Dentistry For Young People

Understanding Childhood Obesity

Date Posted: 6/10/2008

In our super-sized world, there are more obese children than ever before.  Today, nearly 10 percent of kids ages 2-5 are obese and the numbers are growing along the waistlines.

  Obesity is an excess of body fat in proportion to lean body mass.  The most reliable non-invasive and indirect measure of body fat is body mass index (BMI), which is defined as a person’s weight in kilograms divided by the square of his or her height in meters (BMI=kg/m2).  For adults, a BMI of 18.5 to 24.9 to be an ideal target in healthy individuals, while BMI of 25.0 to 29.9 is considered overweight and 30 or higher is judged as obese.

Childhood obesity is defined as a BMI for age and sex greater than the 95^th percentile.  A BMI for age and sex of the 85^th to 95^th percentile is considered as overweight and at risk for obesity in children.  The pediatric growth charts for the U.S. population now include BMI for age and gender, are readily available online at www.cdc.gov/growthcharts, and allow longitudinal tracking of BMI.  Since the 1970’s, the incidence of obesity has more than doubled for children age 2 to 5 years of age and adolescents 12 to 19 years of age, has more than tripled for children 6 to 11 years of age.  The increasing numbers of overweight and obese children and youth has led to federal policymakers to rank it as a critical health threat.

      Prevention of overweight is critical, because long-term outcome data for successful treatment approaches are limited.

    Major causes are poor diet and lack of exercise.

    Genetic, environmental or combinations of risk factors predisposing children to obesity can and should be identified.

    Early recognition of excessive weight gain relative to linear growth should become routine in pediatric ambulatory care settings.  BMI should be calculated and plotted periodically.

    Families should be educated and empowered through anticipatory guidance to recognize to the impact they have on their children’s development of lifelong habits of physical activity and nutritious eating.

    Dietary practices should be fostered that encourage moderation rather than over consumption, emphasizing healthful choices rather than restrictive eating patterns.

    Regular physical activity should be consciously promoted, prioritized and protected within families, schools and communities.

    Optimal approaches to prevention need to combine dietary and physical activity interventions.

Heath Supervision (American Academy of Pediatrics Recommendations):

    Identify and track patients at risk by virtue of family history, birth weight or socioeconomic, ethnic, cultural or environmental factors.

    Calculate and plot BMI once a year in all children and adolescents.

    Use change in BMI to identify rate of excessive weight gain relative to linear growth.

    Encourage parents and caregivers to promote healthy eating patterns by offering nutritious snacks, such as vegetables and fruits, lo-fat dairy foods and whole grains; encouraging children’s autonomy in self-regulation of food intake and setting appropriate limits on choices and modeling healthy food choices.

    Routinely promote physical activity, including unstructured play at home, in school, in child care settings and throughout the community.

    Recommend limitation of television and video time to a maximum of two (2) hours per day.

               Recognize and monitor changes in obesity-associated                        risk  factors for adult chronic disease, such as hypertension,               symptoms of obstructive sleep apnea

Dental Considerations:

Recent study has shown that children who were overweight or obese had accelerated dental development, even after adjusting for age and gender.  Accelerated dental development in obese children is an important variable to consider in pediatric dental and orthodontic treatment planning where timing is crucial.  Another study has reported elevated body mass index is associated with an increased incidence of permanent molar cavities, especially between the teeth.

Pediatric dentists are engaged more than many health care practitioners in dietary counseling.  In addition to recommending dietary changes to reduce caries risk and we strive to provide information to our patients and parents about healthier diets.   The vision of the AAPD is optimal general health for all children therefore our dietary recommendations reflect that vision. 

Source:  Journal of the AAPD