The Epidemic of Children's Obesity
As of 2012, one-third of children and adolescents were overweight or obese. Over the past 30 years, obesity rates for 6-11 year olds have more than doubled, and for 12-19 year olds, has more than quadrupled.
And because of obesity, for the first time in US history, children have a shorter lifespan than their parents.
In the short-term, obesity can lead to a host of health problems, including risk factors for cardiovascular disease such as high cholesterol and high blood pressure. Obese adolescents are also more likely to be prediabetic. Obese children are also at greater risk for bone and joint problems, as well as sleep apnea.
Obese children are more likely to have social and psychological problems which can include loneliness, sadness, anxiety, and depression. Obese children are also less likely to exercise, which in combination with comfort eating from psychological distress, creates a creates a vicious cycle.
Long term, obese children are more likely to be obese as adults, which increases chances of heart disease, type 2 diabetes, stroke, and osteoarthritis. It also increases the chances of several types of cancer, including breast, colon, endometrium, esophagus, kidney, pancreas, gall bladder, thyroid, ovary, cervix, and prostate, as well as multiple myeloma and Hodgkin’s lymphoma.
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Sugar is a Major Contributor to Childhood Obesity
According to the Harvard School of Public Health, soft drinks and other sugar-sweetened drinks are a major cause of obesity in children. This includes fruit juice that has added sugar, fruit punch, lemonade and other "ades", as well as sports and energy drinks.
Sugary drinks (soda, energy, sports drinks) are the top calorie source in teens’ diets (226 calories per day), beating out pizza (213 calories per day).
From 1989 to 2008, calories consumed in the form of sugary beverages increased by 60% in children ages 6 to 11, and the percentage of children consuming them rose from 79% to 91%.
-Source: Harvard School of Public Health
The Institute of Medicine report Preventing Childhood Obesity from 2005 stated that “Because of concerns about excessive consumption of sweetened beverages and the displacement of more nutrient-rich or lower calorie alternatives, children should be encouraged to avoid high-calorie, nutrient-poor beverages.” There are studies that show that people who consume sugary drinks don't feel satisfied and will still eat the same amount of food, so they are taking in a lot more calories with no nutritional value.
Here are 8 reasons to not give your children sugary drinks:
- The American Dental Association tells us that a steady diet of sugary foods and drinks, including juice and sports drinks, can damage teeth. Cavity-causing bacteria in the mouth feed on sugar and produce acids that attack tooth enamel for up to 20 minutes after you eat or drink. Sipping sugary beverages or eating sugary foods results in repeated acid attacks that weaken tooth enamel which can lead to cavities.
- Several studies have found a link between comsumption of sweetened drinks and hyperactivity and inattention. One study reported on Academic Pediatrics found that for every sweetened drink consumed, the young teens’ risk of hyperactivity and inattention increased by 14%. It also showed that middle school kids who consumed energy drinks were 66% more likely to report hyperactivity and inattention.
- Dr. Stanley Grogg of the American Osteopathic Association explains “While studies have shown that caffeine can cause a physical dependence and result in withdrawal symptoms such as headache, fatigue and muscle ache, many parents forget that this substance is a drug. Children who have become accustomed to 3-4 caffeinated drinks per day will have some type of reaction if they’re denied their ‘daily fix.’”
- Caffeine acts as a strong diuretic. A caffeinated drink before bedtime will ensure at least one nighttime trip to the bathroom, disturbing their sleep.
- In moderate doses, caffeine can cause insomnia, headaches, dizziness, irritability, and dehydration.
- Studies connected caffiene with changes in hormone levels that could alter the way still developing brains perceive and evaluate risk. Because caffeine can act on so many brain systems, but there is still little information on its influence on young children, the FDA is currently investigating the safety of caffeine that is added to food products consumed by kids and adolescents, like drinks, chips and even gum.
- The phosphoric acid in soda takes calcium from bones and prevents calcium from being absorbed. Note: Phosphoric acid can clean your car battery and unclog your drain.
- Studies have found a significant link between sugary drink consumption and weight gain in children. One study found that for each additional 12-ounce soda children consumed each day, the odds of becoming obese increased by 60% during 1½ years of follow-up.
The 2015 Dietary Guideline Advisory Committee released new recommendations to limit added sugars to 10% of daily calories. Right now, Americans are eating more sugar than ever before — on average, about 160 pounds a year. Sugar is everywhere, used in approximately 75% of packaged foods purchased in the US. You might be surprised to find added sugar in items such as ketchup, yogurt, barbecue sauce, pasta sauce, sauces in asian cuisine, and even salad dressing.
James DiNicolantonio is a cardiovascular research scientist at St. Luke’s Mid-America Heart Institute in Kansas City, Mo. He says that refined sugar is similar to cocaine, telling an interviewer “even when you get the rats hooked on IV cocaine, once you introduce sugar, almost all of them switch to the sugar.”
According to the New York Times, substance use disorders, defined by the Diagnostic and Statistical Manual of Mental Disorders, exist when at least 2 to 3 symptoms from a list of 11 are present. In animal models, sugar produces at least 3 symptoms consistent with substance abuse and dependence: cravings, tolerance and withdrawal.
Functional M.R.I. tests involving milkshakes demonstrate that it’s the sugar, not the fat, that people crave. Sugar is added to foods by an industry whose goal is to engineer products to be as irresistible and addictive as possible, increasing their bottom line.
Humans have evolved to desire sugar, as it helps the body to store fat, which helped humans survive winters and times of food scarcity in Paleolithic times. He explains, “You get this intense release of dopamine upon acute ingestion of sugar. After you chronically consume it, those dopamine receptors start becoming down-regulated — there’s less of them, and they’re less responsive,” he said. “That can lead to ADHD-like symptoms … but it can also lead to a mild state of depression because we know that dopamine is that reward neurotransmitter.”
For these reasons the American Academy of Pediatrics policy statement on soft drinks in schools recommends that pediatricians should work to eliminate sweetened drinks in schools.
Check out how much sugar some fast food items have compared to the percentage of recommended daily intake of sugar for preschoolers, children ages 4-8, and preteens & teens (sources: Business Insider and the American Heart Association).
Sugar in Fruit
It's different when you eat fruit. According to Julie Baker, Clinical Oncology Dietitian at Southeastern Regional Medical Center in Atlanta, Georgia, the fiber in fruit, found mainly in its skin, suppresses your appetite to prevent overeating and weight gain. The fiber in fruit slows down metabolism, as fruit in the gut expands to make you feel full. Refined sugar is stripped of the fiber, water, vitamins, minerals, and will be converted to glycogen (the form of glucose that's used for quick energy), or fat.
There's also water, vitamins, and minerals, as well as in some fruits, phenols. Phenols are a form of antioxidants that help protect your cells from free radicals, as well as some protection from heart disease, cancer, and other health issues.
And don't be fooled by artificial sweeteners. Dr. David Ludwig, an obesity and weight-loss specialist at Harvard-affiliated Boston Children’s Hospital, explains, "Non-nutritive sweeteners are far more potent than table sugar and high-fructose corn syrup. A miniscule amount produces a sweet taste comparable to that of sugar, without comparable calories. Overstimulation of sugar receptors from frequent use of these hyper-intense sweeteners may limit tolerance for more complex tastes," explains Dr. Ludwig. That means that children who consume artificial sweeteners may start to find less sweet foods unappealing. Vegetables may become inedible to them.
In other words, use of artificial sweeteners can make you shun healthy, filling, and highly nutritious foods while consuming more artificially flavored foods with less nutritional value.
How to Reduce Sugar
Start reading labels. Many foods labeled as "fat free' are filled with sugar. As you discover how many processed foods have large amounts of sugar, you'll start moving towards an overall less processed diet. You'll spend the most amount of time in the fruit and vegetable section, and the least amount of time looking for packaged foods.
If your children are used to consuming large amounts of sugar, it may take some time to reduce their sugar cravings. Replace highly processed, high sugar foods with fruits and vegetables. Fruit is both convenient and nutritious. Apples, blueberries, bananas, cherries, peaches, and many other fruits can be readily available for your children.
The American Dietary Association (ADA) claims that fruit and vegetables can help protect against obesity in children, because of their low energy density, high fiber content, and satiety value. Their evidence was stronger for fruits than it was for vegetables, but this may be influenced by the types of vegetables. One third of all vegetables in the US are iceberg lettuce, potatoes (mostly french fries), and potato chips.
Regarding 100% fruit juice, the ADA found no link between its consumption and childhood obesity, unless it was more than 12 fl oz per day.
Instead of sugary drinks, serve your children water, and you can add lemon or lime (without adding sugar). Milk or vegetable juice are also healthy options. Be careful with juicing fruit, it can contain a lot of sugar, depending on the type and amount of fruit that you use.
A interesting study from the University of California-San Francisco and Touro University put 43 volunteers, ages 9 to 18, and putting them on low-sugar diets. All of the study participants — 27 of whom identified as Latino and 16 as African American — were obese and had at least one other metabolic health issue, such as high blood pressure or a marker of fatty liver.
"All of the surrogate measures of metabolic health got better, just by substituting starch for sugar in their processed food — all without changing calories or weight or exercise," study author Robert Lustig, a pediatric endocrinologist at UCSF Benioff Children's Hospital San Francisco.
After 10 days, the researchers observed:
- a reduction in diastolic blood pressure, triglycerides and LDL, or "bad" cholesterol.
- Glucose tolerance and the amount of excess insulin circulating in the blood improved.
- Participants lost on average 2 pounds. Several children lost so much weight so quick that researchers put them on more calories.
Is Fat Good or Bad For Your Child?
You may be surprised to hear that there's not a clear connection between fat intake and obesity in children (unless you're on the Paleo diet, which generally recommends a diet that's over 50% fat). What you want to do is to avoid the bad fats and add more of the healthy fats. According to the Harvard Medical School Publications, good fats include monounsaturated and polyunsaturated fats. Bad ones include industrial-made trans fats. Saturated fats fall somewhere in the middle.
Sources of good fat include:
- Olive oil
- Nuts such as almonds, peanuts, macadamia nuts, hazelnuts, pecans, cashews, and walnuts
- Fatty fish such as salmon, tuna, mackerel, herring, trout, sardines, or sablefish
- Brussels sprouts, kale, spinach
- Sunflower, sesame, and pumpkin seeds
Bad fat includes trans fat, which have no known health benefits and that there is no safe level of consumption. A diet high in trans fats can lead to high blood pressure, obesity, and heart disease. Studies have also indicated that increased trans fat consumption may lead to Alzheimer’s disease, prostate and breast cancer, Type 2 diabetes, liver dysfunction, infertility, depression, and even aggression. So this means that any product that includes hydrogenated oil or partially hydrogenated oil is dangerous to human health. This includes:
- Most comercially-baked foods including chips, candy, microwave popcorn, cookies, crackers, cakes, muffins, pie crusts, pizza doughs, and many breads.
- Many fried foods, especially fast foods, including french fries, fish sticks, chicken nuggets, and hard taco shells. Some restaurants have switched to non-hydrogenated oil, but many have not.
- Cake mix and pancake mix
- Packaged snack foods (crackers, microwave popcorn, chips, candy)
- Solid fats (stick margarine, vegetable shortening)
- Biscuits and frozen-biscuit sandwiches
- Non-dairy creamer
- Creamy frozen drinks as well as some brands of chocolate milk
- Anything with “partially hydrogenated” oil listed in the ingredients
The problem is that even if a product claims to be trans fat-free, it may still have less than half a gram of trans fat (companies are allowed to round down, such as Crisco).
Why are trans fats so common? Hydrogenated oils and partially hydrogenated oils make the fats in foods stable so they don't melt at room temperature, and less likely to spoil at room temperature. It's cheaper than butter, lard, or palm oil, and a favorite oil for frying in restaurants.
Breakfast Skipping & Obesity
Evidence supports the view that obese children and adolescents are more likely to skip breakfast than their leaner counterparts. Obese children also have been reported to eat smaller breakfasts than their non-obese peers.
The American Academy of Pediatrics (AAP) tells us that larger portion sizes may be associated with obesity in children as it promotes excessive calorie consumption. 3 to 5-year-old children consumed 25% more of an entrée and 15% more energy at lunch when presented with portions that were twice as large as the age-appropriate standard size. A study of 16 preschool children 4 to 6 years of age found that the most powerful determinant of the amount of food consumed at meals was the amount served.
Appropriate portion sizes can be found on healthychildren.org.
Portion control strategies:
- Another strategy is to use smaller plates- the amount of food on the plate looks bigger when it's on a small plate.
- Keep food in the kitchen and off of the table to discourage overeating. Out of sight, out of mind.
- Discourage or don't allow snacking in front of the t.v. If you do allow it, don't let your kids eat directly out of the container. This leads to mindless eating and results in greater calorie consumption.
- Beware of large packages. Research shows that the larger the package, the more people consume from it without realizing it. Divide up the contents of one large package into several smaller containers to help prevent over-consumption.
Another surprise is that the American Academy of Pediatrics has found that snacking has not been found to be an important determinant of weight gain among children and adolescents. In fact, healthy snacking between meals can prevent your child from overeating during their next meal.
Evidence shows that there's a positive association between frequency of family meals and dietary quality in adolescents. Higher frequency of family meals is associated with greater intakes of fruits, vegetables, and milk and lower consumption of fried food and soft drinks. It is also associated with higher nutrient intakes (including calcium, iron, vitamins, and fiber) and lower intakes of saturated and trans fats.
Calorie-Restrictive Diets for Children
Unless under the recommendation of a physician, don't put your child on a calorie restrictive diet. Make permanent changes to their lifestyle in terms of food, exercise, and being non-sedentary, and as they get older, let them grow into their bodies.
The AAP recommends breastfeeding as there's evidence that breastfeeding has a small protective effect on later obesity.
According to the AAP, there's evidence that eating out, especially fast food, may be associated with obesity, especially with adolescents. Many restaurants serve more food than one person needs at one meal, especially when a child or adolescent orders a regular meal (not off the kids menu). A family of 4 could split 2 or 3 entrees, and use to-go boxes.
Food Storage to Reduce Consumption
Easy access to food equals greater consumption. Here are a few strategies to reduce the amount of calories your children have easy access to:
- Replace the candy dish with a fruit bowl.
- If you have calorie rich treats in your house, store cookies, chips, or ice cream, out of immediate eyesight, like on a high shelf or at the back of the freezer. Move the healthier food to the front at eye level.
- When buying in bulk, store the excess in a place that's not convenient to get to, such as a high cabinet or at the back of the pantry.
Exercise Requirements for Children
The CDC recommends 60 minutes per day of physical activity per day, which should include moderately intense aerobic activity, strengthening, as well as running and jumping (for bone strengthening). Moderate intensity can include walking, but children should also be doing more intense aerobic exercise, where their heart rate is elevated and they're breathing hard.
Regarding strength training, adolescents can lift weights but children shouldn't be. They can do exercises like push ups, leg lifts, or climbing.
Outside of exercise, children shouldn't be immobile for long periods of time. Whether they're watching t.v., doing homework, or any other sedentary activity, they should move at least a little but every 20 minutes.
Reduce Sedentary Time
A report by Common Sense, a nonprofit focused on helping children, says that teens are spending 9 hours per day on average in front of a screen. Tweens (ages 8-12), spend 6 hours per day. At school, children spend 65%-70% of their time in class sitting in down. This results in children and adolescents spending the majority of their day sedentary.
There's extensive research showing the damage that extended periods of sitting do to adults, which includes higher rates of type 2 diabetes, obesity, certain types of cancer, cardiovascular disease, and early death.
The AAP recommends that you limit the time your children watch television, play video games, or surf the web to no more than 2 hours per day. And they don't recommend television viewing for children age 2 or younger. Television viewing and having a television in the bedroom both have been associated with overweight in 1 to 5-year-old children.
In addition to children being sedentary when watching television, consider the marketing messages they are exposed to. US beverage companies spend billions of dollars marketing sugary drinks and foods. A significant portion of their ads are directed at youth ages 2-17.
Beverage companies in the US spend billions of dollars marketing carbonated beverages, with a significant portion of marketing aimed directly at youth ages 2–17. The beverage industry generally denies that its products and marketing tactics play any role in the obesity epidemic. Not surprisinglyu, studies funded by the beverage industry are 4 to 8 times more likely to show a finding favorable to industry than independently-funded studies.
Standing Desks for Children
One method that parents and schools are using to get kids to be less sedentary is to use standing desks. A study conducted and published by the Oxford Journal of Public Health showed that standing desks in children’s classrooms are effective in reducing the amount of time that children spend sitting. The study, conducted in Australia and Britain, found that the amount of sitting time dropped by 9.8% or 67 minutes each day in Britain, and in Australia by 10% or 30 minutes each day.
In a study of nearly 300 children in 2nd through 4th grade over the course of a school year, researchers found a 12% greater "on-task" engagement, or an extra seven minutes per hour of engaged instruction, in classrooms with standing desks. Engagement was measured by activities such as whether students were focused on their teacher when the teacher was speaking and raised their hands and participated in class discussions.
Alexandria Country Day School in Alexandria, Virginia, is one of the first schools in the United States to provide adjustable standing desks in every middle school classroom.
Other international research also shows the benefits of standing desks. In a study of a class of 9 to 10-year-olds in England, a bank of six standing desks was provided to students. The teacher rotated the children around each day to ensure the children were exposed to the desks for at least an hour a day.
According to a story on NBC News, nearly every classroom in the school at Vallecito Elementary School in San Rafael, California, has standing desks.
A recent study by Dr. Lu Qi, Assistant Professor in the Department of Nutrition, Harvard School of Public Health, found that among people with a genetic predisposition for obesity, those who drank sugary drinks were more likely to be obese than those who did not. This is a very significant study because it tells us that genetic risk for obesity does not need to become a reality if a good lifestyle is adopted. On the other hand, genetic obesity risk seems to be amplified by consuming sugary drinks. So a parent cannot rationalize that their child is overweight because of their genetics.
Set an Example
If you want your children to eat better, to exercise, and be less sedentary, start doing those things yourself. Parents that exercise have been associated with kids that participate in sports and increased fitness. And adult sedentary behavior is correlated with adolescent sedentary behavior.
You can walk and exercise together, prepare food together, involve them in the choices for snacks and meals. If you've struggled with your weight in the past and have been unable to keep the weight off, maybe making lifestyle changes for your kids will motivate you to stay on the right path.
Action Steps to Reduce Your Child's Chances of Obesity
- Reduce or even better, eliminate sugary drinks from their diet. Replace them with vegetable juice, milk, or water.
- 100% fruit juice is healthier than drinks with sugar added, as it contains nutrients, but contains sugar as well. According to the AAP, limit consumption by age:
- Birth to 6 months. No fruit juice, unless it's used to relieve constipation.
- 6 to 12 months. If juice is given, limit it to 4 to 6 ounces (118 to 177 milliliters) and serve it in a cup (not a bottle) to avoid tooth decay.
- 1 to 6 years. Up to 6 ounces (177 milliliters) a day.
- 7 years and older. Up to 12 ounces (355 milliliters) a day.
- Experiment with different ways to make foods that you currently eat healthier. A google search or search on pinterest can give you options that may be even tastier and healthier than what you're currently consuming. Instead of potato chips, try peppers, celery, or other vegetables with hummus.
- Make sure your children are eating a diet with balanced macronutrients (energy from fat, carbohydrates, and protein in age-appropriate proportions.)
- Get in the habit of reading labels. It will take time, but you'll need to replace some of your current selections with healthier options. If you're looking for a new way to make a recipe, you can search for paleo options (they're always low in sugar). For example, you can google "paleo pancakes."
- Avoid artificial sweeteners.
- Don't eat out as much, and when you do, provide snacks before dinner.
- Pack their lunch when they go to school (school lunch options are sometimes high in calories and low in nutrition).
- Instead of frying, roast, grill, or saute meats and vegetables.
- Breastfeeding is recommended to help prevent obesity.
- Use to-go boxes when eating out.
- Don't skip breakfast.
- Pay attention to portions. Give your child smaller portions, and they'll tend to eat less.
- Eat together as a family.
- When eating in, serve food on a plate, and don't keep the serving dishes on the table, which encourage higher consumption.
- When snacking, to reduce the amount of calories ingested, don't let your kids eat straight out of the package.
- Keep unhealthy snacking foods out of sight and in harder to reach places, and healthy snacks out in the open.
- Enroll your child in activities that they enjoy and gets them moving: martial arts, dance, team sports, swimming, etc. They should be exercising 60 minutes per day (it doesn't have to be all in one session).
- Have your child use a standing desk.
- Limit t.v. and screen time to 2 hours per day, and no t.v. time for those 2 and under.
- Make sure your child is moving every 20 minutes to break up sedentary periods.
- Set a good example for your children by limiting your sedentary behavior and exercising.
A list of apps for tracking sugar consumption, calories, and fitness:
- track sugar intake for Apple iOS
- track sugar intake for Android
- diet apps for Apple iOS
- diet apps for Android
Tips for teachers from the CDC on how to promote healthy eating and exercise in their classrooms.
Follow the CDC on twitter @CDCObesity.