The Chubby American Child -- a Growing Problem

Between 5-25% of children and teenagers in the United States are obese (Dietz, 1983). As with adults, the prevalence of obesity in the young varies by ethnic group. It is estimated that 5-7% of White and Black children are obese, while 12% of Hispanic boys and 19% of Hispanic girls are obese (Office of Maternal and Child Health, 1989).

Obesity is a growing problem in the United States and most of the time it begins in childhood. The way a child is taught to eat at an early age will effect how he/she eats as an adult. Children who eat a lot of junk food such as soda pop, candies, potato chips, and pastries will grow up with the craving to continue eating these foods. Junk food is high in fats, oils, and calories which, over time, will lead to obesity.

Children usually do not gain weight as rapidly as adults. This is because they tend to be more active. However, when children get older, their active lifestyles decrease. Sometimes, a child who was skinny as a child will become obese as an adult. This is mainly because the child ate a lot of junk food but was very active. Then when adulthood started, the active lifestyle ceased and the weight gain began.

Obesity treatment programs for children and adolescents rarely have weight loss as a goal. Rather, their aim is to slow or halt weight gain so the child will grow into his or her body weight over a period of months to years. Dietz (1983) estimates that for every 20% excess of ideal body weight, the child will need one and one-half years of weight maintenance to attain his or her ideal body weight.

Early and appropriate intervention is particularly valuable. Childhood eating and exercise habits are more easily modified than adult habits (Wolf, Cohen, & Rosenfeld, 1985). Three forms of intervention include:

1. Physical Activity

Adopting a formal exercise program or simply becoming more active is a valuable way to burn fat, increase energy expenditure, and maintain lost weight. Most studies of children have not shown exercise to be a successful strategy for weight loss unless it is coupled with another intervention such as nutrition education or behavior modification (Wolf et al., 1985).

However, exercise has additional health benefits. Even when children's body weights and fat percentages did not change following 50 minutes of aerobic exercise three times per week, their blood lipid profiles and blood pressure did improve (Becque, Katch, Rocchini, Marks, & Moorehead, 1988).

2. Diet Management

Fasting or extreme caloric restriction is not advisable for children. Not only is this approach psychologically stressful, but it may adversely affect growth and the child's perception of "normal" eating. Balanced diets with moderate caloric restriction, especially those diets with reduced fat, have been used successfully in treating obesity (Dietz, 1983). Nutrition education may be necessary. Diet management coupled with exercise is an effective treatment for childhood obesity (Wolf et al., 1985).

3. Behavior Modification

Many behavioral strategies used with adults have been successfully applied to children and adolescents: self-monitoring and recording food intake and physical activity, slowing the rate of eating, limiting the time and place of eating, and using rewards and incentives for desirable behaviors. Particularly effective are behaviorally based treatments that include parents (Epstein et al., 1987).

Graves, Meyers, and Clark (1988) used problem-solving exercises in a parent-child behavioral program and found children in the problem-solving group, but not those in the behavioral treatment-only group, significantly reduced their percent overweight and maintained their reduced weight for six months. Problem-solving training involved identifying possible weight-control problems, and as a group, discussing solutions.

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