Since 1990, the rise in childhood overweight and obesity has surged across every continent, almost doubling in prevalence. While the United States has the highest prevalence, other nations are not far behind.
In Southern Europe, including Greece, Italy and Spain, 10 to 15% of children are obese, while Eastern European countries have somewhat lower rates, but are experiencing a rapid increase that may soon match Southern Europe. Globally, Asia has nearly half of all overweight children under the age of 5, and Africa has one-quarter of such children. In Latin America, about 20% of children under 20 are overweight. Many developing countries face the dual challenge of both overweight/obesity and malnutrition in their children.
The deleterious consequences of this epidemic are already evident: childhood hypertension, type 2 diabetes, among others. Researchers from Florida Atlantic University's Schmidt College of Medicine and colleagues sound the alarm and discuss both challenges and potential solutions in a commentary published in The Maternal and Child Health Journal.
"Pediatric overweight and obesity have reached epidemic levels in the U.S. and are becoming a pandemic globally. These conditions lead to high blood pressure, type 2 diabetes and lipid disorders, which contribute to metabolic syndrome. In adults, these issues significantly increase the risks of heart attacks, stroke, liver disease, obstructive sleep apnea, arthritis and certain cancers – many of which are now occurring at younger ages," said Charles H. Hennekens, M.D., first author and the first Sir Richard Doll Professor of Medicine and Preventive Medicine, FAU Schmidt College of Medicine. "Through coordinated clinical and public health efforts, we can address these troubling trends and work toward a healthier future for children and families globally."
In the commentary, the authors report on the leading causes of this epidemic including high body mass index (BMI), which increases the risks of many serious health issues. In the U.S., a preschooler is considered overweight if their BMI exceeds the 85th percentile. Research shows that these children are at a significantly higher risk of being overweight during adolescence compared to those with a BMI at the 50th percentile. This underscores the misconception that children simply "outgrow" overweight issues.
In addition, the authors note that health care providers and public health practitioners face major challenges in boosting daily physical activity among children, which is crucial for increasing metabolic rates, lowering BMI, and reducing future risks of coronary heart disease.
"With declining physical education in schools and excessive time spent on electronic devices, many children fail to meet recommended activity guidelines. This sedentary behavior contributes to overweight and obesity through poor diet, reduced sleep, and decreased physical activity," said Panagiota "Yiota" Kitsantas, Ph.D., co-author and professor and chair, FAU Department of Population Health and Social Medicine, Schmidt College of Medicine. "Encouraging organized, enjoyable activities rather than competitive ones can help children achieve necessary physical activity levels."
The authors also caution that while increasing levels of daily physical activity is necessary, it isn't sufficient to make a major impact on the rates of childhood overweight and obesity. The rise of high sugar containing foods, along with consumption of ultra-processed foods also are major contributors.
"Nearly 70% of the average U.S.-based child's diet is made up of ultra-processed foods," said Hennekens. "Moreover, consumption of ultra-processed foods among children under 24 months is rising worldwide, triggering not only the potential of developing obesity but also decreased immunological protection."
The authors say that more research is needed to pinpoint which components of ultra-processed foods contribute to weight gain in children. However, they warn that a diet high in ultra-processed foods is linked to rising rates of overweight and obesity, with schools being a major source of these foods.
"Evidence suggests that enhancing school lunch nutritional standards could help reduce obesity, particularly among low-income children," said Kitsantas. "We recommend adopting school food policies that remove ultra-processed foods from menus and promote healthier alternatives, alongside educational programs on healthy eating, despite the challenges posed by external influences on children."
Among the challenges highlighted in the commentary is the use of social media and advertising, which significantly affect children's food choices and behaviors that include sharing unhealthy food posts and recognizing many unhealthy food brands upon exposure.
"Despite recommendations from the World Health Organization and public health authorities to restrict food marketing aimed at children, few countries have implemented such measures," said Hennekens. "The effectiveness of existing regulations in today's media landscape is uncertain, creating an opportunity for health providers and public health practitioners to educate families about the impact of this advertising."
The authors explain that addressing the rising pediatric obesity epidemic requires a multifaceted approach. In 2023, the American Academy of Pediatrics endorsed WHO guidelines and released their own recommendations for managing pediatric overweight and obesity. These guidelines advise health care providers and public health practitioners to tackle social determinants of health, use motivational interviewing to modify nutrition and activity behaviors, and consider pharmacotherapy or surgery to meet personalized patient goals.
However, the authors say that while there are approved drug therapies available, before prescribing pharmacologic options, maternal and child health care providers should employ therapeutic lifestyle changes.
"While the ultimate goal is prevention of pediatric overweight and obesity as well as metabolic syndrome, to paraphrase Voltaire, we should not 'let the perfect be the enemy of the good,'" said Hennekens.
In conclusion, the authors urge leveraging all available resources to at least stabilize the rising rates of childhood obesity and its associated health issues. Ignoring these challenges could lead to an unprecedented global epidemic of childhood and adolescent obesity, with severe future health consequences, as seen in the U.S.
"Health care and public health professionals must collaborate across disciplines to address these issues with patients, families, communities and policymakers. United efforts can help reverse these troubling trends and ensure a healthier future for children worldwide," said Kitsantas.
Other co-authors are Dawn Harris Sherling, M.D.; Allison H. Ferris, M.D., associate professor and chair, Department of Medicine, FAU Schmidt College of Medicine; Alicia Caceres, a fourth-year premedical student at Tufts University; Katerina Benson, a third-year pre-medical student at FAU; Alexandra Rubenstein, a second-year medical student at Tufts University School of Medicine; and Sarah K. Wood, M.D., director, Harvard Macy Institute, Harvard Medical School, and former interim dean and professor and chair of maternal and child health, FAU Schmidt College of Medicine.
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