One of the most challenging health problems in the U.S. is obesity in children and teens, in part because it can lead to poor health throughout their lives. Preventing obesity and enabling children to stay healthy is a top job for pediatricians and public health officials. Fortunately, early intervention and education that focuses on the benefits of exercise and healthy foods can pay off in reduced obesity rates. Social programs and legislation aimed at increasing healthy food options for families are also effective.
Social workers can help develop and implement effective childhood obesity interventions. They work with children and their families to provide education and support for healthy lifestyles. As health experts, they also advocate for public policies that support these goals.
What Are the Obesity Rates in America Today?
Obesity is a health issue that impacts Americans in every region of the country and across all socioeconomic and ethnic groups. It correlates with many health issues, especially chronic conditions such as diabetes, heart disease, depression, stroke and cancer. It can lead to gestational diabetes in pregnant women, and it is also connected to infant mortality. The Centers for Disease Control and Prevention (CDC) estimates that the annual medical cost of obesity is more than $170 billion.
In the U.S., 2 in 5 adults and 1 in 5 children suffer from obesity, according to the Office of Disease Prevention and Health Promotion. The following are some key facts and figures that illustrate how obesity breaks down along demographic, geographic and socioeconomic lines.
Obesity and Race
Nearly 50% of Black adults, more than 45% of Hispanic adults and 41% of white adults are obese, according to the CDC. Additionally, 14% of Black adults, 7% of Hispanic adults and 9.5% of white adults suffer from severe obesity (defined as a body mass index of 40 kg/m2). Among children ages 2 to 19, nearly 25% of Black children are obese, 26% of Hispanic children are obese, and more than 16% of white children are obese.
Obesity and Education
Education levels correlate with rates of obesity, according to CDC data, illustrating the importance of a strong educational foundation. However, even among college-educated individuals, percentages of obesity are still high. Nearly 39% of adults without a high school degree suffer from obesity, compared with 25% of college graduates.
Obesity by State
Some states have higher obesity rates than others and therefore have higher rates of chronic diseases. According to non-partisan research organization Trust for America’s Health, 16 states had adult obesity rates of 35% or higher in 2021. This was up from 12 states in 2019, prior to the COVID-19 pandemic. The states with the highest rates of obesity were Alabama, Arkansas, Delaware, Indiana, Iowa, Kansas, Kentucky, Louisiana, Michigan, Mississippi, Ohio, Oklahoma, South Carolina, Tennessee, Texas and West Virginia.
Obesity by Region
Obesity is 6.2 times more prevalent in rural America than in cities, according to a study in the journal Cureus. Rural Americans are more likely to lack health care resources and access to healthy foods, which contributes to obesity. This in turn leads to chronic diseases such as diabetes or heart disease, resulting in higher mortality rates.
Childhood and Teen Obesity at a Glance
The urgency of pursuing childhood obesity interventions is high, considering that obesity affects some 14.7 million children and teens in the U.S., according to the CDC. Rising rates of childhood and teen obesity have troubled health care experts for decades.
The issue is not just specific to the U.S. Researchers from the Imperial College of London found that global rates of childhood obesity are 10 times higher than in 1975. Among high-income countries, the U.S. has the highest rates of childhood obesity.
The impact of the pandemic — and related lockdown measures — has accelerated obesity rates among young people. In 2019, 19% of children and teens were obese; that figure rose to 22% in 2020, according to a report in the BMJ. The change was most apparent in children ages 6 to 11. Pediatricians pointed to less activity as the primary driver of this increase, with children taking classes online and spending more time on screens, as parents had to juggle their own work and child care.
Childhood obesity doesn’t just show up in school-age children. Incidences of obesity in preschool children have also risen. According to the CDC, 12.7% of preschoolers ages 2 to 5 were obese.
Additionally, infant nutrition can impact later childhood weight gain. Formula rather than breastfeeding and the early introduction of protein into an infant’s diet may be factors in childhood obesity, according to an article in Frontiers in Pediatrics.
Obesity in children and teens can result in serious negative health outcomes.
Onset of Chronic Disease
The prevalence of chronic diseases is rising in children and teens with obesity. These illnesses, which had formerly been seen only in adults, include Type 2 diabetes, high blood pressure, fatty liver and gallstones. Cases of asthma, sleep apnea, menstrual irregularities and polycystic ovary syndrome (PCOS) have also risen.
Mental and Emotional Distress
The pandemic had a negative effect on the mental health of children and teens overall. Children with obesity also experience additional pressure due to their condition. They may be vulnerable to being bullied. They may also suffer from anxiety and depression, sleep disturbances, and disordered eating (anorexia or bulimia).
Physical Pain
Obesity can cause joint pain. This may prevent children and teens from exercising, which can worsen their condition. They may suffer from flat feet, knee pain and tendonitis. It can also lead to arthritis when they become adults.
What Are the Causes of Teenage Obesity?
The causes of teenage obesity are complex. Eating calorie-dense foods and not getting enough exercise are the most obvious causes, but several other factors are at play.
Diet and Exercise
Diet and exercise are the two biggest factors in teenage obesity. Teens are at the developmental stage of pulling away from their parents. They have more independence and more access to foods that are low in nutrition. Parents who kept their children’s screen time to a minimum may let up with their teens, leading them to be less active.
Biological Factors
There’s more to eating than just eating. Hunger signals from the brain and the gut microbiome consisting of trillions of microorganisms are just two of the complex biological processes that regulate what people eat, when they eat and how they turn food into energy. If hunger signals don’t work properly, an individual may not know when they’re sated. Likewise, the link between the gut microbiome and obesity may also influence how effectively a person metabolizes food.
Genetic Factors
Certain ethnic and racial groups are more prone to obesity. Additionally, some genetic mutations can cause obesity in children and teens. Epigenetics — the interaction between genes, family history, social environment and other factors — can also lead to obesity, among other illnesses.
Developmental Behaviors
Developing eating habits, including how and what to eat, are among the earliest childhood experiences. Children learn from their parents and elders. These behaviors become ingrained and can set the stage for poor eating habits. In adolescence, teens shift their allegiance to their peer groups, which can also have a big effect on food or entertainment choices. Teens may choose screen time on phones and video games over physical activities. All of these behaviors add up over time.
Food Deserts and Food Insecurity
Neighborhoods that lack grocery stores are called food deserts. People who lack transportation may not be able to get to the nearest supermarket. The alternatives are fast food or packaged foods that are high in salt and sugar and low in nutritional value. These neighborhoods often have high rates of food insecurity as well. While this may seem counterintuitive, food insecurity is directly linked to obesity. With fewer options, families have to make the best choices they can with the resources available.
What Are the Most Effective Interventions for Childhood Obesity?
Intervention is crucial if children and teens are to overcome obesity. Parents, teachers, doctors and social workers can do a lot to encourage healthy habits in children and teens. Even though many causes of teenage obesity result from social determinants of health, such as where a person lives and their education level, resources are available to help.
Effective childhood obesity interventions include commitments to change at the family, community and national levels.
Family Interventions
Good habits begin at home. Parents who see that their children are making poor food choices and don’t get enough exercise can take several actions to turn the situation around. They should recognize, however, that what works for younger children may not be effective with teens, who are becoming more independent.
Additionally, adults shouldn’t label children and teens as bad or lazy for their condition. Diet and exercise are just two of the many factors that contribute to obesity. Parents can help children establish new habits they can carry into adulthood.
Set an Example
When children are young, parents can set an example by making good food choices. Parents should choose healthy foods and encourage children to participate in food preparation. They should refrain from rewarding children with food. It can be trickier with teens — sometimes, a strict focus on healthy eating can lead to an unhealthy relationship with eating, such as bulimia or anorexia.
Reduce Sugar
Another area in which to set an example is by reducing sugar intake. Sugar is a leading cause of weight gain and tooth decay. Adults can keep sugary drinks out of the house to reduce temptation for everyone and make sure that children and teens have water, milk or 100% juice available.
Exercise as a Family
During the pandemic, interest in home exercise exploded. Families who quarantined together needed to find ways to blow off steam and move. For small children, imaginative play and exercise go hand in hand. Exercise doesn’t just tire kids out; it builds muscle and bone and improves cardiovascular health.
Minimize Screen Time
During the pandemic, children and teens often spent several hours a day online, both in school and in their downtime. Too much screen time doesn’t just make kids too sedentary; it also impacts sleep and may contribute to mental health issues.
Set Regular Bedtimes
Children need 9 to 12 hours of sleep, and teens need 8 to 10 hours. Good sleep is associated with a lower risk of obesity and Type 2 diabetes, among other illnesses. Parents can reinforce bedtime rules and make sure children and teens turn off screens and phones before going to bed.
Bariatric Surgery
Teens as young as 13 with severe obesity may be candidates for bariatric surgery. A study of more than 300 teens reported in the medical journal Surgical Endoscopy found that laparoscopic sleeve gastrectomy was effective in reducing obesity in patients. There was no difference in outcomes between older patients and younger patients, and researchers suggested that the younger the patient, the lower their chance of developing more serious illnesses related to obesity.
State and Local Interventions for Childhood Obesity
There’s often an outcry when state and local governments establish laws around food and drink. However, the data shows that these laws can have positive results in some cases. Health care experts and others continue to call for more government intervention to help reduce obesity in children.
School Nutrition Policies
California’s school nutrition policies showed a positive impact on obesity rates in conjunction with the national Healthy, Hunger-Free Kids Act, according to a study in the International Journal of Obesity. Overall, many school districts have chosen to ban sodas and other sugary drinks in public schools. While child and teen obesity rates continue to be a challenge, there is some movement toward better outcomes.
City Nutrition Laws
Chicago authorized its restaurant inspectors to enforce an Illinois law that restaurants must offer water, juice or low-fat milk with children’s meals. The city of New York banned large-size sugary drinks at restaurants and food carts, with some exceptions.
Early Care and Education (ECE) Standards
Some 12.6 million children under the age of 5 are in child care. Many states follow CDC guidelines to set ECE standards that improve nutrition. These standards also call for an increase in physical activity, support for breastfeeding parents and limits on screen time.
State Physical Education Laws
Many states have established the amount of physical activity schools must provide to their students at the elementary, middle school and high school levels. Other laws mandate recess, as well as safe routes to schools so students can walk or bike to school.
National Interventions
At the national level, the federal government has established a number of policies and programs to support efforts to reduce childhood obesity. The effects of these policies directly impact state legislation and also can lead to additional research on the most effective childhood obesity interventions. These include:
Healthy, Hunger-Free Kids Act (HHFKA)
Established in 2010, the goal of the Healthy, Hunger-Free Kids Act is to improve nutrition for children through schools. The legislation sets policy for the Department of Agriculture’s National School Lunch Program, School Breakfast Program and Summer Food Service Program, among other policies. HHFKA provides a hunger safety net for children.
CDC State and Local Programs
The CDC funds state universities and other agencies to carry out initiatives that support healthy eating and exercise at the community level. These include the State Physical Activity and Nutrition program, the High Obesity Program, and the Racial and Ethnic Approaches to Community Health program. These programs carry out evidence-based initiatives to improve services to communities at high risk of obesity and poor nutrition.
Medicaid and CHIP
Nearly 10 million children in low-income households are enrolled in the Children’s Health Insurance Program (CHIP). Medicaid, through CHIP, covers obesity-related health care services for children under its Early and Periodic Screening, Diagnostic and Treatment Benefit. Since income and obesity often go hand in hand, this benefit can help many children with obesity.
Help Others on a Healthy Pathway
For many diseases, prevention is more effective than treatment. This is especially so with obesity. Childhood and teen obesity can contribute to a cascade of chronic illnesses that lead to a diminished quality of life. Fortunately, numerous interventions for childhood obesity are available to help avoid these ill effects.
Social workers are often instrumental in helping children and their families develop healthy habits and connecting them with vital resources to help them live healthier lives. Social workers can help make sure that people have access to healthy food, safe places to exercise, and the education to help themselves and their families make the best choices for their physical, mental and emotional well-being.
If you’re excited about the idea of helping others live healthy, productive, satisfying lives, explore the University of Nevada, Reno’s online Master of Social Work program. With a curriculum that includes work with organizations, communities and legislatures, it provides a solid foundation for a career in helping others live their best lives.
Recommended Readings
Childhood Obesity as an Epidemic
Legal Efforts to Fight the Obesity Crisis
Rethinking the Issue of Heart Health Among the Nation’s Youth
Sources:
BMJ, “Obesity in U.S. Children Increased at an Unprecedented Rate During the Pandemic”
Bone & Joint, “Childhood Obesity Could Cause Future Joint Problems”
Centers for Disease Control and Prevention, Adult Obesity Facts
Centers for Disease Control and Prevention, Adult Obesity Prevalence Maps
Centers for Disease Control and Prevention, Causes of Obesity
Centers for Disease Control and Prevention, Childhood Obesity Facts
Centers for Disease Control and Prevention, Early Care and Education (ECE)
Centers for Disease Control and Prevention, “Public Health Surveillance in Rural Communities”
Centers for Disease Control and Prevention, State and Local Programs
Cureus, “The Burden of Obesity in the Rural Adult Population of America”
Department of Agriculture, Healthy, Hunger-Free Kids Act
Diets in Review, “7-Eleven Double Big Gulps Exempt From NYC Soda Ban”
Frontiers in Pediatrics,“Childhood and Adolescent Obesity: A Review”
Mayo Clinic, Childhood Obesity
Medical News Today, “Childhood Obesity Rates Rise 10-Fold Since the ’70s”
Public School Review, “Soda at School? More Districts Are Just Saying No”
State of Childhood Obesity, State Policies to Prevent Obesity
Trust for America’s Health, “State of Obesity 2021: Better Policies for a Healthier America”
U.S. Department of Health and Human Services, Food Insecurity
U.S. Department of Health and Human Services, Overweight and Obesity
WTTW, “Chicago Measure to Enforce State Law Designed to Reduce Sugary Drinks for Kids Advances”