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U N D E R S TA N D I N G
An educational resource provided by
Childhood Obesity
American
Treatment Association
2
What is Childhood Obesity?Childhood obesity a�ects more than 30 percent ofchildren, making it the most common chronicdisease of childhood.
Today, more and more children are being diagnosedwith diabetes, hypertension and other co-morbidconditions associated with obesity and morbid obesity.
A child is de�ned as “obese” if their body mass index-for-age (or BMI-for-age) percentile is greater than 95percent. A child is de�ned as “overweight” if their BMI-for-age percentile is greater than 85 percent and less than95 percent.
Causes of Childhood ObesityAlthough the causes of childhood obesity are widespread, certain factors are targeted as majorcontributors to this epidemic. Causes associated with childhood obesity include:
EnvironmentToday’ s envir onment plays a major role in shaping the habits and perceptions of children and adoles-cents. The prevalence of television commercials promoting unhealthy foods and eating habits is a lar gecontributor. In addition, children are surrounded by environmental in�uences that demote the impor-tance of physical activity .
Today, it is estimated that approximately 40 to 50 percent of every dollar that is spent on food is spent on foodoutside the home in r estaurants, cafeterias, sporting events, etc. In addition, as portion sizes have increased,when people eat out they tend to eat a larger quantity of food (calories) than when they eat at home.
Beverages such as soda and juice boxes also greatly contribute to the childhood obesity epidemic. Itis not uncommon for a 32 ounce soda to be marketed toward children, which contains approximately400 calories. The consumption of soda by children has increased throughout the last 20 years by 300percent. Scienti�c studies have documented a 60 percent increase risk of obesity for every regular sodaconsumed per day. Box drinks, juice, fruit drinks and sports drinks present another signi�cant problem.These beverages contain a signi�cant amount of calories and it is estimated that 20 percent of childrenwho are currently overweight are overweight due to excessive caloric intake from beverages.
• Environment• Lack of physical activity• Heredity and family
• Dietary patterns• Socioeconomic status• Incorrect attitudes towards food
3
Lack of Physical ActivityChildren in today’s society show a decrease in overall physicalactivity. The growing use of computers, increased time watch-ing television and decreased physical education in schools allcontribute to children and adolescents living a more seden-tary lifestyle.
Another major factor contributing to the childhood obesityepidemic is the increased sedentary lifestyle of children.School-aged children spend most of their day in school wheretheir only activity comes during recess or physical educationclasses. In the past, physical education was required on a dailybasis. Currently, only 8 percent of elementary schools and less than 7percent of middle schools and high schools have daily physical educationrequirements in the U.S.
Heredity and FamilyScience shows that genetics play a role in obesity . It has been pr oven that children with obese parents aremore likely to be obese. Estimates say that heredity contributes between 5 to 25 percent of the risk for obe-sity. However, genes alone do not always dictate whether a child is overweight or obese. Learned behaviorsfrom par ents are a major contributor. Parents, especially of those whose children are at risk for obesity at ayoung age, should promote healthy food and lifestyle choices early in their development.
Dietary Patterns
Behavior and attitudes
Over the past few decades, dietary patterns have changed signi�cantly. The average amount of calories con-sumed per day has dramatically increased, yet the quality of nutrients needed for a healthy diet hasdecreased. Food por tions also play an important role in the unhealthy diet patter ns that have evolved.
Socioeconomic StatusChildren and adolescents that come from lower-income homes are at greater risk of being obese. This isa result of several factors that in�uence behaviors and activities. Lower-income children cannot alwaysa�ord to partake in extracurricular activities, resulting in a decrease in physical activity. In addition, fam-ilies who str uggle to pay bills and make a living often opt for convenience foods, which are higher incalories, fat and sugar.
Behavior and attitudes towards food and physical activity during childhood have a huge impact on how that child feels toward food when he is an adult. An overweigth child is 35% more likely to be obese as an adult then a normal child. The �ght on obesity begins in the crib.
Only 50 percentof children, 12 to 21 years
of age, regularly participate inrigorous physical activity, while 25
percent of children report no physicalactivity. The average child spends two
hours a day watching television,but 26 percent of children
watch at least four hours oftelevision per day.
5 th p e r ce ntile 1 0 th p e r ce ntile 2 5 th p e r ce n tile 5 0 th p e r ce n tile 7 5 th p e r ce n tile 8 5 th p e r ce ntile 9 0 th p e r ce ntile 9 5 th p e r ce ntile
A g e (y e a r s )
B M I-fo r -a g e p e r ce ntile s : B o y s , 2 to 2 0 y e a r s
Boys
Measuring Obesity in ChildrenObesity in children is determined by using BMI-for-age percentiles. BMI-for-age percentiles haveemerged as the favored method to measure weight status in children. This method calculates yourchild’s weight category based on age and BMI, which is a calculation of weight and height.However, it should be kept in mind that this method, among other methods, should be used as atool, and only a physician can best determine and diagnose weight status in your child.
Weight statuscategory
Percentilerange
Underweight
Healthy weight
Over weight
Obese
Less than5th percentile
5th - 85thpercentile
85th - 95thpercentile
95th percentileand greater
4
5 th p e r ce ntile 1 0 th p e r ce ntile 2 5 th p e r ce ntile 5 0 th p e r ce ntile 7 5 th p e r ce ntile 8 5 th p e r ce ntile 9 0 th p e r ce ntile 9 5 th p e r ce ntile
A g e (y e a r s )
B M I-fo r -a g e p e r ce ntile s : G ir ls , 2 to 2 0 y e a r s
5 th p e r ce ntile 1 0 th p e r ce ntile 2 5 th p e r ce ntile 5 0 th p e r ce ntile 7 5 th p e r ce ntile 8 5 th p e r ce ntile 9 0 th p e r ce ntile 9 5 th p e r ce ntile
A g e (y e a r s )
5
Girls
To plot your child’s BMI-for-age percentile, you must �rst calculate his/her BMI. Please see page 8 for aBMI chart which includes weight and heights appropriate for children. Once you calculate his/her BMI,�nd the age of your child on the bottom of the BMI-for-age percentile chart and look to the left or rightto locate their BMI. Plot the point on the graph using a pen or pencil. Once you have plotted the meas-urement, locate the corresponding shaded color on the bottom of the chart to determine your child’s BMI-for-age percentile. You are then able to �nd your child’s weight status by viewing the Weight StatusCategory table located to the right of the chart.
Weight statuscategory
Percentilerange
Underweight
Healthy weight
Over weight
Obese
Less than5th percentile
5th - 85thpercentile
85th - 95thpercentile
95th percentileand greater
6
Measuring Growth in ChildrenYou may have heard your pediatrician refer to your child’s weight in terms of a percentile. To measuregrowth in your child based on their weight, doctors most commonly use weight-for-age percentiles.Weight-for-age percentiles are used to measure your child’s weight based strictly on age. It does not takeinto account the height of a child. This is not a method to determine obesity (or overweight) in children,but simply an indicator of growth as compared to children of the same age.
Boys
2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 2 0
2 3 0
2 2 0
2 10
2 0 0
1 9 0 8 5
9 0
8 0
7 5
7 0
6 5
18 0
17 0
16 0
15 0
14 0
13 0 6 0
5 5 12 0
11 0 5 0
4 5 10 0
4 0 9 0
8 0
7 0
3 5
3 0
2 5
2 0
1 5
1 0
k g
6 0
5 0
4 0
3 0
2 0
lb
W e ig ht-fo r -a g e p e r ce ntile s : B o y s , 2 to 2 0 y e a r s
A g e (y e a r s )
k g lb
9 5
1 0 0
1 0 5
P u b lis he d M a y 3 0 , 2 0 0 0 . S O U R CE: De v e lo p e d b y the N a tio na l Ce nte r fo r H e a lth S ta tis tics in co lla b o r a tio n w ith the N a tio na l Ce nte r fo r Chr o nic Dis e a s e P r e v e n tio n a n d H e a lth P r o m o tio n (2 0 0 0 ).
9 5 th
9 0 th
75 th
5 0 th
25th
10 th
5 th
SAFER • HEALTHIER • PEOPLE
CDC5 th p e r ce ntile 1 0 th p e r ce ntile 2 5 th p e r ce ntile 5 0 th p e r ce ntile 7 5 th p e r ce ntile 9 0 th p e r ce ntile 9 5 th p e r ce ntile 5 th p e r ce ntile 1 0 th p e r c
B MB
Once you have foundyour child’s weight-for-age per centile, you canthen determine whatpercentile (or per centilerange) they fall into, ascompared to children ofthe same age.
For example, if yourchild is in the 95th percentile, this meansthat their weight isgreater than 95 percent of childrenof the same age.
7
To plot your child’s weight-for-age percentile, �nd the age of your child on the bottom of the chart andlook to the left to locate their body weight. Once you locate their weight and age, plot the point on thegraph using a pen or pencil. Once you have plotted the measurement, locate the corresponding shadedcolor on the bottom of the chart to determine your child’s weight-for-age percentile.
Girls
2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 2 0
1 5
1 0
k g
4 0
3 0
2 0
lb
A g e (y e a r s )
2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 2 0
2 3 0
2 2 0
2 10
2 0 0
1 9 0 8 5
9 0
8 0
7 5
7 0
6 5
18 0
17 0
16 0
15 0
14 0
13 0 6 0
5 5 12 0
11 0 5 0
4 5 10 0
4 0 9 0
8 0
7 0
3 5
3 0
2 5
2 0
1 5
1 0
k g
6 0
5 0
4 0
3 0
2 0
lb
W e ig ht-fo r -a g e p e r ce ntile s : G ir ls , 2 to 2 0 y e a r s
A g e (y e a r s )
k g lb
9 5
1 0 0
1 0 5
P u b lis he d M a y 3 0 , 2 0 0 0 . S O U R CE: De v e lo p e d b y the N a tio na l Ce nte r fo r H e a lth S ta tis tics in co lla b o r a tio n w ith the N a tio na l Ce nte r fo r Chr o nic Dis e a s e P r e v e ntio n a nd H e a lth P r o m o tio n (2 0 0 0 ). SAFER • HEALTHIER • PEOPLE
CDC5 th p e r ce ntile 1 0 th p e r ce ntile 2 5 th p e r ce n tile 5 0 th p e r ce n tile 7 5 th p e r ce ntile 9 0 th p e r ce ntile 9 5 th p e r ce ntile
P u b lis he d M a y 3 0 , 2 0 0 0 . S O U R CE: De v e lo p e d b y the N a tio na l Ce nte r fo r H e a lth S ta tis tics in co lla b o r a tio n w ith the N a tio na l Ce nte r fo r Chr o nic Dis e a s e P r e v e ntio n a nd H e a lth P r o m o tio n (2 0 0 0 ). SAFER • HEALTHIER • PEOPLE
CDC5 th p e r ce ntile 1 0 th p e r ce ntile 2 5 th p e r ce n tile 5 0 th p e r ce n tile 7 5 th p e r ce ntile 9 0 th p e r ce ntile 9 5 th p e r ce ntile
9 5 th
9 0 th
75 th
5 0 th
25th
10 th 5 th
B
5 th p e r ce ntile 1 0 th
Once you have foundyour child’s weight-for-age per centile, you canthen determine whatpercentile (or per centilerange) they fall into, ascompared to childr en ofthe same age.
For example, if yourchild is in the 95thpercentile, this meansthat their weight isgreater than 95percent of childrenof the same age.
8
About Body Mass Index (BMI)BMI is the most common method to measure adult obesity. However, BMI is now becoming a popular toolused to measure obesity in children. BMI is a number calculated by dividing a person’s weight inkilograms by his or her height in meters squared.
W eight in pound s 20 30 40 50 60 70 80 90 100 110 120 130 140 150 160 170 180 190 200
He
igh
t
2'0" (24 in ches)2'1" (25 in ches)2'2" (26 in ches)2'3" (27 in ches)2'4" (28 in ches)2'5" (29 in ches)2'6" (30 in ches)2'7" (31 in ches)2 '8" (32 in ches)2'9" (33 in ches)2 '10" (3 4 i nches)2'11" (3 5 i nches)3'0" (36 in ches)3'1" (37 in ches)3'2" (38 in ches)3'3" (39 in ches)3'4" (40 in ches)3'5" (41 in ches)3'6" (42 in ches)3'7" (43 in ches)3'8" (44 in ches)3'9" (45 in ches)3'10" (4 6 i nches)3'11" (4 7 i nches)4'0" (48 in ches)4'1" (49 in ches)4'2" (50 in ches)4'3" (51 in ches)4'4" (52 in ches)4'5" (53 in ches)4'6" (54 in ches)4'7" (55 in ches)4'8" (56 in ches)4'9" (57 in ches)4'10" (5 8 i nches)4'11" (5 9 i nches)5'0" (60 in ches)5'1" (61 in ches)5'2" (62 in ches)5'3" (63 in ches)5'4" (64 in ches)5'5" (65 in ches)5'6" (66 in ches)5'7" (67 in ches)5'8" (68 in ches)5'9" (69 in ches)5'10" (7 0 i nches)5'11" (7 1 i nches)6'0" (72 in ches)
242221191817161514131211111010
373431292725232221191817161515141313121111101010
48454239363331292726242322211918181716151514131312121111101010
565248454239373432302927262423222120191817171615151414131312121111101010
595552494643413937353332302928272524232222212019191817171616151514141313131212111111
58545047444139363433312928262524232221201918181716161514141313131212111111101010
59555148454340383634323129282725242322212020191818171616151514141313121212111111101010
58555249464441403836343331302927262524232322212019191818171616151515141413131312 13
57545149464442403836353332312928272625242322222120191818171716161515141414
565451484644424038373534323130292827262524232221202019181817171616151514 16
58555350484644424038373534323130292827262524232222212020191818171716
17
5754524947454341403837353433313029282726252423232221212019191818
19
59565351494745433839383635343331302928272625242423222221202019
20
5754525048464442413938363534323130292827262525242322222121
21
58565351494745434240393736353332313029282726252524232322
23
595654525048464443414038373634333231302928272625252423
24
57555351494745434240393836353433323130292827262525
25
585653514948464443414038373634333231302928282726
27
59565452504846
4543
4240
39
37
36353433323130292828
If your child’s BMI is not listed on thischart, please visit the AOTA’s Website at www.americanobesity.orgto calculate your child’s BMI.
9
Treating Childhood ObesityTreating obesity in children and adolescents di�ers from treatment in adults. Involving the family in achild’s weight management program is a key element to treatment. Treatment of pediatric obesity isnot accomplished by just dieting. You need to address multiple aspects of the child and the family’slifestyle, nutrition and physical activity patterns.
Prior to discussing any treatment plans, you �rst must determine the desired goals. If your child is over-weight, or at risk for becoming overweight, it is important to work with your healthcare provider todevelop an individualized plan of care that includes realistic goals and action steps.
Similarly, if there is a lot of stress in the family at that time it is notideal to try and tackle yet another major issue. In some situationswhere there is signi�cant depression or stress, it may be mostappropriate for the child and the family to seek counselingto address these issues. In addition, if parents express littleconcern regarding their child being overweight, they arenot ready to make the necessary changes.
It is important to talk with your physician about optionsfor treating childhood obesity. The various treatmentsof obesity in children and adolescents include:
• Dietary therapy• Physical activity• Behavior modi�cation• Natural Supplements (14-21 and in extreme cases)
Dietary TherapyWhen treating an obese child or adolescent, it is often recommended that they have a consultationwith a dietitian that specializes in children’s needs. Dietitians can best help children understandhealthy eating habits and how to implement them in their long-term diet.
Dietitians do not always recommend restricting caloric intake for children. Education on how to readfood labels, cut back on portions, understand the food pyramid and eat smaller bites at a slower paceis generally the infor mation given to change a child’ s eating habits.
As a support system, family is integral in ensuring weight management goals are met. Youmust �rst assess the readiness of the child and the family to make changes. If the child isdepressed, this needs to be addressed prior to working on the child’s weight problem. If adepressed child attempts weight-loss and is unsuccessful, this may worsen their depression orlower their self-esteem.
Physical ActivityAnother form of obesity treatment in children is increasing physicalactivity. Physical activity is an important long-term ingredient forchildren, as studies indicate that inactivity in childhood hasbeen linked to a sedentary adult lifestyle.
Increasing physical activity can decrease, or at leastslow the increase, in fatty tissues in obese children. TheU.S. Surgeon General recommends that children get atleast 60 minutes of physical activity each day.Individualized programs are available and possible forthose children or adolescents that are not able to meetminimum expectations.
Behavior Modi�cation
Things to avoid
Lifestyles and behaviors are established at a young age. It isimportant for parents and children to remain educated and focusedon making long-term healthy lifestyle choices.
There are several ways that children and adolescents can modifytheir behavior for healthier outcomes, such as:
• Changing eating habits
• Do not use food to reward or to bribes the child.
• Avoid food struggles.• Parents should decide What to eat, When to eat, and Where to eat, but children (+5 yrs) should decide how much to eat or not at all.
• Increasing physical activity• Becoming educated about the body and how to nourish
it appropriately• Engaging in a suppor t group or extracur ricular activity
• Setting realistic weight management goals
What can you do to learn more about childhood obesity?The America Obesity Treatment Association, a non pro�t patient-based organization, o�ers many valuable
resources to those a�ected by childhood obesity and their family members. To learn more about
childhood obesity, please visit the “Childhood Obesity” section on the A O T A Web site at
www .americanobesity.org . For more information, please contact us at (334) 651-0821 or
10
Notes:
Date Age Weight Heigh BMI BMI-for-age Percentile
AOTA Resources The AOTA produces well-rounded and comprehensiveeducation and advocacy materials. All AOTA resourcesare free-of-charge and may be requested by contact-ing us at [email protected].
You may also make a request online by visiting ourWeb site at www.americanobesity.org .
Brochures/Guides
E-Newsletter
• Obesity Action Alert – the AOTA’s free monthly
electronic newsletter
The information contained in the “Understanding Childhood
Obesity” brochure is not a substitute for medical advice or treatment
from a healthcare professional. AOTA recommends consultation
with your doctor and/or healthcare professional.
American Obesity Treatment Association117 Anderson CT, Suite 1Dothan, Alabama 36303(334) 651-0821
AOTA was founded as a membership organiza-tion to bring together individuals who are a�ected byobesity. By building a strong Association of members,AOTA is able to represent those a�ected throughits education and advocacy efforts. Consider joiningthe AOTA today!
Yes! I would like to join the e�orts of the AmericanObesity Treatment Association by becoming a member I would like to join as a/an:
Patient/Family Member: $20Professional Member: $50Physician Member: $75Surgeon Member: $150Institutional Member: $200 (Doctors’ o�ces, weightmanagement centers, surgery centers, etc.)
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AOTC
• Understanding Obesity Series
- Understanding Obesity Brochure
- Understanding Obesity Poster- Understanding Obesity Stigma Brochure
- Understanding Childhood Obesity Brochure
- Understanding Childhood Obesity Poster
• Advocacy Primer: Your Voice Makes a Di�erence
• AOTA Insurance Guide: Working with Your
Insurance Provider
• State-speci�c Advocacy Guides
• BMI Chart
American
Treatment Association
