Pediatric obesity in the United States is an epidemic.
Although obesity rates vary among different ethnic groups, an
estimated 17% (12.5 million) of US children ages 2-19 years
are overweight or obese.1 The Endocrine Society sought to
address this epidemic with its 2008 guideline, Prevention and
Treatment of Pediatric Obesity. First Lady Michelle Obama
has acknowledged that childhood obesity rates were rising at
an alarming rate, and established “Let’s Move;” a campaign
to combat pediatric obesity through comprehensive
strategies of mobilizing public and private sector resources.
Obesity occurs when more calories are consumed than are
expended over time. The balance between calories-in and
calories-out differs for each person. Factors that might tip the
balance include genetic makeup, overeating, consumption of
high-calorie, high-sugar foods and drinks, asthma, and not
being physically active. In 2001 to 2004, the average intake of
added sugars in American’s diets was 355 calories per day.
Aside from the obvious lack of nutritional value, the excessive
consumption of sugars has been linked with several
metabolic abnormalities and adverse health outcomes.2
According to the Centers for Disease Control and Prevention
(CDC), the prevalence of obesity among US youth increased
significantly between the 1980’s and 2000’s. Overweight
or obese adults are defined by using weight and height to
calculate the body mass index (BMI).1 An adult who has a
BMI over 30 is considered obese and a BMI of 40 or higher
is considered morbidly obese. For children and teens, BMI
ranges take into account sex, age, and pubertal differences
in body fat. A child who is considered severely obese would
have a BMI above the 97th percentile in their age range.
An elevated BMI is not the only consequence of obesity.
Research has shown that weight gain may increase the risk
of developing diabetes, heart disease, stroke, liver disease,
kidney disease, reproductive disorders, and arthritis and
other skeletal disorders, and other maladies.3 A 2007 CDC study reported that 70% of obese adolescents were at a
high risk for cardiovascular disease and type 2 diabetes.
Overweight children and adolescents are more likely to be
overweight or obese as adults and the associated comorbidities
are often prolonged or exacerbated in adulthood.
To address the pediatric obesity epidemic, endocrinologists,
primary care physicians, schools, and parents must work
together to educate and encourage lifestyle modifications.
Congress must also play a role in strengthening the
health of our children through legislation to reduce the
availability of added sugar, and increase the availability
of healthy, high-fiber foods like vegetables, fruits,
whole grains, and fat-free and low-fat dairy products
in schools, and advocating for communities that are
designed to promote walking and bicycling.
Prevention and Treatment Research
The costs associated with the obesity epidemic have
crippled national health care spending. According to a 2004
CDC study, the medical bills of an obese individual are
42% higher than of someone who is not obese. In 2008,
an estimated $147 billion was spent on overall medical
care costs related to obesity for US adults.1 Approximately
half of these costs are paid by Medicare and Medicaid.1
The amount spent on medical expenses associated with the
treatment and prevention of obesity in individuals should spur
interest in increasing funding for research into new prevention
options for childhood obesity. Research may include support
for experimental studies that will lead to the understanding of
the etiology of obesity and evidence for potential treatments.
Programs such as CDC’s Childhood Obesity Demonstration
Project and the Pediatric Nutrition Surveillance System may
produce recommendations that could stimulate greater
attention to the prevention and treatment of pediatric obesity.
These programs have also alluded to a connection between
maternal weight and obesity of their children. Therefore
research is needed to understand the role of maternal
influences on the risk of obesity in childhood and the value of
preventive strategies targeted to women of childbearing age.
Targeting Public Policy and Schools
In 2002 the food industry spent $10-12 billion advertising
to children; approximately 89% of those advertisements
were for food of poor nutritional quality.4 Passing legislation
that is geared toward both education on healthy eating and
marketing of healthy foods in schools and communities
may increase a child’s exposure to healthy food options and
combat poor nutritional advertisements. Such legislation
is especially important since research shows that food
advertising affects children’s food choices, food purchase
requests, and diets.5 In the school environment students
need access to healthy food and the support of persons
around them.6 The influence of school goes beyond the
classroom and includes normative messages from peers
and adults regarding foods and eating patterns. Students
are more likely to receive a strong, consistent message
when healthy eating is promoted through a comprehensive
school health program which includes, among other
things, health education; integrated school and community
efforts; physical education; and nutrition services.7
Local school systems need to assess the nutrition needs
and issues particular to their communities, and work with
key school- and community-based constituents, including
students, to develop the most effective and relevant
nutrition education plans for their communities. Policy
changes are required that will ensure the adoption of a
coordinated school nutrition system which would identify the
recommended calories in a balanced meal and implement
this recommendation throughout all school lunch programs.
Schools must also play a role in ensuring that children
are physically-active. Mandatory physical activity, either
during physical education or recess, should be included
every day for school-aged children. A recent CDC study
showed that less than 4% of elementary schools, 8% of
middle schools, and 2% of high schools required daily
Physical Education (P.E.) for all students for the entire school
year.8 However, health experts recommend 30 minutes of
daily physical education for elementary school students,
and 45 minutes for those in junior high and high school.
Currently, only Illinois and Massachusetts require P.E.
classes for all kids in kindergarten through 12th grade.8
Role of the Physician
Physicians should have a strong role in the prevention of
obesity and treatment of an overweight patient, and shouldprescribe and support intensive lifestyle modification for
the entire family and the patient in an age-appropriate
manner. Physicians must encourage the development of
team centric treatment options that involve collaboration
with schools, parents, communities and government
agencies to encourage healthy dietary habits and increased
physical activity. To support physicians in this endeavor,
Congress must identify opportunities that would encourage
physicians to pursue additional counseling and eliminate
expenses associated with preventive services. Physicians
should receive incentives to follow-up with the patient after
consultation and provide resources for physical activity
and proper nutritional needs. In addition, physicians should
measure weight and height in a standardized way and
encourage early action by parents in response to an elevated
BMI trajectory. Research has shown that early identification
of trending overweight and early intervention by physicians
and parents are more effective in children and adolescents.9
Increased physical activity and overall community wellness is
an important component of the prevention and treatment of
pediatric obesity. A 2011 report from the National Academy
of Science’s Institute of Medicine recommended that
parents, daycare workers and other preschool personnel
limit the amount of time the child is sedentary and encourage
outdoor physical activity from birth to age five.10 The CDC
also recommends 60 minutes of moderate to vigorous
physical activity daily. The “Communities Putting Prevention
to Work” program, developed by the Department of Health
and Human Services (HHS), was designed to mobilize local
resources at the community-level. Through this program,
communities are encouraged to introduce environmental
changes that promote and allow walking and bicycling.
Governmental incentives could promote development of
more grocery stores and increased access to fresh foods
in communities. Millions of low-income Americans live
in “food deserts,” neighborhoods with an abundance of
fast-food restaurants and convenience stores but lack
convenient access to affordable and healthy food.11 In
addition; stores in low-income communities may stock
fewer and lower quality healthy foods. Therefore, The
Endocrine Society promotes convenient access to grocery
stores and other retailers that sell a variety of healthy foods;
prices that make healthy choices affordable and attractive;
a range of healthy products available in the marketplace; and adequate resources for consumers to make healthful
choices, including access to nutrition assistance programs
to meet the special needs of low-income Americans.
Today’s children get a failing grade meeting physical and
nutritional standards for healthy living. The CDC and other
health agencies have provided guidelines for proper physical
and nutritional routines to prevent pediatric obesity. In January
2011, the United States Department of Agriculture released
its 2010 Dietary Guidelines for Americans that provided
recommendations for healthy food consumption. Some new
tips were to avoid oversized portions; make half your plate
fruits and vegetables; and drink water instead of sugary
drinks. Although resources for healthy habits are available,
the Endocrine Society suggests that the cornerstone to
successful modifications is public policy changes that allow
for effective physician, parental, and societal interventions.
There are few public policies that create, support, and
provide environments for routine physical activity and access
to healthful foods. Without a proper balance of physical
activity, diet, and early interventions, pediatric obesity rates
will continue to rise, leading to high adult obesity rates
and co-morbidities, reduced productivity, and increased
medical expenditures. Immediate action must be taken
to combat this epidemic and nurture a healthy society.
The Endocrine Society supports the implementation of
policies that sustain a prevention care team that includes
medical personnel, family, schools, and the community,
to combat pediatric obesity. As such, the Endocrine
Society recommends that the federal government:
Increase research funding for new prevention
and treatment options for childhood obesity.
Enact legislation for better access to low-sugar, highfiber
food and drinks in schools and communities.
Ensure proper evaluation and treatment of overweight
and obese patients and provide incentives for physicians
to allow for a greater role in the care of these patients.
Offer incentives for the development of
communities that provide the opportunity
for adequate and safe physical activity.
Develop a council under the US Department of
Agriculture or in the Department of Health and Human
Services made of physicians, nurses, registered
dieticians, and business leaders to monitor industrial food
development, commercialization, and nutrition in schools.
Centers for Disease Control and Prevention: Overweight
and Obesity Website, http://www.cdc.gov/obesity/
index.html. Accessed February 2010.
Johnson, R., Appel, L., Brands, M., et. al. AHA Scientific
Statement. Dietary Sugars Intake and Cardiovascular
Health A Scientific Statement From the American Heart
Association. Circulation. 2009; 120: 1011-1020.
Freedman D.S., Mei Z., Srinivasan S.R., Berenson G.S.,
Dietz W.H. Cardiovascular risk factors and excess adiposity
among overweight children and adolescents: the Bogalusa
Heart Study. J Pediatr. 2007 Jan;150(1):12–17.e2.
August, G. et al. Prevention and Treatment of Pediatric Obesity: An Endocrine Society Clinical Practice
Guideline Based on Expert Opinion. J. Clin. Endocrinol. Metab. 2008; 93(12): 4576-4599.
American Psychological Association (2004). Report of the APA task force on advertising and children.
Washington, DC: Author. Retrieved from http://www.apa.org/pi/families/resources/advertising-children.pdf.
Contento I., Balch G.I., Bronner Y.L., et al. Nutrition education for schoolaged
children. J Nutr Educ 1995;27(6):298-311
Allensworth D.D., Kolbe L.J. The comprehensive school health program:
exploring an expanded concept. J Sch Health. 1987;57(10):409-12.
Nancy Armour. Do Schools Need More PE Time to Fight Obesity? USA Today; June 22, 2009
Pryor, Laura E. MSc; Tremblay, Richard E. PhD; Boivin, Michel, PhD, et. al. Developmental
Trajectories of Body Mass Index in Early Childhood and Their Risk Factors: An 8-Year
Longitudinal Study. Arch Pediatr Adolesc Med. 2011; 165:906-912
Institute of Medicine of the National Academies. Early Childhood Obesity
Prevention Policies. Website http://www.iom.edu/Reports/2011/Early-
Childhood-Obesity-Prevention-Policies.aspx. Accessed October 2011.
Let’s Move Campaign Website, http://www.letsmove.gov/index.php. Accessed September 2010.