Overweight and Obesity

AUTHOR:DR VIKAS KUMAR, UNIVERSITY COLLEGE OF MEDICAL SCIENCE ,DELHI

How common are overweight and obesity among children?

Overweight and obesity are common among children and teens in the United States. Among young people ages 2 to 19 years, about

• 16.1% are overweight²
• 19.7% have obesity³

Obesity rates increase as children get older. Obesity is also more common among children from certain racial and ethnic minority groups. Among children and teens ages 2 to 19, obesity affects about³

• 26.2% of Hispanic youth
• 24.8% of non-Hispanic Black youth
• 16.6% of non-Hispanic White youth
• 9.0% of non-Hispanic Asian youth

What causes overweight and obesity in children?

Many factors can contribute to overweight and obesity in children, including^4,5

• genes and family history
• regularly taking in more calories from foods and beverages than their bodies need
• not getting enough physical activity
• not getting enough sleep
• some medical conditions and medicines

A child’s weight can also be affected by the mother’s pregnancy. If a mother has obesity or gains too much weight during pregnancy, it increases the chance that the child will be born larger than expected and develop obesity later in life.⁶

Genes and family history can also affect your child’s weight.

What are the health risks of being overweight or having obesity?

Being overweight or having obesity can increase the chances that your child may develop health problems, such as⁴

• breathing problems
• joint pain
• high blood pressure
• high cholesterol
• nonalcoholic fatty liver disease
• type 2 diabetes

Some children who are overweight or have obesity may experience weight-related teasing or bullying, which can affect their mental health. Children with overweight or obesity may have a higher risk of developing mental health problems, including⁵

• low self-esteem
• depression NIH external link
• eating disorders NIH external link

How can I tell if my child is overweight?

One way to find out if your child is at a healthy weight is by calculating his or her body mass index (BMI), a measurement based on a person’s height and weight. The next step is to compare your child’s BMI with the BMI of other children who are the same age and sex, based on growth charts from the Centers for Disease Control and Prevention (CDC). This will give your child’s “BMI-for-age percentile,” a number that can tell you if your child is underweight, is at a healthy weight, is overweight, or has obesity.

This online tool External link from the CDC lets you calculate your child’s BMI and BMI-for-age percentile.

Does my child need to lose weight?

If you are worried about your child’s weight, talk with your health care professional. In many cases, children who are overweight don’t need to lose weight, but they need to gain weight more slowly as they continue to grow in height. To determine if your child weighs too much or is gaining weight too quickly, your health care professional will consider many factors, such as⁴

• your child’s age, weight, height, and BMI-for-age percentile
• your child’s overall health
• how fast your child is growing
• whether your child has any weight-related health problems, such as high blood pressure or high cholesterol
• your child’s family history of obesity and related health problems

If you’re worried about your child’s weight, talk with your health care professional.

How can I help my child reach and stay at a healthy weight?

Your child may be able to reach and stay at a healthy weight if you help them adopt healthier lifestyle habits, such as following a healthy eating plan, getting regular physical activity, limiting screen time, and getting enough sleep.

Eating plan

Children need meals and snacks that are high in nutrients to help them grow. The Dietary Guidelines for Americans, 2020–2025 External link recommend that children consume a variety of foods and beverages, including

• fruits External link and vegetables External link
• whole grains External link
• fat-free or low-fat dairy products or nondairy beverages fortified with added calcium, vitamin A NIH external link, and vitamin D
• foods high in protein External link

The guidelines also recommend children limit foods and beverages that are high in added sugars, saturated fat, and sodium  or salt. These foods and beverages can add a lot of extra calories without adding much nutrition. Here are some tips for replacing them with healthier options.

• Eat fast food less often. When you do, order healthier side dishes—such as soup or fruit salad—instead of fries.
• Replace high-fat protein foods—such as sausage and fried chicken—with leaner options, such as turkey breast, beans, or tofu.
• Replace highly processed foods with whole foods like fruits, vegetables, whole grains, nuts, and seeds.
• Instead of sugary sodas, serve water, low-fat or fat-free milk, or fortified nondairy beverages.
• Place healthy foods and beverages where they are easy to see and reach. Keep high-calorie foods and beverages out of sight—or don’t buy them at all. Replace the cookie jar with a fruit bowl.

If your child is overweight or is gaining weight too quickly, cutting back on high-calorie foods and beverages can help. Here are some ways to help your child cut back on extra calories.

• To prevent snacking throughout the day, make sure your child eats regular meals, starting with a healthy breakfast.
• Learn about age-appropriate portion sizes and how to avoid serving oversized portions. Repackage high-calorie snacks in smaller containers.
• Avoid letting your child eat in front of the television, computer, or other electronic devices.

Make healthy food options available and within easy reach of your child.

Childhood is the ideal time to develop healthy eating habits that your child can carry into adulthood. To help your child develop a healthy attitude toward food and eating

• Don’t make your child finish all the food on the plate.
• Don’t use food to reward or punish your child. Promising dessert for eating vegetables sends a message that vegetables are less valuable than dessert.

The MyPlate External link website, from the U.S. Department of Agriculture, offers many other tips and resources External link on healthy eating, including guidance on healthy eating on a budget External link.

Physical activity

The Physical Activity Guidelines for Americans, 2nd edition External link(PDF, 14.5 MB) recommend that children ages 3 to 5 be physically active throughout the day to help them grow and develop.

Older children ages 6 to 17 should get at least 1 hour of physical activity every day. Their activities should include

• aerobic activities, such as running, biking, or dancing.
• activities that strengthen the muscles, such as climbing on playground equipment or playing games such as tug of war. These muscle-strengthening activities should be part of your child’s physical activity at least 3 days a week.
• activities that strengthen the bones, such as jumping rope or playing basketball. Bone-strengthening activities should be part of your child’s physical activity at least 3 days a week.

As a parent or other caregiver, you can play a key role in helping your child be more active. Options for adding more physical activity to your child’s daily routine include

• organized sports—including team sports—and fitness activities
• active play, including group walks, biking, outdoor activities and chores, and dog walking
• walking or biking to nearby places, rather than driving or using public transportation

Help your child be more active by doing fun activities outdoors.

Screen time

Research suggests that kids who spend a lot of time watching television and who have a television in their bedrooms may have a higher risk of having childhood obesity.⁷ Experts recommend limiting how much time children spend watching television, playing video games, or using smartphones or other devices when not using them for schoolwork.

An easy rule of thumb is to limit screen time not spent on schoolwork to 1 to 2 hours per day.⁸ Another option is to set screen time limits for each person in your household. The American Academy of Pediatrics suggests that parents and other caregivers of children ages 5 and older work with a health care professional to create a Family Media Use Plan External link.⁹

To limit your child’s screen time^7,9

• Turn off televisions and other media when not in use.
• Turn off all entertainment while your child is doing homework.
• Keep bedrooms and mealtimes screen-free for everyone in your household.
• Don’t eat while watching television or using other screens.

Sleep habits

Just like following a healthy eating plan and engaging in regular physical activity, getting enough sleep is important for your child’s mental and physical health. Getting enough sleep can help your child do well in school, fight off illnesses and infections, and reach and maintain a healthy weight.^10,11

Children need more sleep than adults. Recommended sleep time varies by age.¹¹ The table below shows the amount of sleep recommended for each age group.

Recommended sleep time for children and teens

Having a television, computer, or mobile device in the bedroom—or spending a lot of time using these devices during the day—may delay or disrupt your child’s sleep.^7,9 The blue light from screens can block the production of a hormone called melatonin NIH external link that supports healthy sleep, especially when children have screen time before bedtime. Viewing media content that is exciting or engaging may also keep children awake past their bedtimes.

Exposure to blue light from screens before bedtime can make it harder for your child to fall asleep.

To help your child get enough sleep at night

• Keep televisions, video games, mobile phones, and other screens out of your child’s bedroom.
• Set a bedtime that will allow your child to get a full night of sleep.
• Provide a calm atmosphere for sleep before bedtime.
• Help your child avoid screen time in the hour before bedtime.

How can I support my child?

There are several things you can do to help your child adopt healthy lifestyle habits.

Teach your child about healthy choices

Talk with your child about health, including

• how regular physical activity, healthy eating, and getting enough sleep help our bodies get strong and stay healthy
• how to make healthy choices about food, drinks, and activities at school, at friends’ houses, and at other places outside your home
• how balancing the amount of food and beverages we take in with how active we are during the day will help us reach and maintain a healthy weight

Be a good role model

Children are good learners, and they often copy what they see. Be a good role model by making healthy lifestyle choices yourself.

• Adopt healthy lifestyle habits, and encourage your loved ones to do the same.
• Buy fewer foods and beverages that can lead to weight gain, including sugar-sweetened drinks and snacks high in fat and sugar. When buying these items for a special event, remove them as soon as the event is over.
• Get the whole family involved in building healthy eating, drinking, physical activity, and sleep habits. Everyone benefits, and your child won’t feel singled out.

Help your child build healthy eating habits by being a role model.

Be supportive

Children need support, understanding, and encouragement from caring adults. Their feelings about themselves are often based on how they think their parents and other caregivers feel about them. Tell your child that they are loved, special, and important.

Studies suggest that a parenting style that combines setting rules and limits with warmth—called authoritative parenting—may help children adopt healthy behaviors that support a healthy weight.^5,12 Children in homes that use this style of parenting tend to understand authority and rules, but also feel comfortable seeking support from their caregivers.

Motivate your child to make healthy lifestyle choices by

• listening to your child’s concerns
• encouraging healthy behaviors and setting limits for less healthy choices
• making it easier to choose healthy foods and beverages by keeping less healthy options out of your home
• helping your child set goals for physical activity and healthy eating, and tracking their progress
• rewarding your child’s successes with praise and love
• sharing information about these lifestyle choices with other caregivers, such as babysitters or grandparents, so they can also help your child adopt the new behaviors

What other treatments may help my child reach a healthy weight?

Your health care professional may recommend a weight-loss plan tailored to your child’s needs or refer you to a weight-management specialist or a registered dietitian. Your local hospital, a community health clinic, or the health department may offer weight-management programs for children and teens or have information about where your child can enroll in one. Don’t put your child on a weight-loss plan without the help of your health care professional.

If your child is 12 or older and has obesity, ask your health care professional about other treatment options, such as

• weight-management medicines for children ages 12 and older
• weight-loss surgery, also called bariatric and metabolic surgery, for teens ages 13 and older

Treatments such as medicines and surgery don’t replace lifestyle changes as a way for your child to lose weight. These treatments work best when your child is physically active and consumes healthy foods and beverages.¹³

Tell your child that they are loved, special, and important.

Clinical Trials for Overweight and Obesity in Children

NIDDK conducts and supports clinical trials in many diseases and conditions, including overweight and obesity. The trials look to find new ways to prevent, detect, or treat disease and improve quality of life.

Why are clinical trials with children important?

Children respond to medicines and treatments differently than adults. The way to get the best treatments for children is through research designed specifically for them.

We have already made great strides in improving children’s health outcomes through clinical trials and other types of clinical studies NIH external link. Vaccines, treatments for children with cancer, and interventions for premature babies are just a few examples of how this targeted research can help. However, we still have many questions to answer and more children waiting to benefit.

The data gathered from trials and studies involving children help health care professionals and researchers

• find the best dose of medicines for children
• find treatments for conditions that only affect children
• treat conditions that behave differently in children than in adults
• understand the differences in children as they grow

How do I decide if a clinical trial is right for my child?

We understand you have many questions, want to weigh the pros and cons, and need to learn as much as possible. Deciding to enroll in a study can be life changing for you and for your child. Depending on the outcome of the study, your child may find relief from their condition, see no benefit, or help to improve the health of future generations.

Talk with your child and consider what would be expected. What could be the potential benefit or harm? Would you need to travel? Is my child well enough to participate? While parents or guardians must give their permission, or consent, for their children to join a study, the children must also agree to participate, if they are capable (verbal). In the end, no choice is right or wrong. Your decision is about what is best for your child.

The National Institutes of Health (NIH) is committed to ensuring you get all the information you need to feel comfortable and make informed decisions. The safety of children remains the utmost priority for all NIH research studies. For more resources to help decide if clinical trials are right for your child, visit Clinical Trials and You: Parents and Children NIH external link.

What aspects of overweight and obesity are being studied in children?

Researchers are studying many aspects of overweight and obesity, such as

• parenting approaches that can prevent infants from developing overweight or obesity
• eating behaviors of teens who have overweight or obesity
• how a mother’s weight during pregnancy may affect the child’s weight
• how changes in the brain affect the weight of children
• how children from low-income families are affected by overweight and obesity
• how treatments such as medicines or surgery may help teens with severe obesity

Watch a video of NIDDK Director Dr. Griffin P. Rodgers explaining the importance of participating in clinical trials.

https://youtube.com/watch?v=36Sd8WpgR94%3Fenablejsapi%3D1%26origin%3Dhttps%253A%252F%252Fwww.niddk.nih.gov

What clinical studies for overweight and obesity are available for child participants?

You can view a filtered list of clinical studies on overweight or obesity in children that are federally funded, open, and recruiting at www.ClinicalTrials.gov NIH external link. You can expand or narrow the list to include clinical studies from industry, universities, and individuals; however, NIH does not review these studies and cannot ensure they are safe. If you find a trial you think may be right for your child, talk with your child’s health care provider about how to enroll.

References

[1] Drozdz D, Alvarez-Pitti J, Wójcik M, et al. Obesity and cardiometabolic risk factors: from childhood to adulthood. Nutrients. 2021;13(11):1–20. doi:10.3390/nu13114176

[2] Fryar CD, Carroll MD, Afful J. Prevalence of overweight, obesity, and severe obesity among children and adolescents aged 2–19 years: United States, 1963–1965 through 2017–2018. NCHS Health E-Stats. Centers for Disease Control and Prevention; 2020. www.cdc.gov/nchs/data/hestat/obesity-child-17-18/overweight-obesity-child-H.pdf External link (PDF, 352 KB)

[3] Stierman B, Afful J, Carroll MD, et al. National Health and Nutrition Examination Survey 2017–March 2020 prepandemic data files: Development of files and prevalence estimates for selected health outcomes. National Health Statistics Reports. 2021;(158):1–20. doi:10.15620/cdc:106273

[4] Kohut T, Robbins J, Panganiban J. Update on childhood/adolescent obesity and its sequela. Current Opinion in Pediatrics. 2019;31(5):645–653. doi:10.1097/MOP.0000000000000786

[5] Smith JD, Fu E, Kobayashi MA. Prevention and management of childhood obesity and its psychological and health comorbidities. Annual Review of Clinical Psychology. 2020;16:351–378. doi:10.1146/annurev-clinpsy-100219-060201

[6] Godfrey KM, Reynolds RM, Prescott SL, et al. Influence of maternal obesity on the long-term health of offspring. Lancet Diabetes Endocrinology. 2017;5(1):53–64. doi:10.1016/s2213-8587(16)30107-3

[7] Council on Communications and Media. Media and young minds. Pediatrics. 2016;138(5):1–6. doi:10.1542/peds.2016-2591

[8] Styne DM, Arslanian SA, Connor EL, et al. Pediatric obesity—assessment, treatment, and prevention: an Endocrine Society clinical practice guideline. Journal of Clinical Endocrinology & Metabolism. 2017;102(3):709–757. doi:10.1210/jc.2016-2573

[9] Hill D, Ameenuddin N, Chassiakos YLR, et al. Media use in school-aged children and adolescents. Pediatrics. 2016;138(5):1–6. doi:10.1542/peds.2016-2592

[10] Daniels SR, Hassink SG, Abrams SA, et al. The role of the pediatrician in primary prevention of obesity. Pediatrics. 2015;136(1):e275–e292. doi:10.1542/peds.2015-1558

[11] Paruthi S, Brooks LJ, D’Ambrosio C, et al. Recommended amount of sleep for pediatric populations: a consensus statement of the American Academy of Sleep Medicine. Journal of Clinical Sleep Medicine. 2016;12(6):785–786. doi:10.5664/jcsm.5866

[12] Kiefner-Burmeister A, Hinman N. The role of general parenting style in child diet and obesity risk. Current Nutrition Reports. 2020;9(1):14–30. doi:10.1007/s13668-020-00301-9

[13] Hampl SE, Hassink SG, Skinner AC, et al. Clinical practice guideline for the evaluation and treatment of children and adolescents with obesity. Pediatrics. 2023;151(2):e2022060640. doi:10.1542/peds.2022-060640