Severe Obesity Rises Among Kids With ‘Significant Implications’ for Future Health: Study

Girls saw higher severe obesity than boys, with the prevalence rising with age among all children.

Overweight twins are weighed in a nutritionist office in Medellin, Antioquia department, Colombia, on Sept. 22, 2011. Raul Arboleda/AFP via Getty Images

Rates of severe obesity among children aged 2 to 4 in the United States rose between 2016 and 2020, reversing an earlier declining trend, according to a new study.

The study, published in the American Academy of Pediatrics (AAP) journal on Dec. 18, examined the prevalence of severe obesity among 16.6 million low-income children aged 2 to 4 who were enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) between 2010 and 2020.

Researchers found that the prevalence of severe obesity “significantly decreased” between 2010 and 2016, dropping from 2.1 to 1.8 percent. However, severe obesity then increased to 2 percent by 2020.

The researchers found that girls had a “slightly higher” prevalence of severe obesity compared to boys. Prevalence of severe obesity rose with age, with the highest incidence found among 4-year-olds.

Children from American Indian/Alaska Native and Hispanic communities were the most obese. Children living below the poverty level suffered more from severe obesity than those from higher household incomes.

Researchers attributed the decline in obesity earlier in the 2010–2020 period to WIC food packages which provided cash allowances for healthy food options like fruits, vegetables, and food grains while restricting allowances for milk, cheese, and juice allowances.

“Several studies have revealed that these revisions improved the dietary intake habits of WIC participants, potentially contributing to the reduction in obesity prevalence among WIC children,” the authors noted.

The significant increase in severe obesity between 2016 and 2020 is attributed to factors like variations in funding support for WIC agencies and the COVID-19 pandemic.

“The pandemic has introduced various challenges, including reduced opportunities for physical activity, increased sedentary behaviors, limited access to healthy food, and heightened stress levels within households,” the study stated.

“These factors can have significant implications for weight gain, particularly among children with excessive weight, and may potentially influence future trend in severe obesity.”

Children with severe obesity are at a greater risk of health complications, including type 2 diabetes, cardiovascular disease, fatty liver disease, metabolic syndrome, and premature death.

The study noted that the upward trend in severe obesity since 2016 is a “concerning” matter, especially if the trend continues.

“Given that children with higher BMI [body mass index] are at greater risk of future health consequences, continued understanding of the ongoing state trends of obesity, especially severe obesity among young children, is warranted.”

BMI is used to measure the obesity levels of an individual, with higher values denoting higher obesity.

“Ensuring that children and families from low-income households have access to early clinical detection, and referrals to effective and sustainable family-based interventions, could help promote healthy child growth,” the study said.

The authors indicated that they have “no potential conflicts of interest” related to the study.

‘Cause for Great Concern’

A Dec. 18 commentary on the study called the revelations from the research “a canary in the coal mine for the health of future generations.” The new data showing a reversal of severe obesity decline “is a cause for great concern for policymakers, clinicians, and public health professionals.”

It noted that factors like food insecurity, sleep duration, daily consumption of fast food or soft drinks, and screen time accounted for a 43 percent obesity risk in children up to the age of 4.5 years. “Thus, effective prevention of early life obesity will need to target multiple behavioral and social drivers to be successful.”

A March 2023 press release from the World Obesity Federation predicted that childhood obesity could more than double by 2035 compared to 2020 levels.

“Rates are predicted to double among boys to 208 million (100% increase) and more than double among girls to 175 million (125% increase) and are rising more rapidly among children than adults.”

Commenting on the prediction, Professor Louise Baur, president of the federation, said that “it is particularly worrying to see obesity rates rising fastest among children and adolescents.” She asked for governments and policymakers to do “all they can to avoid passing health, social, and economic costs on to the younger generation.”

Meanwhile, the AAP issued updated guidelines on treating childhood obesity earlier this year, triggering controversy.

The guidelines encourage doctors to treat obese kids as young as 12 years old with drugs and even bariatric surgery in some situations.

The AAP justified the new guidelines, stating that medical interventions are necessary owing to the stigma attached to weight. The guidelines stressed the measurements of BMI, blood glucose, and blood pressure.

The Collaborative of Eating Disorder Organizations (CEDO) group criticized the guidelines and their emphasis on measurements, saying that they “strongly oppose” the recommendations.

“We do not support intentional weight loss in children via methods included in the guidelines, especially the recommendation of bariatric surgery and pharmaceutical products,” it said.

“We are very concerned about the message this aggressive approach to childhood and adolescent ‘obesity’ sends to the healthcare community, parents and guardians, and young people.”

The guidelines put American kids at “serious risk of developing eating disorders, disordered eating, and other mental and physical health issues,” the group stated.