Overweight in Children

AHA Recommendation

Overweight children are more likely to be overweight adults. Successfully preventing or treating overweight in childhood may reduce the risk of adult overweight. This may help reduce the risk of heart disease and other diseases.

When defining overweight in children and adolescents, it's important to consider both weight and body composition.

Among American children ages 6–11, the following are overweight, using the 95th percentile or higher of body mass index (BMI) values on the CDC 2000 growth chart:

* For non-Hispanic whites, 16.9 percent of boys and 15.6 percent of girls.
* For non-Hispanic blacks, 17.2 percent of boys and 24.8 percent of girls.
* For Mexican Americans, 25.6 percent of boys and 16.6 percent of girls.

Among adolescents ages 12–19, the following are overweight, using the 95th percentile or higher of BMI values on the CDC 2000 growth chart:

* For non-Hispanic whites, 17.9 percent of boys and 14.6 percent of girls.
* For non-Hispanic blacks, 17.7 percent of boys and 23.8 percent of girls.
* For Mexican Americans, 20.0 percent of boys and 17.1 percent of girls.

The prevalence of overweight in children ages 6–11 increased from 4.0 percent in 1971–74 to 17.5 percent in 1999–2004 The prevalence of overweight in adolescents ages 12–19 increased from 6.1 percent to 17.0 percent. (NHANES, NCHS)

How do you prevent and treat overweight in children?

Reaching and maintaining an appropriate body weight is important. That's why recommendations that focus on small but permanent changes in eating may work better than a series of short-term changes that can't be sustained.

* Reducing caloric intake is the easiest change. Highly restrictive diets that forbid favorite foods are likely to fail. They should be limited to rare patients with severe complications who must lose weight quickly.
* Becoming more active is widely recommended. Increased physical activity is common in all studies of successful weight reduction. Create an environment that fosters physical activity.

* Parents' involvement in modifying overweight children's behavior is important. Parents who model healthy eating and physical activity can positively influence their children's health.

In treating most overweight children, the main emphasis should be to prevent weight gain above what's appropriate for expected increases in height. This is called prevention of increased weight gain velocity. For many children this may mean limited or no weight gain while they grow taller. Recommendations for maintaining weight should include regular physical activity and careful attention to diet to avoid too many calories. Factors predicting success are:

* including parents in the dietary treatment program

* strong social support of dietary intervention from others involved in preparing food

* regular physical activity prescription including social support

The importance of continuing these lifestyle changes well past the initial treatment period should be emphasized to the entire family. The healthiest way to change weight is gradually.

How is body fat measured?

The body mass index (BMI) formula assesses weight relative to height. It provides a useful screening tool to indirectly measure the amount of body fat. Weight in kilograms is divided by height in meters squared (kg/m2), or, multiply weight in pounds by 703, divide by height in inches, then divide again by height in inches. In children, the Centers for Disease Control and Prevention defines BMI-for-age at or above the 95th percentile as being overweight. It is important to assess the trend of the child’s BMI as this is an indirect measure of body fat.

The CDC recommendations for screening and assessing for obesity and overweight in children and adolescents mention the use of the triceps skinfold test for further evaluation when the BMI-for-age is assessed above the 95th percentile. Importantly, while triceps skinfold thickness can be unreliable, evidence suggests that children and adolescents assessed to have a skinfold measure greater than the 95th percentile are more likely to have excess body fat as opposed to increased lean body mass or large frame size.