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Bright Futures in Practice: Physical Activity

OBESITY

Obesity is defined as the presence of excess adipose (fatty) tissue in the body. The term "overweight" may connote a milder degree of excess fat than "obesity," but there are no clearly defined criteria to distinguish between the two terms. Thus, the two terms are used interchangeably.1

Although its underlying causes are not fully understood, obesity is a complex chronic disease involving genetics, metabolism, and physiology, as well as environmental and psychosocial factors. Unhealthy eating behaviors and low levels of physical activity are contributing to the continuing increase in the prevalence of obesity among children and adolescents.2

Significance

Obesity is a major public health problem. Studies have shown a dramatic increase in the prevalence of obesity among children (including those younger than 5 years of age) and adolescents.3,4 Data from the National Center for Health Statistics (NCHS) indicate that more than 1 in 5 children and adolescents in the United States are overweight.3

BFPAIC_PB50Few studies have examined the long-term effect of childhood or adolescent obesity on adult morbidity and mortality. Longitudinal studies of children followed into young adulthood suggest that overweight children may become overweight adults, particularly if obesity is present during adolescence.5–7 Overweight during adolescence affects blood pressure and blood lipid, lipoprotein, and insulin levels in adolescents.8 Perhaps the most widespread consequences of childhood and adolescent obesity are psychosocial, including discrimination.8,9

Health professionals need to be aware of the demographic and personal risk factors for childhood and adolescent obesity and be diligent in their prevention efforts and screening.2 Children and adolescents are considered at high risk for overweight if

  • One or both parents are overweight.

  • They are from families with low incomes.

  • They have a chronic disease or disability that limits mobility.

In addition, members of certain racial/ethnic groups such as African-American female children and adolescents and Hispanic and American Indian/Alaska Native children and adolescents are considered at high risk for overweight.2–4

Prevention

Enough is known to guide efforts to reverse the trend of increasing obesity.2 Because obesity is difficult to treat, efforts need to focus on prevention. Although genetic influences largely determine whether a child or adolescent will become overweight, environmental influences may determine the manifestation and extent of obesity.

The primary strategies for preventing obesity are healthy eating behaviors (see the Nutrition chapter), regular physical activity, and reduced sedentary behaviors (e.g., watching television and videotapes, playing computer games). These strategies are part of a healthy lifestyle that should be developed during early childhood. The goal is to promote and model positive attitudes toward eating and physical activity without emphasizing body weight. Behavioral techniques are needed to encourage healthy eating and physical activity behaviors.


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