WHO Says Childhood Obesity Among Most Serious Health Challenges this Century

The World Health Organization made this assertion in an assessment published March of 2012.  Childhood obesity is certainly a growing epidemic in the United States. According to the CDC, it affects more than 30 percent of children, making it the most common chronic health concern for the young. This number has more than tripled in the US since the 1970’s, and, if current trends continue, more than half of all children in the US today will be characterized as obese as an adult.

Obesity can harm nearly every system in a developing body – heart and lungs, muscles and bones, kidneys and digestive tract, as well as the hormones that control blood sugar and puberty.  It can also take a heavy social and emotional toll that is incalculable.   Medical experts say youth who are overweight or obese have substantially higher odds of remaining so into adulthood, increasing their risk of disease and disability later in life.

WARNING:  Those with patterns of disordered eating may be triggered by this article, and there are certainly strong opinions associated with the word obesity and anyone being characterized as “obese”.

Childhood Obesity Statistics

Globally, an estimated 43 million preschool children (under age 5) were overweight or obese in 2010, a 60 percent increase since 1990. The problem affects countries rich and poor, and by sheer numbers, places the greatest burden on the poorest.  Of the world’s 43 million overweight and obese preschoolers, 35 million live in developing countries. By 2020, if the current epidemic continues unabated, 9 percent of all preschoolers will be overweight or obese – nearly 60 million children.

Here in the United States, childhood obesity has increased nearly 3-fold since 1980, and today, the country has some of the highest obesity rates in the world. One out of six children is obese, and one out of three is overweight or obese. Though the overall U.S. child obesity rate has held steady since 2008, some groups have continued to see increases, and some groups have higher rates of obesity than others.  For children and adolescents aged 2-19 years:

  • The prevalence of obesity was 18.5% and affected about 13.7 million children and adolescents.
  • Obesity prevalence was 13.9% among 2- to 5-year-olds, 18.4% among 6- to 11-year-olds, and 20.6% among 12- to 19-year-olds. Childhood obesity is also more common among certain populations.
  • Hispanics (25.8%) and non-Hispanic blacks (22.0%) had higher obesity prevalence than non-Hispanic whites (14.1%).
  • Non-Hispanic Asians (11.0%) had lower obesity prevalence than non-Hispanic blacks and Hispanics.
  • The prevalence of obesity decreased with increasing level of education of the household head among children and adolescents aged 2-19 years.
  • Obesity prevalence was 18.9% among children and adolescents aged 2-19 years in the lowest income group, 19.9% among those in the middle income group, and 10.9% among those in the highest income group.
  • Obesity prevalence was lower in the highest income group among non-Hispanic Asian and Hispanic boys.
  • Obesity prevalence was lower in the highest income group among non-Hispanic white, non-Hispanic Asian, and Hispanic girls. Obesity prevalence did not differ by income among non-Hispanic black girls.

How Childhood Obesity is Measured

A child is described as “affected by obesity” if their body mass index-for-age (or BMI-for-age) percentile is greater than 95 percent. A child is described as “overweight” if their BMI-for-age percentile is greater than 85 percent and less than 95 percent.

Measuring Weight Status

Obesity in children is determined by using BMI-for-age percentiles. BMI-for-age percentiles have emerged as the favored method to measure weight status in children. This method calculates your child’s weight category based on age and BMI, which is a calculation of weight and height. However, it should be kept in mind that this method, among other methods, should be used as a tool, and only a physician can best determine and diagnose weight status in your child.

Measuring Growth in Children

You may have heard your pediatrician refer to your child’s weight in terms of a percentile. To measure growth in your child based on their weight, doctors most commonly use weight-for-age percentiles. Weight-for-age percentiles are used to measure your child’s weight based strictly on age. It does not take into account the height of a child. This is not a method to determine obesity (or overweight) in children, but simply an indicator of growth as compared to children of the same age.

For example, if your child is in the 95th percentile, this means that their weight is greater than 95 percent of children of the same age.

About Body Mass Index (BMI)

BMI is the most common method to measure adult obesity. However, BMI is now becoming a popular tool, which is combined with BMI-for-age percentiles, used to measure obesity in children. BMI is a number calculated by dividing a person’s weight in kilograms by his or her height in meters squared.

It should be noted, again, BMI is one simple measure that may or may not correlate with true health.  Other measures, such as actual metabolic scores and grip strength may be better indicators of overall health.

Risks Associated with Childhood Obesity

Children who are considered affected by obesity are 70 percent more likely to continue being affected by obesity into adulthood. In addition, they are at greater risk for serious medical issues such as:

  • Heart disease
  • High cholesterol
  • High blood pressure
  • Diabetes
  • Sleep Apnea
  • Cancer

Aside from the clinical perspective, children who are affected by obesity face social discrimination, leading to low self-esteem and depression.

Causes of Childhood Obesity

Although the causes of childhood obesity are widespread, certain factors are targeted as major contributors to this epidemic. Causes include:

  • Environment
  • Microbiome
  • Lack of physical activity
  • Heredity and Family
  • Dietary Patterns
  • Socioeconomic status

Environment

Today’s environment plays a major role in shaping the habits and perceptions of children and adolescents. The prevalence of television commercials promoting unhealthy foods and eating habits is a large contributor. In addition, children are surrounded by environmental influences that demote the importance of physical activity.

Today, it is estimated that approximately 40 to 50 percent of every dollar that is spent on food is spent on food outside the home in restaurants, cafeterias, sporting events, etc. In addition, as portion sizes have increased, when people eat out they tend to eat a larger quantity of food (calories) than when they eat at home.

Beverages such as soda and juice boxes also greatly contribute to the childhood obesity epidemic. It is not uncommon for a 32-ounce soda to be marketed toward children, which contains approximately 400 calories. The consumption of soda by children has increased throughout the last 20 years by 300 percent. Scientific studies have documented a 60 percent increase risk of obesity for every regular soda consumed per day. Box drinks, juice, fruit drinks and sports drinks present another significant problem. These beverages contain a significant number of calories and it is estimated that 20 percent of children who are currently overweight are overweight due to excessive caloric intake from beverages.

Microbiome

Recent studies indicate weight gain trajectories in early childhood are related to the composition of oral bacteria of two-year-old children, suggesting this understudied aspect of a child’s microbiota –  the collection of microorganisms, including beneficial bacteria, residing in the mouth –  could serve as an early indicator for childhood obesity. A study describing the results appears September 19 in the journal Scientific Reports. [1]

Lack of Physical Activity

Children in today’s society show a decrease in overall physical activity. The growing use of computers, increased time watching television and decreased physical education in schools, all contribute to children and adolescents living a more sedentary lifestyle.

Another major factor contributing to the childhood obesity epidemic is the increased sedentary lifestyle of children. School-aged children spend most of their day in school where their only activity comes during recess or physical education classes. In the past, physical education was required on a daily basis. Currently, only 8 percent of elementary schools and less than 7 percent of middle schools and high schools have daily physical education requirements in the U.S.

Heredity and Family

Science shows that genetics play a role in obesity. It has been proven that children with parents affected by obesity are more likely to be affected as well. Estimates say that heredity contributes between 5 to 25 percent of the risk for obesity.

However, genes alone do not always dictate whether a child is affected by excess weight or obesity. Learned behaviors from parents are a major contributor. Parents, especially of those whose children are at risk for obesity at a young age, should promote healthy food and lifestyle choices early in their development.

Dietary Patterns

Over the past few decades, dietary patterns have changed significantly. The average amount of calories consumed per day by has dramatically increased. Furthermore, the increase in caloric intake has also decreased the nutrients needed for a healthy diet.

Food portions also play an important role in the unhealthy diet patterns that have evolved. The prevalence of “super size” options and “all you can eat” buffets create a trend in overeating. Combined with a lack of physical activity, children are consuming more and burning off less.

Socioeconomic Status

Children and adolescents that come from lower-income homes are at greater risk of being affected by obesity. This is a result of several factors that influence behaviors and activities.

Lower-income children cannot always afford to partake in extracurricular activities, resulting in a decrease in physical activity. In addition, families who struggle to pay bills and make a living often opt for convenience foods, which are higher in calories, fat and sugar.

Educational levels also contribute to the socioeconomic issue associated with obesity. Parents with little to no education have not been exposed to information about proper nutrition and healthy food choices. This makes it difficult to instill those important values in their children.

What to do about Treating Childhood Obesity

Treating obesity in children and adolescents differs from treatment in adults. Involving the family in a child’s weight management program is a key element to treatment. As a support system, family is integral in ensuring all health goals, not just weight, are met.

It is important to talk with your physician about options for treating childhood obesity. The various treatments of obesity in children and adolescents include:

  • Diet therapy
  • Physical activity
  • Behavior Modification
  • Surgery

Diet Therapy

When treating a child or adolescent affected by obesity, it is often recommended they have a consultation with a nutritionist that specializes in children’s needs. Nutritionists can best help children understand healthy eating habits and how to implement them in their long-term diet.

In some cases, nutritionists do not always recommend restricting caloric intake for children. Education on how to read food labels, cut back on portions, understand the food pyramid and eat smaller bites at a smaller pace is generally the information given to change a child’s eating habits.

The goal should be to enjoy a balanced and nutritious diet and have an appropriate level of physical activity to promote overall health and well-being.

Physical Activity

Another form of treatment of obesity in children is increasing physical activity. Physical activity is an important long-term ingredient for children, as studies indicate that inactivity in childhood has been linked to a sedentary adult lifestyle.

Increasing physical activity can decrease, or at least slow the increase, in fatty tissues in children affected by obesity. The US Surgeon General recommends that children get at least 60 minutes of physical activity each day. Individualized programs are available and possible for those children or adolescents that are not able to meet minimum expectations.

Behavior Modification

Lifestyles and behaviors are established at an early age. It is important for parents and children to remain educated and focused on making long-term healthy lifestyle choices.

There are several ways that children and adolescents can modify their behavior for healthier outcomes, such as: changing eating habits, increasing physical activity, becoming educated about the body and how to nourish it appropriately, engaging in a support group or extracurricular activity and setting realistic weight management goals.

Surgery

While surgery has been performed on adolescents in extreme cases to treat obesity, it is only considered for those with severe medical conditions that can only be improved through such intervention.

Get Connected

Everyday, you can find physicians in your area who are looking for new and unique ways to connect and collaborate with you on your care and the wellness of your family.  You might find them in HealthLynked – the first of its kind social ecosystem designed to truly allow patients and physicians to engage online in ways never before possible.

If you have a loved one facing the challenges of Childhood Obesity, or any other health concern, find help by getting Lynked.  Go to HealthLynked.com to sign up for free and start taking control of your family’s health.

 

Adapted from:

ObesityAction.org

Harvard.edu

CDC.gov

References:

[1]  Sarah J. C. Craig, Daniel Blankenberg, Alice Carla Luisa Parodi, Ian M. Paul, Leann L. Birch, Jennifer S. Savage, Michele E. Marini, Jennifer L. Stokes, Anton Nekrutenko, Matthew Reimherr, Francesca Chiaromonte, Kateryna D. Makova. Child Weight Gain Trajectories Linked To Oral Microbiota CompositionScientific Reports, 2018; 8 (1) DOI: 10.1038/s41598-018-31866-9

 

What is Celiac Disease and Why Is It on the Rise?

Historically, the United States Senate has designated September 13th as “National Celiac Awareness Day.”  According to the original resolution, the Senate “recognizes that all people of the United States should become more informed and aware of celiac disease” and encourages all Americans to participate in activities to observe this day.

Why September 13th?  The 13th is the birthday of Samuel Gee, a pediatrician who published the first complete clinical description of celiac disease in 1888.  Gee was the first to recognize the symptoms of celiac disease are related to diet.

Celiac disease affects an estimated 3 million Americans, 85% of whom remain undiagnosed or misdiagnosed.  It is generally considered an autoimmune disorder with genetic predisposition. Some important exceptions notwithstanding, the prevalence of celiac disease is estimated to range between 0.6 and 1 percent of the world’s population.

The name celiac derives from the Greek word for “hollow,” as in bowels. Gluten proteins in wheat, barley and rye prompt the body to turn on itself and attack the small intestine. Complications range from diarrhea and anemia to osteoporosis and, in extreme cases, lymphoma.

Celiac disease

Overview

Celiac disease (gluten-sensitive enteropathy), sometimes called sprue or coeliac, is an immune reaction to eating gluten, a protein found in wheat, barley and rye.

If you have celiac disease, eating gluten triggers an immune response in your small intestine. Over time, this reaction damages your small intestine’s lining and prevents absorption of some nutrients (malabsorption). The intestinal damage often causes diarrhea, fatigue, weight loss, bloating and anemia, and can lead to serious complications.

In children, malabsorption can affect growth and development, in addition to the symptoms seen in adults.

There’s no cure for celiac disease — but for most people, following a strict gluten-free diet can help manage symptoms and promote intestinal healing.

Symptoms

The signs and symptoms of celiac disease can vary greatly and are different in children and adults. The most common signs for adults are diarrhea, fatigue and weight loss. Adults may also experience bloating and gas, abdominal pain, nausea, constipation, and vomiting.

However, more than half of adults with celiac disease have signs and symptoms that are not related to the digestive system, including:

  • Anemia, usually resulting from iron deficiency
  • Loss of bone density (osteoporosis) or softening of bone (osteomalacia)
  • Itchy, blistery skin rash (dermatitis herpetiformis)
  • Damage to dental enamel
  • Mouth ulcers
  • Headaches and fatigue
  • Nervous system injury, including numbness and tingling in the feet and hands, possible problems with balance, and cognitive impairment
  • Joint pain
  • Reduced functioning of the spleen (hyposplenism)
  • Acid reflux and heartburn

Children

In children under 2 years old, typical signs and symptoms of celiac disease include:

  • Vomiting
  • Chronic diarrhea
  • Swollen belly
  • Failure to thrive
  • Poor appetite
  • Muscle wasting

Older children may experience:

  • Diarrhea
  • Constipation
  • Weight loss
  • Irritability
  • Short stature
  • Delayed puberty
  • Neurological symptoms, including attention-deficit/hyperactivity disorder (ADHD), learning disabilities, headaches, lack of muscle coordination and seizures

Dermatitis herpetiformis

Dermatitis herpetiformis is an itchy, blistering skin disease that stems from intestinal gluten intolerance. The rash usually occurs on the elbows, knees, torso, scalp and buttocks.

Dermatitis herpetiformis is often associated with changes to the lining of the small intestine identical to those of celiac disease, but the disease may not produce noticeable digestive symptoms.

Doctors treat dermatitis herpetiformis with a gluten-free diet or medication, or both, to control the rash.

Causes

Celiac disease occurs from an interaction between genes, eating foods with gluten and other environmental factors, but the precise cause isn’t known. Infant feeding practices, gastrointestinal infections and gut bacteria might contribute to developing celiac disease.

Sometimes celiac disease is triggered — or becomes active for the first time — after surgery, pregnancy, childbirth, viral infection or severe emotional stress.

When the body’s immune system overreacts to gluten in food, the reaction damages the tiny, hair-like projections (villi) that line the small intestine. Villi absorb vitamins, minerals and other nutrients from the food you eat. If your villi are damaged, you can’t get enough nutrients, no matter how much you eat.

Some gene variations appear to increase the risk of developing the disease. But having those gene variants doesn’t mean you’ll get celiac disease, which suggests that additional factors must be involved.

The rate of celiac disease in Western countries is estimated at about 1 percent of the population. Celiac disease is most common in Caucasians; however, it is now being diagnosed among many ethnic groups and is being found globally.

Risk factors

Celiac disease can affect anyone. However, it tends to be more common in people who have:

  • A family member with celiac disease or dermatitis herpetiformis
  • Type 1 diabetes
  • Down syndrome or Turner syndrome
  • Autoimmune thyroid disease
  • Microscopic colitis (lymphocytic or collagenous colitis)
  • Addison’s disease
  • Rheumatoid arthritis

Complications

Untreated, celiac disease can cause:

  • Malnutrition. The damage to your small intestine means it can’t absorb enough nutrients. Malnutrition can lead to anemia and weight loss. In children, malnutrition can cause slow growth and short stature.
  • Loss of calcium and bone density. Malabsorption of calcium and vitamin D may lead to a softening of the bone (osteomalacia or rickets) in children and a loss of bone density (osteoporosis) in adults.
  • Infertility and miscarriage. Malabsorption of calcium and vitamin D can contribute to reproductive issues.
  • Lactose intolerance. Damage to your small intestine may cause you to experience abdominal pain and diarrhea after eating lactose-containing dairy products, even though they don’t contain gluten. Once your intestine has healed, you may be able to tolerate dairy products again. However, some people continue to experience lactose intolerance despite successful management of celiac disease.
  • Cancer. People with celiac disease who don’t maintain a gluten-free diet have a greater risk of developing several forms of cancer, including intestinal lymphoma and small bowel cancer.
  • Neurological problems. Some people with celiac disease may develop neurological problems such as seizures or peripheral neuropathy (disease of the nerves that lead to the hands and feet).

In children, celiac disease can also lead to failure to thrive, delayed puberty, weight loss, irritability and dental enamel defects, anemia, arthritis, and epilepsy.

Nonresponsive celiac disease

As many as 30 percent of people with celiac disease may not have, or be able to maintain, a good response to a gluten-free diet. This condition, known as nonresponsive celiac disease, is often due to contamination of the diet with gluten. Therefore, it’s important to work with a dietitian.

People with nonresponsive celiac disease may have additional conditions, such as bacteria in the small intestine (bacterial overgrowth), microscopic colitis, poor pancreas function, irritable bowel syndrome or intolerance to disaccharides (lactose and fructose). Or, they may have refractory celiac disease.

Refractory celiac disease

In rare instances, the intestinal injury of celiac disease persists and leads to substantial malabsorption, even though you have followed a strict gluten-free diet. This combination is known as refractory celiac disease.

If you continue to experience signs and symptoms despite following a gluten-free diet for six months to one year, your doctor may recommend further testing and look for other explanations for your symptoms. Your doctor may recommend treatment with a steroid to reduce intestinal inflammation, or a medication that suppresses your immune system. All patients with celiac disease should be followed up to monitor the response of their disease to treatment.

Celiac is on the Rise

While we know proteins called gluten provoke celiac disease; and, we understand the disease is treated with a gluten free diet, the rapid increase in prevalence of celiac disease, which has quadrupled in the United States in just 50 years, is mystifying.

Scientists are pursuing some intriguing possibilities. One is that breast-feeding may protect against the disease, and it has been on the decline in our fast paced, Self-care society.  Another is that we have neglected the microbes teeming in our gut — bacteria that may determine whether the immune system treats gluten as food or as a deadly invader.  The microbiome wants us to survive.

Nearly everyone with celiac disease has one of two versions of a cellular receptor called the human leukocyte antigen, or H.L.A. These receptors, the thinking goes, naturally increase carriers’ immune response to gluten.

This detailed understanding makes celiac disease unique among autoimmune disorders. Two factors — one a protein, another genetic — are clearly defined; and in most cases, eliminating gluten from the patient’s diet turns off the disease.

When to see a doctor

Consult your doctor if you have diarrhea or digestive discomfort that lasts for more than two weeks. Consult your child’s doctor if your child is pale, irritable or failing to grow or has a potbelly and foul-smelling, bulky stools.

Be sure to consult your doctor before trying a gluten-free diet. If you stop or even reduce the amount of gluten you eat before you’re tested for celiac disease, you may change the test results.

Celiac disease tends to run in families. If someone in your family has the condition, ask your doctor if you should be tested. Also ask your doctor about testing if you or someone in your family has a risk factor for celiac disease, such as type 1 diabetes.

Get Help

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Sources Adapted from:

MayoClinic.org

nyt.com