IMPORTANT NOTE: JAAPA CME activities consist of 2 articles. To obtain credit, you must also read
Childhood obesity: Complications, prevention strategies, treatment; the post-test will include questions related to both articles. AAPA Fellow members should complete and submit the post-test on the AAPA Web site by going to
www.aapa.org and searching for keyword
JAAPA post-tests. All others may complete and submit the post-test online at no charge at
www.mycme.com. To obtain 1 hour of AAPA Category I CME credit, PAs must receive a score of 70% or better on each test taken.
KEY POINTS
■ BMI has high specificity and is moderately sensitive, so using BMI alone will underestimate obesity in some children. Waist circumference and triceps skinfold determinations have also been used to define obesity, but neither can be used alone to determine whether a child is overweight or obese.
■ Socioeconomic status is one of the most significant epidemiologic factors in childhood obesity. Compared with children of middle class or affluent households, children of households at or below the poverty level have an 83% increased risk of becoming obese.
■ One theory holds that spending more time in sedentary pursuits increases the risk of becoming obese. Physical activity can promote a healthy lifestyle and decrease the risk of obesity among children.
■ One way to open the discussion of overweight or obesity is to have a BMI chart on hand. When the BMI places a child in the overweight or obese category (BMI in the 85th percentile or higher), the clinician can show the child and/or parent the objective information about the specific BMI.
In February 2010, Michelle Obama announced the "Let's Move" initiative. The goal of this comprehensive program is to eliminate childhood obesity.1 Her goal may seem ambitious, but achieving it is necessary. Childhood obesity has become a growing problem among US children.2 Currently, an estimated 16.9% of them between 2 and 19 years old are obese or above the 95th percentile according to the body mass index (BMI)-for-age growth charts; 11.9% of US children in the 2- to 19-year-old age-group are at or above the 97th percentile.3 In addition, the number of overweight and obese children has increased in almost all countries worldwide.4
Genetic factors, lack of physical activity, and increased consumption of fast food are all possible explanations for childhood obesity.5 Research suggests that families are eating out much more today than they did in the late 1970s.5 One study reported that between 1970 and the mid- to late-1990s, the number of meals eaten away from home by children in the United States nearly doubled.5 Not only is there a convenience factor to less healthy food choices, but the cost of healthy foods seems to be increasing.5 The prices of fruits and vegetables increased by 118% between 1985 and 2000, while the prices of foods high in fats and oils increased by 35%.6 These statistics suggest that foods with added sugars and fats may be the only affordable dietary option for those with limited family incomes.6 Eating a diet that is rich in fat and sugar and limited in fruits and vegetables can lead to childhood obesity and subsequently to adverse consequences, such as issues of self-esteem, insulin resistance, and chronic health concerns, including cardiovascular problems.7
Because of this growing epidemic, physician assistants must maintain an awareness of childhood obesity and be able to recognize children who are obese, overweight, or at risk of becoming obese. This article, the first of two in the current issue of JAAPA, focuses on the etiology, pathophysiology, diagnosis, treatment, complications, and prevention of childhood obesity.
DEFINING CHILDHOOD OBESITY
Obesity is a disease in which a person is at increased risk of unfavorable health outcomes as a result of excess body fat.8 Many methods have been utilized to classify a person as overweight or obese. These methods include measuring waist circumference, calculating BMI, and assessing skinfold tests. Various organizations have advocated different methods of classifying childhood obesity. For example, according to the CDC, the best tool for monitoring weight in children is the BMI,9 which is first calculated based on the child's weight and height, then plotted according to age and gender.9,10Table 1 presents the equations used to calculate BMI and the corresponding weight category status by percentiles. The World Health Organization (WHO) does not state a preference for one method over another, noting that measuring obesity is challenging because there is no standard definition worldwide. Thus, WHO has developed several charts and tables for clinicians to use to assess a child's weight status.11 These include weight-for-age, weight-for-height, BMI-for-age, and triceps skinfold-for-age, among others.11 The American Academy of Pediatrics (AAP) uses the same guidelines for BMI-for-age as the CDC to define childhood obesity and states that for children older than 2 years, BMI is an acceptable measure to assess obesity.10