The study, which is based on analysis of data collected from 26,690 children aged 2 to 19 from 1999 to 2012 as part of the National Health and Nutrition Examination Survey, also found an upward trend in more severe forms of obesity, which are associated with heart disease and diabetes risk in children and adolescents, and are more difficult to treat.
According to the data, 17.3% of children in the US aged 2 to 19 were obese in 2011-2012. Furthermore, 5.9% of children met criteria for class 2 obesity and 2.1% met criteria for class 3 obesity. Although these rates were not significantly different from 2009 to 2010, all classes of obesity have increased over the last 14 years.
Adam Tsai, MD, MSc specializing in adult obesity and public affairs chair of the Obesity Society, said it will take a combination of policy changes, consumer education and individual responsibility to make an impact on obesity in the US.
“Obesity is a complex problem,” he said. “We’re going to need an all-of-the-above approach to fix it. We do need regulatory action in terms of nutrition labeling and portion size and what gets served to kids in schools, along with requirements for physical activity. But individual responsibility is also a key piece. Parents need to look at nutrition labels and not give their kids foods with a lot of added sugar.”
Focusing on one category, like sugar-sweetened beverages, makes 'added sugar' easier to grasp
He applauded the FDA’s proposed nutrition label update for its added emphasis on calories and added sugar, despite that the added sugar line has come under fire by some for being difficult for consumers to internalize. Dr. Tsai noted that starting with a single category, like sugar-sweetened beverages, could provide a good starting point.
“Starting with sugar-sweetened drinks in general—not just soda but sports drinks, energy drinks and most juices [though 100% juice is more of a gray area, he noted]—is a good place to start if we’re trying to get people to understand the concept of added sugar,” he said. “Most people understand that with these beverages they’re essentially putting pure sugar in their bodies.”
Strong measures, like soda warning labels, would shake people up a little
What about the role of more aggressive policy efforts, such as the soda warning label currently advancing in the California legislature? Dr. Tsai said he’s not opposed to them, as they may help force the issue.
“I think there’s a lot of hand wringing in public policy related to obesity,” he said. “I support strong measures because I think most of what we’ve done hasn’t done enough. I think people need to be shaken up a little bit if we’re really going to make an impact, but I can only speak for myself here.” (The Obesity Society hasn’t taken a position on the issue.)
Dr. Tsai added that starting preventive efforts early is important, as research has shown early childhood to be a critical time to introduce healthy foods into the diet.
“From what I’ve read there seems to be a critical period between the ages of two and five when kids develop a palate for things. So if kids don’t start early with eating all kinds of fruits and vegetables then it just gets harder as they get older,” he said.
For the study, "overweight" was defined as BMI greater than or equal to the 85th percentile for age and sex, and "obesity" was BMI greater than or equal to the 95th percentile. The more severe forms of obesity—Class 2 and Class 3 obesity—were defined as a BMI greater than 120 percent of the 95th percentile for Class 2 and greater than 140% of the 95th percentile for Class 3. This means a 10-year-old boy at average height (4 and half feet tall) who weighs 95 pounds would be considered obese, but would meet criteria for class 2 obesity at 115 pounds and class 3 obesity at about 130 pounds.
Source: JAMA Pediatrics
“Prevalence and Trends in Obesity and Severe Obesity Among Children in the United States, 1999-2012”
Authors: Asheley Cockrell Skinner, PhD; Joseph A. Skelton, MD, MS