An epidemic largely tied to poor eating and exercise habits is affecting one in five U.S. children and sending many of those youth on the pathway to future health problems and even premature death, federal data and U.S. health officials conclude.
As September marks National Childhood Obesity Month, our country continues to grapple with an issue exacerbated by the aftereffects of overeating during pandemic isolation.
The most recently available data from the U.S. Centers for Disease Control and Prevention shows that about 19.7% of adolescents aged 2-19 years in 2017-2021 were classified as obese. In all, about 14.7 million children throughout the nation suffered from obesity during that time period, the CDC concludes.
In a separate sampling, the CDC estimates that in 2019, 15.5% of U.S. children in grades 9-12 struggled with obesity.
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In that same sampling, childhood obesity was most prevalent in Mississippi, where 23.4% of children in grades 9-12 were categorized as obese.
The ramifications of the issue could be dire, particularly if the problem isn't stemmed among youth and is allowed to continue into adulthood.
Obesity is linked to a number of serious health concerns, including high blood pressure, high cholesterol, Type 2 diabetes, chronic breathing problems, joint problems and heart disease — the current number one killer in the country.
Health experts across the nation agree that the COVID-19 pandemic only worsened the issue.
“We saw unprecedented levels of weight gain in children — specifically in the first six to nine months of the lockdowns in 2020,” said Dr. Kavitha Selvaraj, medical director of the Wellness and Weight Management Program at Lurie Children’s Hospital of Chicago. Selvaraj is also a certified member of the American Board of Obesity Medicine.
Generally, dramatic weight gain in children has slowed down in the past six to 12 months, Selvaraj said.
“But some of that metabolic damage that happened with new diagnoses in children of Type 2 diabetes, fatty liver disease and heart concerns — that’s irreversible damage that occurred to children’s physical health, not to mention mental health. That doesn’t just go away when businesses open back up,” Selvaraj said.
Several factors contribute to childhood obesity, including genetics and behavior. But medical experts agree that a lack of access to nutritious food in certain areas of the country and an intense stigma surrounding being overweight are making matters even worse.
It’s an insidious problem with roots in a variety of causes, and experts say solutions — both within the home and at the government level — are not easily reached.
“We as a society need to support people and families to be able to live lives that prioritize health,” Selvaraj said.
Former First Lady Michelle Obama launched the ”Let’s Move!” campaign in 2010 with a goal to end childhood obesity. President Donald Trump’s administration later rolled it back, discarding rules for vegetable and fruit serving size requirements in school lunches.
President Joe Biden announced earlier this year that his administration plans to host a conference to address efforts toward “ending hunger, improving nutrition and physical activity, reducing diet-related disease, and closing the disparities around them.” The conference, slated for Sept. 28, will be the first of its kind in over 50 years.
“Hunger, diet-related disease and the disparities surrounding them impact millions of Americans, and the COVID-19 pandemic put a spotlight on the urgency of addressing these issues,” said Susan Rice, the president’s adviser for domestic policy. “No one should have to wonder where their next meal will come from.”
Food insecurity and access
Health care providers across the nation say one of the biggest obstacles in preventing obesity is the lack of access to affordable, healthy food options. Experts say the problem disproportionately affects minority communities.
“We know that some groups tend to have higher rates of obesity related to socioeconomic disadvantage and system barriers related to injustices and racism and different forms of discrimination,” Selvaraj said.
From 2017 to 2021, obesity prevalence was 26.2% among Hispanic children ages 2 to 19, 24.8% among Black children, 16.6% among White children, and 9% among Asian children, according to the CDC.
Felicia Anderson, as the regional educator for the Lincoln University Cooperative Extension in Sikeston, Missouri, has been serving the southeast corner of the state, known as the bootheel, with some of the highest rates of poverty and poorest health outcomes for 20 years.
As a whole, 18.4% of Missouri children in grades 9-12 were estimated to be suffering from obesity in 2019, compared to a national percentage of 15.5.
Anderson said she has always made exercise and nutrition a priority in her programs. While she sees her students starting to carry around a water bottle instead of getting a soda and grabbing an apple instead of chips, the biggest challenge remains eating healthy at home, she said. Many families don’t know how to make enjoyable and healthy food — or aren’t able to spend more money to do so.
“There’s not a lot of options for nutritious cooking classes or how to eat healthy on a budget,” in the rural area, Anderson said. “We just have to educate our parents.”
Families in low-income urban centers and rural areas may find themselves living in “food deserts,” a designation assigned by the distance from a grocery store. Limited access to a supermarket makes it harder for some families to access healthy food.
In Alabama, where in 2019 17.2% of youth in grades 9-12 were estimated to be struggling with obesity, pediatrician Dr. Richard Glaze noted that regional dietary staples of fried foods and sweet tea pose a unique issue.
“What you’ll also find here in the South is we love to eat. We eat stuff that oftentimes isn’t good for us and that’s often generations of those kinds of choices,” said Glaze, who works at Pediatric Clinic LLC, with offices in Auburn and Opelika.
“...Food is an important part of our lives. It’s a part of our celebrations, it’s a part of our family time together, and we don’t want to demonize food in general. But we want to make sure we give it its proper place,” he said.
Sugary drinks also contribute to the obesity problem in North Carolina, according to Dr. Suzanne Lazorick, a professor of pediatrics and public health at East Carolina University.
“We have sometimes 3-to-5-year-old children that are drinking 1,400 calories a day from beverages, which is more than what even their total calories should be from all of their nutrition,” Lazorick said.
If the causes are complex, treatment is even more difficult.
It's why doctors, public health officials and nutritionists across the country are increasingly focusing on youth to prevent the obesity epidemic among children and adults from growing worse.
One hurdle has been stigma, experts and parents said. Many people see obesity not as an illness but as evidence of a moral failing, the result of laziness or a lack of willpower.
As a result, many youth feel shame about having obesity. The shame can keep them from socializing, dating, putting on exercise clothes or bathing suits and participating in classroom and extracurricular activities.
Many take cover — and comfort — in food.
"In the culture we live in where there's so much shaming and people saying 'you're fat, you're bad,' we have to look a little deeper," said Jessica Jones, a youth pastor in Lawrenceville, Virginia, a community of about 1,400 just north of the North Carolina border.
Her church, Tabernacle of Zion, has partnered with a program at Virginia Tech to address childhood obesity through building community support, which research suggests is crucial to success.
"If you look a little deeper, there's often more going on," Jones said. "Sometimes there's trauma attached."
From her practice in one of the nation's premier children's hospitals in Chicago, Selvaraj agrees.
“There is absolutely massive weight stigma in our society,” Selvaraj said. “The way we treat children and adults who have high weight is really shameful. We really value in our society a certain type of body. And when people do not meet a certain societal ideal of children, young children feel that shame.”
Weight-related bullying only worsens the situation, Selvaraj said. Children internalize what is said to them by classmates, parents, siblings and others.
“They can actually start having a negative voice in their head where they’re telling themselves they’re bad,” Selvaraj said. This can lead to depression, anxiety and eating disorders.
“We see an unfortunate number of eating disorders, which kind of gets missed in patients with elevated weight,” she said. “People think that elevated weight and eating disorders are two separate categories when there is actually a massive overlap.”
Planting seeds of change
Shoveling compost, tearing out old vegetable plants and assembling a new garden bed, a group of seventh- and eighth-graders at Redwood Middle School spent part of a recent afternoon working in the campus garden. The students were getting ready to grow new food and — hopefully — healthy food habits.
Redwood’s garden is one way the Napa Valley Unified School District in California is exploring different ways to integrate gardens and garden-based nutrition into its curriculum.
Similar initiatives are taking place in Nebraska. In the 2021-2022 school year, schools across the state spent more than $3 million on locally produced dairy, meat, fruits and vegetables. That includes more than 1,840 pounds of broccoli, 66,000 cobs of corn, 107,000 pounds of chicken and millions of milk cartons.
Sarah Smith, the farm to school coordinator at the Nebraska Department of Education, said recent policy victories have led to increased interest in the program.
In 2021, the Nebraska legislature passed the Farm to School Act, which allocated funding and created Smith's full-time position within the NDE to coordinate farm to school programs.
“There are public health and food security benefits, as well as lifelong health benefits when farm to school is in the picture,” Smith said.
Dr. Amy Christison is the medical director of Healthy Kids U Clinic at OSF Children’s Hospital of Illinois. Healthy Kids U is a weight management clinic in Peoria that partners with children and families to make healthy lifestyle choices and to prevent and manage children with obesity-related problems.
“We want them to have a great healthy relationship with food and to be able to nourish their bodies so their bodies are strong and healthy all their lives,” said Christison.
Empowering parents and guardians to help their children in making healthy lifestyle choices is also a key component to preventing obesity rates from climbing.
“It’s the work you do every single day, which is not always appreciated in the moment, but it pays off over time. We hope,” Selvaraj said.
States with the most physically active teens
States With the Most Physically Active Teens
Rates of physical activity among teens are declining
Physical activity varies by gender _ declines with age
13. North Dakota
6. West Virginia
4. New Mexico
1. South Dakota
Midwest Investigative Reporter Analisa Trofimuk can be reached at firstname.lastname@example.org.