Estimated read time: 7-8 minutes
Childhood obesity is on the rise worldwide, and the complex condition is quickly becoming a critical concern for an increasing number of American families. Here in Utah, the average rate of obesity for kids 10 to 17 years old is one of the lowest in the country at 26% compared to 33% nationally and 41% in some Southern states like West Virginia.
Even the lowest numbers are alarming and support the contention that childhood obesity is one of the most serious public health challenges of the 21st century. Health care providers here in Utah already see plenty of evidence that reflects a spike in the rates of children with obesity during COVID-19 lockdowns.
"There has been a dramatic increase in childhood obesity," says Jacqueline T. Chan, M.D., a pediatric endocrinologist at University of Utah Health. "I think the biggest factor that we are seeing is the economic status of the children and their families, and COVID-19 made it worse. A lot of people lost their jobs and started accessing foods that are not very nutritious or calorie-packed."
In addition to a lack of access to healthy foods, Chan suggests more screen time and sedentary behavior as factors driving up rates of childhood obesity. These were behaviors that began before COVID-19 closed schools and limited play time and supervised activities. But those factors were aggravated by the pandemic.
"These are children who don't have access to outdoor activities on a routine basis," Chan says. "Their parents are working more so they can't always safely bring their kids outside."
The Centers for Disease Control and Prevention (CDC) defines obesity in children as a body mass index (BMI) at or above the 95th percentile in growth charts. Based on this criterion, only around 5% of U.S. children were obese in the early 1960s, but that rate rose to 19% by 2019. And today it has climbed even higher.
Obesity is such a challenging medical condition that even specialists like Chan struggle to explain the troubling patterns in the youngest children she is seeing. "There is a steep and significant increase in obesity in children less than 5 years old, both during and after COVID-19, and a lot of clinicians don't know how to address it," she says.
In 2023, the American Academy of Pediatrics reviewed more than 16,000 studies evaluating the treatment of children with obesity. But only 40 of those studies included children under the age of 5. In a January 2024 article in the journal Pediatrics titled "Severe Obesity in Toddlers: A Canary in the Coal Mine for the Health of Future Generations," doctors argued that development of severe obesity in a child's early life is often irreversible.
When Chan was training as an endocrinologist, it was rare to see children with obesity under the age of 5. Usually, children that young are considered to likely have a genetic cause for obesity. Currently, it is becoming a regular occurrence to see these children, and Chan calls it very troubling. No matter when a child is diagnosed as overweight or with obesity, the condition raises the risk of type 2 diabetes, cardiovascular disease, sleep apnea, certain cancers, and mental health conditions.
Before, it was rare to see type 2 diabetes in kids who have not yet started puberty. But now I have been seeing 7-year-olds and 8-year-olds with type 2 diabetes. My youngest is 6 years old.
–Dr. Jacqueline T. Chan, pediatric endocrinologist, University of Utah Health
"Before, it was rare to see type 2 diabetes in kids who have not yet started puberty," Chan says. "But now I have been seeing 7-year-olds and 8-year-olds with type 2 diabetes. My youngest is 6 years old." CDC researchers forecasted the number of children who will be diagnosed with diabetes from 2017 to 2060. If the rates of new cases remain as they are now, the rate of increase in type 2 diabetes would be 700% by 2060 compared to about 65% for type 1 diabetes.
Chan says there are more therapies now for children with type 2 diabetes than just insulin. But these conditions still pose major concerns for kids and their families as they move into adulthood. In addition, patient resources are limited, most of the medications used to treat obesity are costly, and insurance coverage is an issue.
"Unfortunately, I have seen the worst of it," Chan says. "I've seen kids diagnosed with type 2 diabetes at 12 years old, and by 18 they are on the brink of dialysis (due to kidney disease). Some might not even make it past their 18th birthday."
The quality of life for these children is already diminished as teenagers and threatens their overall health and mortality as they age. The onset of type 2 diabetes in a 10-year-old brings much higher long-term risks than it might when the condition is diagnosed in a patient in their 30s or 40s. "Type 2 diabetes just gets worse faster and earlier in a child than in an adult and must be treated quickly and aggressively," Chan warns. This is where the adult data differs greatly compared to pediatrics.
Turning the tide on increasing rates of obesity in children, Chan says, will take a whole community approach. It must include prevention and early intervention efforts by the child's family, primary care doctors and pediatricians, schools, and the community they call home. To meet these goals, Chan encourages primary care doctors to start working closely with parents and guardians as soon as they identify a child who is showing signs of obesity or at risk of obesity.
"Before they see me, I should assume that the child's pediatrician has already offered a dietary consultation and resources to access healthy food and activities," Chan says. "Then, if they do come to see me, I will immediately treat any comorbidities like diabetes, hypertension, or cholesterol problems. At the same time, I would address the obesity problem."
The good news for kids struggling with obesity is that the same drugs Chan or a primary care physician would prescribe to treat diabetes in their young patients are now FDA approved for weight loss.
New guidelines recently issued by the American Academy of Pediatrics also give pediatricians permission to move away from a watch-and-wait strategy with kids who are diagnosed as being overweight or with obesity. But Chan believes doctors must also talk and listen to a child so they can consider a patient's mental health and environment before launching into any drug treatment program. Behavioral modifications and lifestyle changes remain the cornerstone strategies in the treatment of childhood obesity.
"I always try to see if the obesity is causing a mental health problem or if a mental health issue is causing the obesity," Chan says. If the child is being bullied at school because they are overweight, then treating the obesity with medication might be the right path in addition to behavioral modifications. But if there is an underlying mental health problem, Chan might refer the child to a therapist.
It is hard for a family to hear their child has a serious weight problem. "It takes some practice in being able to open up the topic with a family without them feeling overwhelmed, attacked, or judged," Chan says. She advises doctors to start with a discussion of the child's growth chart before assessing what intervention or treatment the family might be open to accepting.
Chan describes it as a holistic approach aimed at making a child and their family feel comfortable addressing the difficult issue of obesity. Today, there is an urgency to act quickly and focus on prevention and treatment for early life obesity. The future health and life span of the youngest generations is at stake.
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