Obesity, Pediatric

Definition of Pediatric Overweight

Most health surveys use the Body Mass Index (BMI) to express the relationship between weight and height; BMI = (weight in kilograms)/(height in meters)21. Because the distribution of body fat varies by children's age and gender, gender-specific BMI-for-age is used for children and adolescents aged 2 to 20 years. Current cut points established by the CDC are (a) underweight: BMI-for-age < 5th percentile; (b) at risk of overweight: BMI-for-age > 85th percentile to < 95th percentile; and (c) overweight: BMI-for-age > 95th percentile. BMI-for-age compares well to more invasive estimates of body fat and therefore is used to identify underweight, risk for overweight, and over-weight children and adolescents (CDC, 2003).

Factors Contributing to Pediatric Overweight

Overweight results from energy imbalance. In other words, when the energy consumed exceeds the energy expended, excessive weight gain occurs. Energy balance is regulated by genetics and environmental factors. Heredity alone cannot explain the current epidemic of overweight among children and adolescents. Only a small percentage (1%–4%) of severely overweight children and adolescents have genetic defects involved in food intake regulation. Therefore, intervention and prevention efforts must focus on the environmental factors that contribute to energy imbalance.

The primary environmental factors related to over-weight are excessive calorie consumption and low calorie expenditure, through sedentary activities and lack of physical activities. Children and adolescents have notoriously unhealthy diets. They do not adhere to the dietary guidelines, and their diets are high in fats and sugars and low in many required macro- and micro-nutrients. Meals and snacks are often eaten outside of the home. Food obtained from fast-food restaurants tends to be higher in fat and calories than home-cooked food, often because portions are “super-sized.” Prepackaged foods and fast foods that are high in fat, sugar, and calories are replacing home-cooked meals. Portion sizes have increased, resulting in increased calorie consumption.

Modern conveniences such as cars, elevators, televisions, and computers contribute to the decline in physical activity, particularly during the adolescent years. As adolescents get older, their sedentary activities increase, particularly among females and minorities. In some communities, the unavailability of safe outdoor facilities, elimination of physical education classes, and lack of access to grocery stores exacerbate the problem of overweight.

Health Consequences

The consequences of overweight affect almost every system in the body, ranging from the psychosocial to the musculoskeletal systems (Ebbeling, Pawlak, & Ludwig, 2002). In a society that values thinness, overweight children and adolescents are often teased by their peers. As a result, many over-weight children suffer from low self-esteem and may be at risk for depression. In addition, since overweight children tend to be taller than their peers, they may be viewed as more mature and subjected to more demanding expectations than their peers.

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