Study: Severe pediatric obesity trending upward
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Key takeaways:
- The prevalence of severe obesity dropped from 2010 to 2016 but increased from 2016 to 2020.
- Of 56 WIC agencies, 21 reported a significant increase in pediatric severe obesity.
Despite years of progress, severe obesity among children from households with lower incomes is just as prevalent as it was a decade ago and trending upward, according to a study published in Pediatrics.
“Obesity is a complex, chronic condition that should be evaluated and treated with long-term care strategies, with ongoing monitoring and taking into account the context of the child, family, and community,” Lixia Zhao, PhD, a researcher in the CDC’s Division of Nutrition, Physical Activity, and Obesity and co-author of the study, told Healio.
“Watchful waiting of obesity — ie, staged treatment — is no longer recommended,” Zhao said. “Children with severe obesity are at greater risk for various future health complications, including type 2 diabetes, cardiovascular disease, metabolic syndrome, fatty liver disease and risk of adiposity-related cancers.”
Zhao and colleagues pulled data from the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) Participant and Program Characteristics (PC) study, which is conducted every 2 years by the U.S. Department of Agriculture’s Food and Nutrition Service to summarize demographic, income and health-related characteristics and behaviors of all WIC participants in the 89 state agencies, as well as the benefits they receive through WIC.
“WIC safeguards the health of women, infants, and children up to age 5 [years] from low-income families by providing supplemental foods, nutrition education and health care referrals, and the study is used for program monitoring and managing WIC information needs,” Zhao said.
The study included approximately 16.6 million WIC-participating children aged 2 to 4 years — 3.3 million children in 2010, 2.8 million children in 2016 and 1.6 million in 2020. BMI categories for children and teens are based on sex- and age-specific BMI percentiles, whereas BMI categories for adults are based on BMI only. Severe obesity for children and teens was noted as 120% or greater of the 95th percentile or 35 kg/m2 or greater.
Overall, the researchers found that the prevalence of severe obesity dropped from 2.1% in 2010 to 1.8% in 2016 but increased to 2% in 2020.
“Between 2016 [and] 2020, the prevalence of severe obesity increased significantly overall, and among all sociodemographic groups except for American Indian and Alaska Native and white children,” Zhao said.
The researchers also found that that 21 of 56 WIC agencies reported a significant increase in pediatric severe obesity and only Alaska had a significant decrease in prevalence between 2016 and 2020.
The largest decreases in severe obesity prevalence during 2010 to 2016 occurred among 4-year-old children, from 3.31% to 2.87%; Asian/Pacific Islander, from 1.51% to 1.14%; Hispanic children, from 2.81% to 2.41%; and children from households with income between 100% and 150% the federal poverty level, from 2.02% to 1.66 %. During the 2016 to 2020 period, the largest increases occurred in 4-year-old children from 2.87% to 3.14%, and Hispanic children from 2.41% to 2.79%.
Such upward trends are “concerning,” Zhao said.
“Continuing to screen for barriers to health such as access to adequate and safe housing, nutritious food, etc. and facilitating enrollment in supplemental nutrition assistance programs and other community supports will help children and families in healthful behaviors and stress reduction,” Zhao said.
Zhao added that further assessment is needed to pinpoint specific reasons behind the increases in severe obesity among children enrolled in WIC.
“Another area for future studies would be the expansion of research on family healthy weight programs as a treatment strategy for younger children,” Zhao said. “These are important points as [they further support] the need for children and families from households with lower incomes across the nation to have access to early clinical detection, such as health care screenings and referrals to effective family-based interventions to support healthy growth.”
In a related commentary, Sarah C. Armstrong, MD, and Asheley C. Skinner, PhD, both researchers in the Duke Clinical Research Institute, called the findings a “canary in the coal mine for the health of future generations.”
“It will be important to continue the surveillance initiated by Zhao and colleagues in this early childhood and low-income group,” they wrote. “However, these data are likely to underestimate the current prevalence of severe obesity in toddlers.”
The authors also noted that the time period evaluated in the study does not capture pandemic-related changes.
During the pandemic, “BMI increased at double the previous rate, particularly for children who had obesity before the pandemic,” they wrote. “In addition, these data do not include children who qualify for WIC but are not enrolled, a group that is at greater risk of [food insecurity] than the rest of the population.”
Given the strong association between food insecurity and future obesity at an early age, future obesity prevention and treatment research may include policies or interventions to treat food insecurity in novel ways, they wrote.
“Although many questions remain, the urgency to act quickly and with a focus on social drivers of health is clear. Interventions, whether aimed at preventing or treating early life obesity, will be most effective if they follow the general principles of the 2023 American Academy of Pediatrics CPG, including whole-child care, addressing social and structural drivers of health, and providing nonstigmatizing options for families,” they wrote.
References:
Armstrong SC, et al. Pediatrics. 2023;doi:10.1542/peds.2023-063799.
Zhao L, et al. Pediatrics. 2023;doi:10.1542/peds.2023-062461.
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