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Commentary

The spread of the childhood obesity epidemic

Ross E. Andersen
CMAJ November 28, 2000 163 (11) 1461-1462;
Ross E. Andersen
Dr. Andersen is with Johns Hopkins School of Medicine, Baltimore, Md.
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There is an old Chinese proverb that states “A journey of a thousand miles begins with one step.” It is time for physicians and health care professionals to embark on the journey to reduce levels of obesity in children and adolescents. In this issue (page 1429) Mark Tremblay and Douglas Willms report that Canadian children are becoming progressively more overweight.1 Alarmingly, they report that from 1981 to 1996 the prevalence of overweight increased by 92% in boys and by 57% in girls. Moreover, during that same time frame, the prevalence of obesity has more than doubled in both boys and girls. These data mirror recent reports from the United States,2,3 Europe,4 China5 and several developing countries.6

In the United States alone the estimated annual number of deaths attributable to obesity is about 280 000.7 A major concern regarding childhood obesity is that obese children tend to become obese adults, facing an increased risk of diabetes, heart disease, orthopedic problems and many other chronic diseases.8 Dietz9 has also cautioned that obese children are much more likely to face both health and psychological challenges related to their obesity during childhood and adolescence than their leaner counterparts. Increasingly, pediatricians are seeing hyperlipidemia, hypertension and diabetes in their obese patients.

The dramatic increases in the prevalence of obesity among both children and adults reflects a population shift toward a positive energy balance. Clearly, we become a fatter society when overall kilojoules consumed exceed kilojoules expended. Dietary intake and energy expenditure represent the 2 modifiable factors of this equation. It is apparent that there is an abundance of high-energy, high-fat foods readily available to children throughout the developed world and increasingly in the developing world, and access to these types of foods should be reduced for overweight children. However, the consumption of high-energy food alone cannot explain completely the exponential increases in the prevalence of overweight seen in recent years. Physical activity is also a key factor in the energy balance equation, and children are increasingly watching television or playing video games in their leisure time.

A sedentary lifestyle has been found to be strongly related to adiposity in children.10 We have reported that US children (aged 8–16 years) who watch 4 or more hours of television per day had a higher body mass index (BMI), measured in kg/m2, and thicker skinfolds than those who watched fewer than 2 hours per day. Moreover, the fattest children were those who reported low levels of vigorous activity and high levels of television watching.10 Sixty percent of US children watch at least 2 hours of televison per day. We have also recently found that total energy intake is positively associated with hours of television watched in a nationally representative sample of US children.11 This trend persisted even after adjusting for age, BMI, ethnic origin, family income and weekly bouts of physical activity. Robinson12 recently examined the effects of a 6-month classroom curriculum aimed at reducing television, videotape and video game use in fourth-grade children. They found that compared with controls, children in the intervention group had statistically significant relative decreases in BMI, triceps skinfold thickness and waist circumference. This underscores the work of Epstein and colleagues13 who have reported that decreasing sedentary behaviour is a key ingredient in the successful treatment of childhood obesity.

With school budgets tightening across Canada and elsewhere in Western countries, physical education and after-school sport programs have recently been on the chopping block. The Canadian Association for Health, Physical Education, Recreation and Dance (CAHPERD) advocates that all Canadian children participate in 150 minutes of physical education per week (i.e., 30 minutes per day) for every child from kindergarten through grade 12.14 Moreover, the Canadian Medical Association also passed a resolution 2 years ago echoing CAHPERD's call for 30 minutes per day of compulsory physical education for every child.15 Unfortunately, few school administrators and educators have implemented this resolution or taken it seriously. From CAHPERD's experience, schools average only 60 minutes of physical education per week. This is particularly troubling since high-quality, school-based physical education can help promote healthier living and encourage a lifetime of active living.

Clearly, the dramatic increase in the prevalence of obesity in Canadian children represents a serious threat to public health. The etiology of obesity represents a complex interaction of genetics, diet, metabolism and physical activity levels. Physicians also need to address and discuss weight loss strategies with both obese children and their families. Community leaders, school boards and the entire health care community also need to engage actively in strategies to prevent obesity in children and adolescents. By encouraging all children to consume healthier diets and to remain physically active, we can take the first step in our journey to reduce levels of childhood obesity.

Footnotes

  • Competing interests: None declared.

References

  1. 1.↵
    Tremblay MS, Willms JD. Secular trends in the body mass index of Canadian children. CMAJ 2000;163(11):1429-33. Available: www.cma.ca/cmaj/vol-163/issue-11/1429.htm
    OpenUrlAbstract/FREE Full Text
  2. 2.↵
    Ogden CL, Troiano RP, Briefel RR, Kuczmarski RJ, Flegal KM, Johnson CL. Prevalence of overweight among preschool children in the United States, 1971 through 1994 [abstract]. Pediatrics 1997;99(4):E1.
  3. 3.↵
    Troiano RP, Flegal KM, Kuczmarski RJ, Campbell SM, Johnson CL. Overweight prevalence and trends for children and adolescents. The National Health and Nutrition Examination Surveys, 1963 to 1991. Arch Pediatr Adolesc Med 1995;149:1085-91.
    OpenUrlCrossRefPubMed
  4. 4.↵
    Livingstone B. Epidemiology of childhood obesity in Europe. Eur J Pediatr 2000;159(Suppl 1):S14-34.
  5. 5.↵
    Wang Y, Ge K, Popkin BM Tracking of body mass index from childhood to adolescence: a 6-y follow-up study in China. Am J Clin Nutr 2000;72:1018-24.
    OpenUrlAbstract/FREE Full Text
  6. 6.↵
    De Onis M, Blossner M. Prevalence and trends of overweight among preschool children in developing countries. Am J Clin Nutr. 2000;72:1032-9.
    OpenUrlAbstract/FREE Full Text
  7. 7.↵
    Allison DB, Fontaine KR, Manson JE, Stevens J, VanItallie TB. Annual deaths attributable to obesity in the United States. JAMA 1999;282:1530-8.
    OpenUrlCrossRefPubMed
  8. 8.↵
    Braddon FE, Rodgers B, Wadsworth ME, Davies JM. Onset of obesity in a 36 year birth cohort study. Br Med J (Clin Res Ed) 1986;293(6542):299-303.
  9. 9.↵
    Dietz WH. Childhood weight affects adult morbidity and mortality. J Nutr 1998;128(Suppl 2):411S-4S.
    OpenUrlAbstract/FREE Full Text
  10. 10.↵
    Andersen RE, Crespo CJ, Bartlett SJ, Cheskin LJ, Pratt M. Relationship of physical activity and television watching with body weight and level of fatness among children: results from the Third National Health and Nutrition Examination Survey. JAMA 1998;279:938-42.
    OpenUrlCrossRefPubMed
  11. 11.↵
    Crespo CJ, Smit E, Troiano RP, Bartlett SJ, Macera CA, Andersen RE. Television watching, energy intake, and obesity in U.S. children: results from the Third National Health and Nutrition Examination Survey, 1988–1994. Arch Pediatr Adolesc Med. In press.
  12. 12.↵
    Robinson TN. Reducing children's television viewing to prevent obesity: a randomized controlled trial. JAMA 1999;282:1561-7.
    OpenUrlCrossRefPubMed
  13. 13.↵
    Epstein LH, Paluch RA, Gordy CC, Dorn J. Decreasing sedentary behaviors in treating pediatric obesity. Arch Pediatr Adolesc Med 2000;154:220-6.
    OpenUrlCrossRefPubMed
  14. 14.↵
    Canadian Association for Health, Physical Education and Recreation. Quality Daily Physical Education Rationale Handbook. Ottawa: The Association; 1987.
  15. 15.↵
    Canadian Medical Association. Resolution 43 adopted by CMA at 1998 General Council. Available: www.cma.ca/inside/annmeet/131/resolutions.htm (accessed 2000 Oct 30).
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28 Nov 2000
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The spread of the childhood obesity epidemic
Ross E. Andersen
CMAJ Nov 2000, 163 (11) 1461-1462;

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Ross E. Andersen
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