with a physician or dietitian about how to plan healthy meals. This will include lessons about how to read food labels. Generally diets should be rich in fruits, vegetables and whole grains with no more than 30 percent of daily calories from fat. Parents are advised to avoid buying foods that are prepackaged, sugary or high in fat.

Other steps that can help reduce a child’s risk of obesity include:

• Serve as a role model. Parents who exercise regularly and eat healthy foods create a powerful role model for children to follow.
  
  
• Encourage children to eat breakfast. Skipping breakfast reduces a child’s energy levels, and often leads to hunger and snacking throughout the day.
  
  
• Serve vitamin-rich foods, such as salmon, lean top sirloin beef, fortified whole-grain breakfast cereals, eggs and low-fat milk. This will help prevent vitamin deficiencies and promote a feeling of fullness that may curb a child's urge to snack.
  
  
• Do not insist that children eat when they are not hungry, or that they finish every meal.
  
  
• Do not reward or comfort a child with food. This includes not offering dessert as a reward for finishing a meal or another task. Doing so promotes sweets.
  
  
• Allow children to occasionally eat sweets. Forbidding sweets altogether may make children rebel and sneak sweets behind a parent's back.
  
  
• Encourage children to snack on fresh and canned fruit, vegetables, low-fat yogurt and low-fat graham crackers, animal crackers or vanilla wafers.
  
  
• Do not eat fast food more than once a week.
  
  
• Limit a child's TV and computer time.
  
  
• Spend time being active with children. This may include family walks or outdoor games.
  
  
• Teach children good eating and exercise habits.
  
  
• Promote good sleep habits. Keep regular bedtimes and allow for adequate rest. For example, children ages 6 to 9 need about 10 hours of sleep a night, and those 10 to 12 need a little more than nine hours of sleep nightly, according to the Nemours Foundation. Seek treatment for sleep disorders.

Some states are also trying to reduce childhood obesity by:

• Reviving physical education in schools
• Promoting opportunities for sports and exercise
• Improving foods offered by school cafeterias
• Restricting vending machines

The National Institutes of Health and other government agencies released a report in 2005 that provided updated guidelines to prevent obesity. Many of the recommendations centered around a sensible diet and being active most days of the week (30 minutes a day to reduce the risk of chronic disease, 60 minutes or more to maintain or lose weight).

The report also recommended that:

• The United States government makes prevention of childhood obesity a national priority.
  
  
• Industries promote healthful eating and physical activity.
  
  
• Nutrition labeling is clear so parents and youths can make informed choices.
  
  
• Marketing and advertising to children minimize risk of obesity.
  
  
• A long-term federal public relations campaign focuses on obesity prevention in children.
  
  
• Governments and community groups promote healthful eating and physical activity.
  
  
• Governments, community groups and developers create local recreational opportunities for children.
  
  
• Healthcare professionals and organizations including insurers track body mass index (BMI) and establish programs on obesity prevention.

Schools make it easy for students to eat well and be physically active. Parents should promote good eating and physical activity behaviors at home.

Preparing questions in advance can help patients and parents have more meaningful discussions with their physicians regarding their or their child's treatment options. The following questions about childhood obesity may be helpful:

1. How can I tell if my child is overweight?
   
   
2. Should I use the body mass index (BMI) chart for my children?
   
   
3. How will I know if it is time for my child to see a physician?
   
   
4. Is my child overweight or obese?
   
   
5. Does my child have any associated health risks or illnesses?
   
   
6. Which foods should I prepare for my child? Which foods should I avoid?
   
   
7. My children insist on eating meals from the school cafeteria. What can I do to ensure they are making good choices?
   
   
8. If my child is overweight, is it safe to start a weight-loss program?
   
   
9. If so, which weight-loss program do you recommend?
   
   
10. What exercise program do you recommend to help prevent my child from being overweight?
    
    
11. Should my child have a checkup before starting an exercise program?