Childhood Obesity: Causes,
Consequences, and Solutions
Relatives As Parents Program Grantees
The Brookdale Foundation
Jana R. Kicklighter, PhD,RD
Associate Professor
Division of Nutrition
Georgia State University
Atlanta, Georgia
June 17, 2009
Objectives: Participants will…
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Describe how to determine a child’s
weight status
Identify trends in childhood obesity
Explain the causes and consequences of
childhood obesity
Interpret results of a healthy habits quiz
Describe potential solutions to the
childhood obesity problem
Identify goals for change to address
weight issues in childhood
Determination of Healthy Weights for
Children
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Use Body Mass Index (BMI) as
screening tool
Calculated from child’s weight and
height
Indicator of body fatness
Use for children 2 years of age and
older
CDC Growth Chart Example
CDC: Weight Definitions for Children
based on BMI
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>5th percentile,
< 85th percentile
>85th percentile,
< 94th percentile
>95th percentile
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Healthy weight
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Overweight
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Obese
Prevalence of Childhood Overweight:
National Health and Nutrition Examination
Surveys (NHANES)
NHANES
1976-1980
NHANES
2003-2004
2-5 year olds
5.0%
13.9%
6-11 year olds
6.5%
18.8%
12-19 year olds
5.0%
17.4%
Consequences of Childhood
Overweight
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Cancer
Heart disease
Stroke
Type 2 diabetes
High blood pressure
High blood cholesterol
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Asthma
Bone and joint
problems
Fatty liver
Emotional pain
Obese adult
Cause of Childhood Obesity
Energy Imbalance
Food/Beverages
Activity
Energy Imbalance
Socioecological Model
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To promote healthy weight incorporate
strategies at four levels:
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Individual: increase individuals’ knowledge and
skills
Relationships: use family, friends and social
networks as positive influences
Community: work for positive changes in
schools and neighborhoods
Societal level: advocate for educational and
social policies to support positive changes
Factors Contributing to Energy Imbalance
and Weight Problems (Last 2-3 Decades)
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Heredity: Plays a small role
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Way we live, eat and play has changed
dramatically:
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Greater variety of readily available, low cost
energy dense foods
Larger portion sizes
Increase in eating out: fast food
More exposure to food and beverage
advertisements
Increased screen time
Decreased physical activity
Healthy Habits Quiz
Do you and your family…
Yes
No
(2 pts)
(0 pt)
Sometimes
(1 pt)
Have regularly scheduled meals when
you are at home?
Eat meals together at least once a
day?
Plan snacks?
Tailor portion sizes to each person’s
needs?
Plan and prepare meals together
once a day?
Eat three meals every day?
Try to make mealtimes enjoyable?
Healthy Habits Quiz (cont)
Do you and your family…
Yes
No
(2 pts)
(0 pt)
Sometimes
(1 pt)
Avoid making everyone eat
everything on their plate?
Make meals last more than fifteen
minutes?
Eat only in designated areas of the
house?
Avoid using food to punish or reward?
Enjoy physical activities together
once or twice a week?
Source: Kosharek SM. If Your Child is Overweight: A Guide for Parents.
3rd ed. Chicago, IL: American Dietetic Association; 2006.
Healthy Habits Quiz Scores
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Add up total points and interpret as
follows:
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20-24: Your family is on the right track.
13-19: Your family is doing well but could
work on areas where you answered “no” or
sometimes.”
<12: The next section on solutions should be
very helpful as you help your grandchild(ren)
toward healthier habits.
Solutions: Eat regular meals and
increase family meals
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Eat meals 3 times/day and only in
designated areas
Eat together as a family one time/day
Keep meals simple, easy and nutritious
Get everyone involved in planning,
shopping and preparing meals
Make mealtimes relaxed, pleasurable,
enjoyable and engaging
Get creative and be flexible: a family
meal could be a picnic prior to a sports
event
Benefits of Family Meals
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More healthful diets
Better school performance
Grandparents serve as role models for
healthful attitudes toward food and eating
Grandparents can model healthy food
habits
Promotes psychological wellness: Lower
rates of smoking, drinking and drug use,
getting in fights, later initiation of sexual
activity
Grandparent/Grandchildren
Responsibilities
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Grandparents are responsible for the what,
when and where of feeding
 Nutritionally and developmentally
appropriate foods
 Opportunity to eat every 2 1/2 – 3 hours
 Provide support
Grandchildren are responsible for whether,
what and how much to eat from those
provided
Source: Satter E. Secrets of Feeding a Healthy Family. Madison,
WI: Kelcy Press; 1999.
MyPyramid for Kids:
Key Messages
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Be physically active every day
Every color every day:5 different food
groups
Eat more from some food groups than
others
Choose healthier foods from each group
Take one step at a time and start with
small changes
Solution: Tips for Healthier Foods
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Make half your grains whole
Vary your veggies
Focus on fruits
Get your calcium-rich foods
Go lean with protein
Change your oil
Don’t sugarcoat it
Know your portions
Recommended Number of Servings
By Age and Sex
2-3 years
Milk/dairy (c)
2
Lean meat &
beans (oz)
2
4-8 years
9-13 years
2
3
5
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Female
3
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Male
4
Fruits (c)
1
Vegetables (c)
1
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Female
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Male
Grains (oz)
1.5
1.5
1
2
1.5
2.5
3
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Female
4
5
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Male
5
6
3 Star Meal and Snack Guidelines
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Include more than one food group
Limit fat and sugar
Include fruits, vegetables, and
foods made with whole grains
Solution: Appropriate Portion Sizes
Serving
Grains (oz)
1 slice bread
1 c dry cereal
½ c rice, pasta
or cereal
Vegetables (cup)
½ c chopped
1 c lettuce
Fruits (cup)
3/4 c juice
1/2 c chopped
1 medium fruit
1/4 c raisins
What it Looks Like
Solution: Appropriate Portion Sizes
Serving
Milk and Dairy
(cup)
1 c milk or
yogurt
1 1/2 oz cheese
Lean Meat and
Beans (oz)
3 oz cooked
meat, fish and
poultry
2 eggs
1 c cooked dried
beans
2 tablespoons
peanut butter
1/2 c nuts
What it Looks Like
Solution: Be Aware of Portion
Distortion
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Portion sizes have increased over
past 20 years
Larger portions add up
100 extra calories/day can lead to
weight gain of 10 pounds/year
Examples that follow are from the
National Heart, Lung and Blood
Institute website
Portion Distortion: 257 More Calories
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20 years ago
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Today
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333 calories
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590 calories
Portion Distortion: 350 More Calories
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20 years ago
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Today
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500 calories
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850 calories
Portion Distortion: 525 More Calories
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20 years ago
1 cup spaghetti with
sauce; 3 small
meatballs;500 calories
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Today
2 cups spaghetti with
sauce; 3 large
meatballs;1,025
calories
Portion Distortion: 165 More Calories
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20 years ago
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Today
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6.5 oz; 85 calories
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20 oz;250 calories
Portion Distortion: 290 More Calories
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20 years ago
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Today
1.5 oz; 210
calories
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4 oz; 500 calories
Portion Distortion: 400 More Calories
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20 years ago
2.4 oz;210
calories
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Today
6.9 oz;610
calories
Effect of Eating Out on Children
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Consume more:
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Consume fewer:
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Calories
Fat
Added sugar
Sugar sweetened beverages
Fruits
Non-starchy vegetables
Consume less:
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Fiber
Milk
Characteristics of Children’s Meals
at Chain Restaurants
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Dominated by burgers, chicken
nuggets, macaroni & cheese, French
fries and soft drinks
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Most common entrée – fried chicken
Most common side order – fries
Most popular beverage – soft drinks
Source: Wootan MG, Batada A, Marchlewicz E. Kid’s Meals:
Obesity on the Menu. Center for Science in the Public
Interest. Available at: www.cspinet.org/kidsmeals.
Children’s Menu Hall of Shame
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Chili’s
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Cheese pizza, homestyle fries &
lemonade
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1000 calories
Popcorn chicken, baked beans,
biscuit, fruit punch & Teddy
Grahams
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940 calories
Double cheeseburger, fries &
chocolate milk
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910 calories
Grilled cheese, fries & slushie
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830 calories
Burger King
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1020 calories
KFC
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Chili’s
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Country-fried chicken crispers,
cinnamon apples & chocolate
milk
Sonic
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Healthier Restaurant Choices
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Subway
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Chili’s
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Arby’s
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Ham mini-sub with juice box
& apple slices or raisins
Grilled chicken sandwich with
apple juice, corn kernels or
mandarin oranges or
pineapple
Popcorn chicken or Jr. roast
beef sandwich with fruit cup
and fruit juice
Solution: Emphasize Healthy Eating
Out
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Plan ahead where to go
Look beyond the child’s menu: Consider
appetizers, soups, salads and side dishes
Be a good role model
Make portion control a priority: split a
sandwich, share an entrée, or take home
a doggy bag
Build a healthier food: choose whole
wheat bread and lean ham for a
sandwich; load up the pizza with veggies
and lean meats
Solution: Limit Exposure to
Advertisements Geared to Children
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Typical child watches > 40,000 TV
commercials each year
> $12 billion per year is spent on
marketing to children
Most heavily advertised:
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Fast foods
Snack foods
Highly sugared foods
Source: Ritchie LD, Welk G, Styne D, Gerstein DE, Crawford
PB. Family environment and pediatric overweight: What is a
parent to do? J Am Diet Assoc. 2005; 105: S70-S79.
Solution: Decrease Screen Time
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Negative effects of TV
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Snacking on sweets, chips, pizza, fast foods
Advertisements encourage unhealthy foods
Lower intake of fruits and vegetables
Increased inactivity
Limit screen time
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< 2 hours/day
No TV for child < 2 years old
Remove TV and computers from bedroom
Establish family rules
Source: American Academy of Pediatrics
Solution: Increase Family Physical
Activity
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Benefits of physical activity
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Strengthens bones
Decreases blood pressure
Relieves stress
Increases self-esteem
Helps with weight management
Physical Activity Recommendations for
Children
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One hour or more of moderate or
vigorous physical activity per day
Examples of moderate activities
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Hiking; skateboarding; bicycle riding; brisk
walking
Examples of vigorous activities
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Jumping rope; running; soccer; basketball
Sources: American Academy of Pediatrics; American Heart
Association; Centers for Disease Control and Prevention
Tips for Getting the Family more Active
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Build into family routines
Focus on fun activities and use
them as rewards for good behavior
Encourage children to play outside
with other children
Include in daily routines
Solution: Identify What to Change
How many of these describe your family?
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Little physical activity (< 15
minutes/day)?
Snacks frequently on high fat, high
calorie foods (chips, cookies, candy,
ice cream)?
Does not eat at regular mealtimes?
Skips meals and snacks throughout
the day?
Solution: Identify What to Change
(Cont) How many of these describe your family?
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Watches > 2 hours TV/day?
Spends several hours each day playing
videogames or using computer?
Snacks while watching TV or playing
videogames?
Eats a lot of sugary or fried foods?
Eats fast food more than 1 time/week?
Drinks sweetened beverages daily (soda,
juice drinks, fruit juice, sweetened milk
drinks)?
Identify Specific Behaviors to Change
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Examine the behavioral statements
answered with a yes
Identify 2-3 behaviors you would
like your family to change
Start with those
Solution: Identify Barriers to Change
and Brainstorm Ways to Overcome
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Do barriers include:
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Lack of skills?
Lack of time?
Lack of money?
Or a combination of these?
Solution: How to Change
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Make it a family affair
Start with small changes
Write down realistic and measurable
goals (2-3)
Make weekly goals and track
progress
Don’t expect perfection
Reward with nonfood prizes
Solution: Become an Advocate for
Community and Societal Change
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More sidewalks in neighborhoods
Community gardens and farmers’ markets
“Walking school bus” program
Changes in schools
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Ban soft drinks and candy sales
Teach nutrition
Incorporate physical education
Teach healthy cooking
Regulate advertising to children
Healthier menu options for kids
Post nutrition information in restaurants
In Summary:
G - Grandparents can:
R – role model good eating habits/attitudes
A – arrange for family physical activities
N – note the 3 star meal and snack guidelines
D – decrease screen time
P – plan and prepare regular family meals
A – avoid using food to punish or reward
R – restrict eating out
E – encourage fruits, vegetables & whole grains
N – note food label nutrition information
T – tailor portion sizes to individual needs
S – set realistic and measurable goals
Quote
Grandparents are a family's greatest
treasure, the founders of a loving legacy,
The greatest storytellers, the keepers of
traditions that linger on in cherished
memory. Grandparents are the family's
strong foundation. Their very special love
sets them apart. Through happiness and
sorrow, through their special love and
caring, grandparents keep a family close
at heart.
~author unknown