Answers to questions families often have about caring for their child with childhood obesity

Obesity in children is defined as having a body mass index at or above the 95th percentile—meaning 95% of children of the same age and gender have a lower BMI. Overweight in children is defined as having a BMI between the 85th and 95th percentiles. Body Mass Index (BMI) (KidsHealth) explains what BMI is.

Every effort should be made during childhood and adolescence to help children avoid unhealthy lifestyles that put them at risk for overweight or obesity. Because being overweight or obese can impact health so much, parents should not wait to address the issue until adulthood when lifestyles and habits are more difficult to change. Childhood obesity is becoming more common in the United States and the rest of the world. It is estimated that this generation will be the first in U.S. history to have a shorter life expectancy than their parents, partly because of the high rates of obesity.

Many children with obesity and who are overweight won’t show symptoms. However, obese children are more likely than healthy-weight children to have risk factors for cardiovascular disease, such as high blood pressure, high cholesterol, and fatty liver disease.

In addition, obese children are more likely than non-obese children to develop:

• Type 2 diabetes
• Skin infections
• Metabolic syndrome (risk factors for heart disease)
• Bone and joint problems
• Sleep apnea
• Irregular periods and other menstrual problems
• Social and psychological problems such as bullying and poor self-esteem

The definitions of overweight and obesity are based on BMI. BMI is calculated by plotting the child’s height and weight on a pediatric growth chart to determine the percentile. It is very important that the height and weight are calculated accurately. In children older than 2 years, BMI percentiles specific to the age and sex of the child are used. Charts, wheels, websites (BMI Calculator (KidsHealth) ), and apps are available to calculate the BMI and the percentile.

Childhood obesity is associated with complications that may affect short- and long-term physical and mental health, such as hypertension, diabetes, sleep apnea, chronic inflammation, polycystic ovarian syndrome (PCOS), asthma, liver and gall bladder disease, and orthopedic problems. Research suggests that obese children have weaker immune systems and are at increased risk of chronic illnesses. Obese children have an increased chance of becoming obese adults. Success often depends on the treatment, how soon it begins, and family support.

Obesity and overweight are one of the most heritable conditions. A child born to 2 obese parents has about an 80% risk of developing obesity. The heritability of obesity is due to a complex interaction between genetics and the environment in which a child grows and develops. Determining whether there is a history of obesity and/or type 2 diabetes in first and second-degree relatives is a useful approach to identifying children at greater than average risk of becoming obese. Genetic syndromes associated with pediatric obesity include Prader-Willi syndrome, Turner syndrome, and Laurence-Moon-Bardet-Biedl syndrome; however, these syndromes are relatively rare. Findings such as developmental delay, short stature/delayed growth, abnormal facial features, abnormal or absent genitalia, and finger abnormalities should raise suspicion of an underlying genetic disease.

Preventing and treating obesity is about developing healthy, lifelong habits. For infants, breastfeeding may reduce the risk of obesity later in life. The 5-2-1-0 message has been widely supported as a way to prevent and address obesity:

• 5 servings of fruits and vegetables
• Less than 2 hours of screen time
• More than 1 hour of exercise
• 0 sweetened beverages

Frequent follow-ups focused on motivational interviewing, behavioral therapy, dietician referrals, and healthy lifestyle programs are the main treatment. Weight loss medications and bariatric surgery are becoming more available and recommended by pediatric experts for patients with severe obesity who are older than 12 years old.

Parents with healthy weights are more likely to have children with healthy weights. Parents can model healthy behaviors and encourage those healthy behaviors in siblings.

Obesity screening and counseling are covered under the Affordable Care Act. Depending on the insurance plan, children may be able to receive services at no cost to families. Coverage for behavioral therapy, subspecialty care, and medications varies by insurance. If you have health insurance, the best option is to call your insurance company to clearly identify what is covered. See Find a Health Center.