Story at a glance
- A number of factors, from screen use to a lack of access to healthy food, have been linked with high obesity rates — and many were supercharged by the COVID-19 pandemic.
- The rising rates increase the risks of diabetes, cardiovascular disease and other chronic conditions.
- Experts say both individual behavioral changes and public health interventions are needed to address the rise.
Rates of childhood obesity in the United States have tripled in the past three decades, and early data suggest already surging rates were further exacerbated by the COVID-19 pandemic.
Experts and advocates warn this could have significant long-term impacts on everything from the toll of chronic disease to military recruitment.
To help address the crisis, the U.S. Department of Agriculture (USDA) recently updated its nutrition standards for school lunches, and the American Academy of Pediatrics issued new guidelines for treating childhood obesity — its first updated comprehensive guidance on the subject in 15 years.
However, as more children gain weight at younger ages, and racial and economic disparities persist, more action may be needed to prevent rates from rising even further. And experts stress that efforts to treat obesity in children should also take mental health into account to avoid worsening another concern: the risk of developing eating disorders.
What’s causing rates to rise
The Centers for Disease Control and Prevention (CDC) defines childhood obesity as a body mass index (BMI) at or above the 95th percentile. Although BMI, which measures overall weight and not body fat specifically, is an imperfect metric, it is widely used to diagnose obesity.
In the early 1960s around 5 percent of U.S. children and teens were obese. By 2019, that total rose to 19 percent.
Should current trends continue, some reports estimate 57 percent of children between the ages 2 and 19 will be obese as adults in 2050.
More severe levels of obesity are also on the rise, explained Solveig Cunningham, an associate professor of global health at Emory University’s Rollins School of Public health.
“The average child with obesity is heavier than he or she would have been even 12 years ago,” Cunningham told Changing America.
The increase seems to have picked up still more momentum in the last three years: Although researchers are still working to get a full picture of the impact of COVID-19 on childhood obesity, some data suggest the rate of BMI increase nearly doubled during the pandemic compared with the period preceding it. The increase was most pronounced among younger children, and those who were already obese or overweight.
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There’s no one reason why rates are climbing.
“[Obesity] is a complex, chronic medical condition. There’s lots of factors that are playing a role,” said Crystal Lim, a pediatric psychologist and associate professor at the University of Missouri.
Researchers have tied an increased risk of childhood obesity to a wide range of factors, from structural racism to a rise in sedentary lifestyles.
And the COVID-19 pandemic supercharged some of the issues that led to high childhood obesity rates in the first place, explained Erica Kenney, assistant professor of public health nutrition at Harvard’s T.H. Chan School of Public Health.
School closures meant more children were stuck at home, engaging in more sedentary behavior. “A lot of parents, myself included, had to turn to more screen time than they probably would have under normal circumstances,” said Kenney.
Even high levels of physical activity do not offset obesity risk among youth who spend eight or more hours a day looking at screens, research shows.
The rise in screen use could have also exposed children to more food advertising, “which we know is associated with extra weight gain in kids and consumption of ultra processed foods and sugary drinks,” Kenney said.
It’s estimated four in every 10 child-influencer videos on YouTube contain branded food or beverages, with candy brands appearing the most often.
Additionally, for children who received free or reduced-price meals at school, the transition to a virtual setting could have worsened cost or access barriers to healthy food, explained Lim, the pediatric psychologist. A lack of access to food on a consistent basis is associated with an increased risk of becoming overweight and obese, she added.
Where a child grows up, household income and structural racism contribute to obesity risk as well.
Childhood obesity tends to be more prevalent in rural and underserved areas of the country with limited access to affordable, healthy food.
“A lot of families I’ve worked with in rural areas are concerned about kids being more active outside,” said Lim. “There’s no sidewalks, it’s dark. It’s not as safe, maybe, for kids to be active outside.”
Hispanic and Black youth have higher rates of obesity compared with white youth. Although the rate has somewhat plateaued for Hispanic children over the past 15 years “it has continued to go much, much higher for African American kids,” said Cunningham.
Historic redlining influences the availability of affordable healthy food in certain neighborhoods, along with access to play areas and greenspace for physical activity.
Genetic and biological factors, like whether a mother has gestational diabetes, can also increase the risk of obesity before a child is born.
“People who have obesity and diabetes are at higher risk of having children who will also have earlier onset of obesity and diabetes,” explained Cunningham.
The health toll of obesity
Obesity raises the risk of diabetes, cardiovascular disease, sleep apnea, certain cancers and other physical and mental health conditions.
The rise in severe levels of obesity means more kids are shifting into areas with “much, much higher risks, especially of diabetes and cardiovascular disease,” said Cunningham.
Earlier development of obesity means longer exposure to its consequences and increased risks of developing other co-morbidities, she added.
And as more people suffer from chronic diseases as a result of high obesity rates, that rise could in turn also rack up health care costs and increase stress on an already strained health care system.
Should the nation fail to adequately address the rise, one of the big concerns from a policy standpoint is that there will be uncontrolled health care costs as a result, Kenney explained.
It’s estimated obesity already costs the nation’s health system around $173 billion annually.
Impact on military readiness
In addition to costs and disease burden, advocates are raising alarms about the crisis’s impact on the military.
More than three-quarters of young American adults cannot currently qualify for military service without a waiver. Eleven percent of these individuals are disqualified from serving if they so choose due to being overweight, and it is also a factor for 44 percent who are disqualified for multiple reasons, data from the Pentagon’s 2020 Qualified Military Available Study show.
According to the CDC, just 2 in 5 young adults meet weight eligibility requirements and are adequately active to prepare themselves for basic training.
Last year the U.S. Army missed its recruitment goal by 15,000 soldiers thanks to disqualifiers like drug use, mental health and obesity.
“Physical health challenges, including obesity, prevent far too many young Americans from reaching their dreams. For many young people, those dreams include serving their country in uniform,” said Lt. Gen. Norm Seip, U.S. Air Force, retired, in a Mission: Readiness statement on the Pentagon’s findings.
The organization, part of the Council for a Strong America, is made up of retired admirals, generals and military leaders advocating for public policy solutions to strengthen national security by investing in the nation’s youth.
“Investments that bolster the health and nutrition of our children are critical to national security and the future strength of our country,” Seip said.
Updated nutrition standards
Just as there are many factors that contribute to obesity, experts say a number of different actions will be needed to combat the rising rates.
“We need prevention and treatment at multiple levels,” said Lim.
Cutting back on added sugar, especially the intake of sugary drinks, can make a big difference, experts say.
A new report from the CDC found that in 2021, more than 30 percent of children did not eat a piece of fruit each day during the preceding week and nearly half did not eat a vegetable daily. However, 57 percent reported drinking a sugar-sweetened beverage at least once during the previous week.
The latest USDA standards target added sugars and sodium in school lunches, and recommend more whole grains. Boosts in nutrition standards for school lunches have been shown to help curb the rise in obesity among children.
The standards are “a good step from a policy and implementation standpoint, in terms of increasing access to healthier foods for kids,” said Lim.
But when it comes to federal policies “the way that they’re implemented in the school setting is really variable and really dependent on resources,” she added.
“I think these policies are important. We also just need to be mindful that they need to have funding tied to them as well, especially for under-resourced settings.”
New treatment guidelines and mental health concerns
In addressing the rising rates, experts say it’s crucial that intervention and prevention programs take children’s mental health into account to help address the stigma around obesity and to more holistically treat the condition.
The new American Academy of Pediatrics guidelines have raised concerns on that score.
The guidelines recommend moving away from a “watch and wait” strategy for children with obesity and say state providers can consider medication interventions for youth as young as 12 and surgery for those as young as 13 in certain cases.
The guidelines have been met with some criticism, as some are concerned they could increase the risk of eating disorders among children. Individuals with higher weights are already at a greater risk of developing eating disorders.
Explicit focus on weight could also perpetuate stigma around obesity and increase body dissatisfaction among vulnerable youth.
“There’s so much stigma related to overweight and obesity. It’s the number one reason kids are teased and bullied in schools,” said Lim.
“But they also experience weight stigma in the health care setting and in their own families, by family members. So helping everybody be more sensitive and aware is so important.”
When it comes to treating children with intensive pharmacological interventions or surgery, “having it paired with mental health support is going to be really important,” said Kenney.
However, interventions that encourage healthy behaviors for their own sake could improve children’s physical health without focusing on weight loss, experts say.
Healthy nutrition and physical activity are good for everybody, said Kenney. “It isn’t just about weight when you want to eat healthfully or be physically active. It’s about your overall health and well being.”
Increasing exposure to healthy food options at school can play a big role, while parents and teachers can also model healthy behaviors for children.
These can include being more positive about their own bodies and asking children what they like about their body.
“We spend a lot of time talking about things we don’t like or things we want to change [about our bodies],” Lim said. “Helping even parents model [positive behaviors] for their kids is really important.”
Addressing root causes
The myriad of determinants for childhood obesity creates an opportunity to address root causes that could have meaningful impacts in the future at the population level.
From a public health perspective, tackling easy access to cheap, ultra-processed food, the lack of physical activity opportunities for kids and overall food insecurity resulting from household income disparities is crucial on a societal level, said Kenney.
“We should be addressing some of these root causes, so that down the line, everybody can be healthier,” she said.
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