Perspectives on childhood obesity


The high prevalence of overweight and obesity in children in the United States over the past 30 years makes it a topic of great interest. This article reviews the current understanding of childhood obesity, including its causes, effects, persistence into adulthood, and treatment. Societal and familial influences are addressed, as well as genetic factors.

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References and Recommended Reading

  1. 1.

    Rodin J: Cultural and psychosocial determinants of weight concerns. Ann Intern Med 1993, 119:643–645.

    PubMed  CAS  Google Scholar 

  2. 2.

    Kuczmarski RJ, Ogden CL, Grummer-Strawn LM, et al.: CDC Growth Charts: United States [Advance Data from Vital and Health Statistics, no. 314]. Washington, DC: National Center for Health Statistics; 2000.

    Google Scholar 

  3. 3.

    Barlow SE, Dietz WH: Evaluation and treatment of pediatric obesity: recommendations from an Expert Committee. Pediatrics 2002, in press. The Expert Committee’s recommendations provide an excellent summary of the clinician’s and specialist’s approach to defining and treating childhood obesity. The importance of family and behavioral interventions are highlighted.

  4. 4.

    Centers for Disease Control and Prevention: Update: prevalence of overweight among children, adolescents, and adults — United States, 1988–1994. MMWR 1997, 46:199–202.

    Google Scholar 

  5. 5.

    Gortmaker SL, Dietz WH, Sobol AM, Wehler CA: Increasing pediatric obesity in the United States. Am J Dis Child 1987, 141:535–540.

    PubMed  CAS  Google Scholar 

  6. 6.

    Troiano R, Flegal KM, Kuczmarski RJ, Campbell SM, Johnson CL: Overweight prevalence and trends for children and adolescents. The National Health and Nutrition Examination Surveys 1963 to 1991. Arch Pediatr Adolesc Med 1995, 149:1085–1091.

    PubMed  CAS  Google Scholar 

  7. 7.

    Ogden CL, Troiano RP, Briefel RR, et al.: Prevalence of overweight among preschool children in the United States, 1971 through 1994. Pediatrics 1997, 99:e1.

    PubMed  Article  CAS  Google Scholar 

  8. 8.

    Mei Z, Scanlon KS, Grummer-Strawn LM, et al.: Increasing prevalence of overweight among US low-income preschool children: the Centers for Disease Control and Prevention Pediatric Nutrition Surveillance, 1983 to 1995. Pediatrics 1998, 101:e12.

    PubMed  Article  CAS  Google Scholar 

  9. 9.

    Strauss RS, Pollack HA: Epidemic increase in childhood overweight, 1986–1998. JAMA 2001, 286:2845–2848.

    PubMed  Article  CAS  Google Scholar 

  10. 10.

    Gauthier BM, Highner JM, Ornstein S: High prevalence of overweight children and adolescents in the Practice Partner Research Network. Arch Pediatr Adolesc Med 2000, 154:625–628.

    PubMed  CAS  Google Scholar 

  11. 11.

    Melnick TA, Jesaitis AT, Wales KR, Bonam SB: Prevalence of overweight among third-and sixth-grade children — New York City, 1996. MMWR 1998, 47:980–984.

    Google Scholar 

  12. 12.

    Garn SM, LaVelle M: Two-decade follow-up of fatness in early childhood. Am J Dis Child 1985, 139:181–185.

    PubMed  CAS  Google Scholar 

  13. 13.

    Whitaker RC, Wright JA, Pepe MS, et al.: Predicting obesity in young adulthood from childhood and parental obesity. N Engl J Med 1997, 337:869–873. This study provides the most comprehensive assessment of the persistence of childhood obesity from infancy to adulthood. Understanding which children are likely to remain obese is critical for determining the appropriate timing for both treatment and prevention.

    PubMed  Article  CAS  Google Scholar 

  14. 14.

    Dietz WH: Critical periods in childhood for the development of obesity. Am J Clin Nutr 1994, 59:955–959. A thorough review of the concept of critical periods to the development of childhood obesity. Identifying developmental periods when children are at highest risk for becoming obese is essential for targeting preventive and treatment efforts. Data supporting increased risk of obesity during the prenatal period, adiposity rebound, and adolescence are highlighted.

    PubMed  CAS  Google Scholar 

  15. 15.

    Mellits ED, Cheek DB: The assessment of body water and fatness from infancy to adulthood. Monogr Soc Res Child Dev 1970, 35:12–26.

    PubMed  Article  CAS  Google Scholar 

  16. 16.

    Garn SM, Cole PE: Do the obese remain obese and the lean remain lean? Am J Public Health 1980, 70:351–353.

    PubMed  CAS  Google Scholar 

  17. 17.

    Bouchard C, Tremblay A, Depres JP, et al.: The response to long-term overfeeding in identical twins. N Engl J Med 1990, 332:14777–14782.

    Google Scholar 

  18. 18.

    Bouchard C, Perusse L: Genetics of obesity. Ann Rev Nutr 1993, 13:337–354.

    Article  CAS  Google Scholar 

  19. 19.

    Stunkard AJ, Harris JR, Pedersen NL, McClearn GE: The body-mass index of twins who have been reared apart. N Engl J Med 1990, 322:1483–1487.

    PubMed  CAS  Article  Google Scholar 

  20. 20.

    Stunkard AJ, Sorensen TIA, Hanis C, et al.: An adoption study of human obesity. N Engl J Med 1986, 314:193–198.

    PubMed  CAS  Article  Google Scholar 

  21. 21.

    Sallis JF, Patterson TL, Buono MJ, et al.: Aggregation of physical activity habits in Mexican-American and Anglo families. J Behav Med 1988, 11:31–41.

    PubMed  Article  CAS  Google Scholar 

  22. 22.

    Heath GW, Pratt M, Warren CW, Kann L: Physical activity patterns in American high school students. Arch Pediatr Adolesc Med 1994, 148:1131–1136.

    PubMed  CAS  Google Scholar 

  23. 23.

    Janz KF, Golden JC, Hansen JR, Mahoney LT: Heart rate monitoring of physical activity in the Muscatine study. Pediatrics 1992, 89:256–261.

    PubMed  CAS  Google Scholar 

  24. 24.

    Livingstone BE, Coward WA, Prentice AM, et al.: Daily energy expenditure in free-living children: comparison of heart-rate monitoring with the double labeled water method. Am J Clin Nutr 1992, 56:343–352.

    PubMed  CAS  Google Scholar 

  25. 25.

    Strauss RS, Rodzilsky, Burak G, Colin M: Psychosocial correlates of physical activity in healthy children. Arch Pediatr Adolesc Med 2001, 155:897–902.

    PubMed  CAS  Google Scholar 

  26. 26.

    U.S. Department of Transportation, Federal Highway Administration, Research and Technical Support Center: National Personal Transportation Survey. Lantham, MD: Federal Highway Administration; 1997.

    Google Scholar 

  27. 27.

    Promoting Better Health for Young People Through Physical Activity and Sports: A Report to the President from the Secretary of Health and Human Services and the Secretary of Education. Washington, DC: Department of Health and Human Services; 2000.

  28. 28.

    Gordon-Larsen P, McMurray RG, Popkin BM: Determinants of adolescent physical activity and inactivity patterns. Pediatrics 2000, 105:E83.

    PubMed  Article  CAS  Google Scholar 

  29. 29.

    Dietz WH, Gortmaker SL: Do we fatten our children at the television set? Obesity and television viewing in children and adolescents. Pediatrics 1985, 75:807–812.

    PubMed  Google Scholar 

  30. 30.

    Dietz WH, Gortmaker SL: TV or not TV: fat is the question. Pediatrics 1993, 91:499–501.

    PubMed  CAS  Google Scholar 

  31. 31.

    Gortmaker SL, Must A, Sobol AM, et al.: Television viewing as a cause of increasing obesity among children in the United States, 1986–1990. Arch Pediatr Adolesc Med 1996, 150:356–362.

    PubMed  CAS  Google Scholar 

  32. 32.

    Harnack L, Stang J, Story M: Soft drink consumption among US children and adolescents: nutritional consequences. J Am Diet Assoc 1999, 99:436–441.

    PubMed  Article  CAS  Google Scholar 

  33. 33.

    Ludwig DS, Peterson KE, Gortmaker SL: Relation between consumption of sugar-sweetened drinks and childhood obesity: a prospective, observational analysis. Lancet 2001, 357:505–508. This large prospective study highlights the importance of excessive soda intake in the development of childhood obesity. Clinically, it is not unusual to find obese children drinking in excess of 32 to 64 oz of soda or juice per day.

    PubMed  Article  CAS  Google Scholar 

  34. 34.

    Bandini L, Schoeller DA, Cyr HN, Dietz WH: Validity of reported energy intake in obese and nonobese adolescents. Am J Clin Nutr 1990, 52:421–425. A classic study documenting underreporting of caloric intake among obese children.

    PubMed  CAS  Google Scholar 

  35. 35.

    Bruch H: Emotional aspects of obesity in children. Pediatr Ann 1975, 4:91–99. An excellent and insightful overview of the emotional burden of childhood obesity. Although written over 25 years ago, Bruch’s observations remain insightful and fresh.

    Google Scholar 

  36. 36.

    Strauss RS, Knight J: The role of the home environment and socioeconomic factors in the development of childhood obesity. Pediatrics 1999, 103:e85.

    PubMed  Article  CAS  Google Scholar 

  37. 37.

    Birch LL: The relationship between children’s food preferences and those of their parents. J Nutr Educ 1980, 12:14–18.

    Google Scholar 

  38. 38.

    Klesges RC, Stein RJ, Eck LH, et al.: Parental influence on food selection in young children and its relationships to childhood obesity. Am J Clin Nutr 1991, 53:859–864.

    PubMed  CAS  Google Scholar 

  39. 39.

    Harper LV, Sanders KM: The effect of adults eating on young children’s acceptance of unfamiliar foods. J Exp Child Psychol 1975, 20:206–214.

    Article  Google Scholar 

  40. 40.

    Fisher JO, Birch LL: Fat preferences and fat consumption of 3-to 5-year old children are related to parent adiposity. J Am Diet Assoc 1995, 95:759–764.

    PubMed  Article  CAS  Google Scholar 

  41. 41.

    Perusse L, Tremblay A, Leblanc C, et al.: Familial resemblance in energy intake: contribution of genetic and environmental factors. Am J Clin Nutr 1988, 47:629–635.

    PubMed  CAS  Google Scholar 

  42. 42.

    Kelder SH, Perry CL, Klepp KI, Lytlle LL: Longitudinal tracking of adolescent smoking, physical activity, and food choice behaviors. Am J Public Health 1994, 84:1121–1126.

    PubMed  CAS  Article  Google Scholar 

  43. 43.

    Johnson SL, Birch LL: Parents‘ and children’s adiposity and eating style. Pediatrics 1994, 94:653–661. A study of the influence of parents‘ feeding style and their children’s ability to regulate their own food intake. Young girls whose parents are overly restrictive in their feeding style are much less able to regulate their caloric intake than are other children. This is a very interesting hypothesis and a study that needs to be replicated.

    PubMed  CAS  Google Scholar 

  44. 44.

    Sallis JF, Alcaraz JE, McKenzie TL, et al.: Parental behavior in relation to physical activity and fitness in 9-year-old children. Am J Dis Child 1992, 146:1383–1388.

    PubMed  CAS  Google Scholar 

  45. 45.

    Moore LL, Lombardi DA, White MJ, et al.: Influence of parents‘ physical activity levels on activity levels of young children. J Pediatr 1991, 118:215–219.

    PubMed  Article  CAS  Google Scholar 

  46. 46.

    Monello L, Mayer J: Obese adolescent girls: unrecognized ‘minority’ group? Am J Clin Nutr 1963, 13:3.

    Google Scholar 

  47. 47.

    Erickson S, Robinson T, Haydel K, Killen J: Are overweight children unhappy? Body mass index, depressive symptoms, and overweight concerns in elementary school children. Arch Pediatr Adolesc Med 2000, 154:931–935.

    PubMed  CAS  Google Scholar 

  48. 48.

    Allon N: Self-perceptions of the stigma of overweight in relationship to weight losing patterns. Am J Clin Nutr 1979, 32:470–480.

    PubMed  CAS  Google Scholar 

  49. 49.

    Sallade J: A comparison of psychological adjustment of obese vs. non-obese children. J Psychosom Res 1973, 17:89–96.

    PubMed  Article  CAS  Google Scholar 

  50. 50.

    Strauss C, Smith K, Frame C, Forehand R: Personal and interpersonal characteristics associated with childhood obesity. J Ped Psychiat 1985, 10:337–43.

    Article  CAS  Google Scholar 

  51. 51.

    Strauss R: Childhood obesity and self-esteem. Pediatrics 2000, 105:e15.

    PubMed  Article  CAS  Google Scholar 

  52. 52.

    Kilpatrick S, Sanders D: Body image stereotypes: a developmental comparison. J Genet Psychol 1978, 132:87–95.

    Google Scholar 

  53. 53.

    Caskey S, Felker D: Social stereotyping of female body image by elementary school age girls. Res Q 1971, 42:251–255.

    PubMed  CAS  Google Scholar 

  54. 54.

    Richardson S, Hastorf A, Goodman N, Dornbusch S: Cultural uniformity in reaction to physical disabilities. Am Sociol Rev 1961, 26:241–247. A landmark study demonstrating that children prefer to be friends with almost everyone else compared with obese children. Although the methodology may not be current or validated, the message delivered by this study is strong and worrisome.

    Article  Google Scholar 

  55. 55.

    Canning H, Mayer J: Obesity: its possible effect on college acceptance. N Engl J Med 1966, 275:1172–1174.

    Article  Google Scholar 

  56. 56.

    Gortmaker S, Must A, Perrin J, et al.: Social and economic consequences of overweight in adolescence and young adulthood. N Engl J Med 1993, 329:1008–1012.

    PubMed  Article  CAS  Google Scholar 

  57. 57.

    Moran JR, Ghishan FK, Halter SA, Greene HL: Steatohepatitis in obese children: a cause of chronic liver dysfunction. Am J Gastroenterol 1983, 78:374–377.

    PubMed  CAS  Google Scholar 

  58. 58.

    Baldridge AD, Perez-Atayde AR, Graeme-Cook F, et al.: Idiopathic steatohepatitis in childhood: a multicenter retrospective study. J Pediatr 1995, 127:700–704.

    PubMed  Article  CAS  Google Scholar 

  59. 59.

    Kinugasa A, Tsunamoto K, Furukawa N, et al.: Fatty liver and its fibrous changes found in simple obesity of children. J Pediatr Gastroenterol Nutr 1984, 3:408–414.

    PubMed  CAS  Article  Google Scholar 

  60. 60.

    Tominaga K, Kurata JH, Chen YK, et al.: Prevalence of fatty liver in Japanese children and relationship to obesity. Dig Dis Sci 1995, 40:2002–2009.

    PubMed  Article  CAS  Google Scholar 

  61. 61.

    Strauss RS, Barlow SE, Dietz WH: Prevalence of abnormal liver enzymes in obese and very obese adolescents. J Pediatr 2000, 136:727–733. This report is from the largest epidemiologic study of the prevalence of abnormal liver enzymes in overweight and normal-weight children. Other studies documenting much higher levels of prevalence have relied on either clinic or referral populations. Although the estimates in this study are somewhat lower than in other studies (6% to 10% vs 20% to 30%), overweight and obesity are, nevertheless, the most common cause of increased elevations in liver function in American children.

    PubMed  Article  CAS  Google Scholar 

  62. 62.

    Powell EE, Cooksley WG, Hanson R, et al.: The natural history of nonalcoholic steatohepatitis: a follow-up of forty two patients for up to 21 years. Hepatology 1990, 11:74–80.

    PubMed  Article  Google Scholar 

  63. 63.

    Lee RG: Nonalcoholic steatohepatitis: a study of 49 patients. Hum Pathol 1989, 20:594–598.

    PubMed  Article  CAS  Google Scholar 

  64. 64.

    Bacon BR, Farahvash MJ, Janney CG, Neuschwander-Tetri BA: Nonalcoholic steatohepatitis: an expanded clinical entity. Gastroenterology 1994, 107:1103–1109.

    PubMed  CAS  Google Scholar 

  65. 65.

    Lavine JE: Vitamin E treatment of nonalcoholic steatohepatitis in children: a pilot study. J Pediatr 2000, 136:734–738.

    PubMed  Article  CAS  Google Scholar 

  66. 66.

    Soper RT, Mason EE, Printen KJ, Zellweger H: Gastric bypass for morbid obesity in children and adolescents. J Pediatr Surg 1975, 10:51–58.

    PubMed  Article  CAS  Google Scholar 

  67. 67.

    Anderson AE, Soper RT, Scott DH: Gastric bypass for morbid obesity in children and adolescents. J Pediatric Surg 1980, 15:876–881.

    Article  CAS  Google Scholar 

  68. 68.

    Webber LS, Osganian SK, Feldman HA, et al.: Cardiovascular risk factors among children after a 2 1/2 year intervention: the CATCH study. Prevent Med 1996, 25:432–441.

    Article  CAS  Google Scholar 

  69. 69.

    Luepker RV, Perry CL, McKinlay SM, et al.: Outcomes of a field trial to improve children’s dietary patterns and physical activity (CATCH). JAMA 1996, 275:768–776.

    PubMed  Article  CAS  Google Scholar 

  70. 70.

    Robinson TN: Reducing children’s television viewing to prevent obesity: a randomized controlled trial. JAMA 1999, 82:1561–1567.

    Article  Google Scholar 

  71. 71.

    Whitaker RC, Wright JA, Koepsell TD, et al.: Randomized intervention to increase children’s selection of low-fat foods in school lunches. J Pediatr 1994, 125:535–540.

    PubMed  Article  CAS  Google Scholar 

  72. 72.

    Gortmaker SL, Peterson K, Wiecha J, et al.: Reducing obesity via a school-based interdisciplinary intervention among youth: Planet Health. Arch Pediatr Adolesc Med 1999, 153:409–418.

    PubMed  CAS  Google Scholar 

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Strauss, R. Perspectives on childhood obesity. Curr Gastroenterol Rep 4, 244–250 (2002).

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  • Physical Activity
  • Obesity
  • Gastric Bypass
  • Childhood Obesity
  • Overweight Child