By Mylika Scatliffe,
AFRO Women’s Health Writer
What is obesity?
According to the Oxford English dictionary obesity is “the condition in which excess fat has accumulated in the body, mostly in the subcutaneous tissues.” The Centers for Disease Control and Prevention (CDC) defines obesity as an adult with a body mass index (BMI) of 30 or higher.
According to the CDC, “Obesity is a complex disease that occurs when an individual’s weight is higher than what is considered healthy for his or her height. It affects children as well as adults.”
September is National Childhood Obesity Awareness Month. Sponsored by the CDC’s Division of Nutrition, Physical Activity, and Obesity, its observance provides citizens opportunities to learn more about what has developed into a major public health concern. As reported by the CDC, obesity affected about five percent of children and adolescents aged 2-19 between 1971 and 1974. For the years 2017-2020, it skyrocketed to 19.7 percent.
That is 14.7 million children living with a chronic medical condition that has been stigmatized for decades.
“A multitude of factors are related to the increase in childhood obesity rates, but in terms of awareness we need to change the narrative that obesity is a disease of choices and blame,” said Dr. Nakiya Showell, a general pediatrician and medical director of the Johns Hopkins Harriet Lane Clinic in Baltimore, Md.
Numerous changes in today’s environments compared to 50 years ago, especially for minoritized and marginalized populations, contribute to the pediatric obesity rate. Children living in disadvantaged conditions are faced with more limited access to healthy food and less safe, accommodating play spaces.
“Frankly, we also have to recognize the practice of the targeted marketing of unhealthy foods in certain regions and for certain populations. It’s a well-known fact,” said Showell.
As reported by the National Institutes of Health, “Black youth are exposed to 86 to 119 percent more food/beverage TV ads than their white peers, and the majority of these ads are for products high in fat, sugar, and salt…Food ads targeting Black youth are often embedded with cultural features intended to appeal to Black individuals…these ads may feature Black actors, celebrities, music or other activities perceived to align with Black cultural preferences or values.”
For families living in areas where the only high-quality food is too expensive or in food deserts where grocery stores might be several miles away, healthy eating becomes a matter of choice, or more accurately, not enough adequate choices. Showell lives close to Hopkins in Baltimore city.
“We’re the country’s number one school of public health, a major health system and employer, yet an easily accessible grocery store in this area is missing,” Showell said.
Pediatricians calculate a child’s BMI and determine where it falls on the BMI for age growth chart. Using this chart, the doctor determines a child’s percentile, which is where he or she compares with other children of the same sex and age. For example, a child in the 70th percentile means that 70 percent of children of the same sex and age have a lower BMI. Children in the 95thpercentile are classified as obese and those in the 99th percentile, severely obese.
There are also increases in obesity related health conditions.
“As the prevalence of obesity in children has risen, so have comorbidities including obstructive sleep apnea, type 2 diabetes or evidence of insulin resistance, high blood pressure, and high cholesterol,” said Showell.
“Stressful conditions in daily living environments contribute to high obesity levels, particularly in marginalized and minoritized communities. Stress drives cortisol – the hormone that regulates your body’s response to stress. This promotes weight gain,” Showell continued.
What are some ways to combat childhood obesity?
According to the American Academy of Pediatrics (AAP), “Obesity can be treated successfully with the recognition that complex genetic, physiologic, socioeconomic, and environmental factors are at play.”
As with many other chronic health conditions, combatting childhood obesity is best handled with a comprehensive approach.
Weigh Smart® is an interdisciplinary program at the Mt. Washington Pediatric Hospital in Baltimore. Between 300-400 children have been evaluated annually since its inception in 2007. Its mission is to address childhood obesity using a family-focused approach.
“We are committed to tackling obesity as a public health issue,” said Michelle Demeule-Hayes, director of Weigh Smart® and a registered dietitian.
“We’ve always been committed to addressing the many issues that plague children here in Baltimore, one of which is the higher rates at which our African American and Hispanic populations are affected by childhood obesity,” Demeule-Hayes continued.
Demeule-Hayes pointed to some societal changes and environmental factors that contribute to childhood obesity reaching the level of a public health crisis.
“Portion sizes are much bigger than they used to be. Physical education is no longer the norm in many schools eliminating built in time for daily exercise. Kids are not playing outside as they did in the past; add to that the dramatic increase in screen time,” said Demeule-Hayes.
At Weigh Smart®, parents and children attend group programs, learn about nutrition and physical activity, and exercise together under medical supervision. The average participant’s age is 12-years old, and the average weight is 200 pounds.
The group program is eight weeks long and once completed, children have clinical follow ups every three months to monitor progress and prevent relapse. Virtual and individual one-on-one sessions are also offered to meet the varying needs of families.
Earlier this year, Jennifer Armenteros of Baltimore, became concerned with her son Ryan’s weight gain. At age nine, he was already five feet, two inches tall and 220 pounds.
“He was always at the top of the weight and height charts for his age, but I recently noticed he was gaining weight too quickly,” said Armenteros. “I also noticed that we were passing along some bad habits.”
“Me and my husband both have busy schedules. Prior to Covid, we were working long hours, and I was commuting to D.C. every day. We were eating a lot of fast food because it’s easier than going to the grocery store and cooking after a long day,” Armenteros added.
Armenteros and her husband had been looking into other remedies like joining a gym and dieting but didn’t really know where to start. Then they were referred to Weigh Smart® by a friend.
“Joining Weigh Smart® was the kick start for our family to implement changes in our lifestyle,” said Armenteros. “I realized Ryan will eat whatever we have in the house. He’s not providing the food, we are. If we make sure to have nutritious food in the house, that’s what he’ll eat.”
Ryan was personally motivated to make some changes after experiencing bullying from classmates. Now 10-years-old, Ryan is using what he’s learned in the nutrition classes at Weigh Smart® and has discovered a new passion for cooking.
“Now he’s really enthusiastic about eating healthy meals, especially when he’s had a hand in the preparation and cooking,” said Armenteros.
Ryan is now five feet, six inches tall and 200 pounds. He gets regular exercise by swimming and working out at the fitness facilities at the YMCA with his parents.
“I’d definitely recommend the Weigh Smart® program to other families,” said Armenteros.
Ways To Combat Childhood Obesity
In February 2023, the AAP published a comprehensive guidance that highlights the safety and effectiveness of obesity treatment.
“Research tells us that we need to take a close look at families — where they live, their access to nutritious food, health care and opportunities for physical activity–as well as other factors that are associated with health, quality-of- life outcomes and risks,” according to Dr. Sarah Hampl in the AAP.
Demeule-Hayes outlined how past guidelines directed treatment.
“We had this four-stage approach where the pediatrician would start with prevention classes, decreasing sugary beverages, and screen time and have the child come back to the doctor after three months’ time to reassess their weight gain,” said Demeule-Hayes.
“If children were still gaining in three to six months’ time, there would be a referral to a dietitian or exercise physiologist. The next recommendation would be a multidisciplinary approach like Weigh Smart® and the last stage was essentially medications or bariatric surgery,” Demeule-Hayes continued.
“With the new guidelines, we can intervene with surgery and medications much earlier, when children are as young as 12 or 13,” said Demeule-Hayes.
Surgery and medication aren’t the first lines of approach, but if needed, these interventions can be used much earlier instead of a watch and wait approach.
Demeuele-Hayes outlined to the AFRO early ways to combat childhood obesity which include limiting juices and sugary drinks, promoting healthy lifestyles and eating choices as a family and encouraging children to maintain an hour of exercise per day.
These solutions also include parents promoting a positive, healthy image to serve as role models to the healthy behaviors for their children. Demeuele-Hayes also stated that stopping childhood obesity begins at birth during breastfeeding.
“Breastfed versus bottle fed babies tend to have a lower BMI. Early introduction of solid foods correlate to higher BMIs later in life,” said Demeule-Hayes.