TCS Daily

Fat Kids: Fact, Fiction and Fear

By John Luik - April 13, 2006 12:00 AM

Editor's note: This article is the first of two parts.

A large number of press reports lately have claimed that almost half of the children in North and South America will be overweight by 2010. Based on a recently published study in the International Journal of Pediatric Obesity (Wang and Lobstein, "Worldwide trends in childhood overweight and obesity 2006"), news reports, such as that in USA Today, claim that these high numbers of overweight and obese children will have "profound impacts on everything from public health care to economies."

Dr. Philip James, chairman of the International Obesity Task Force, proclaimed, "We have a truly global epidemic which appears to be affecting most countries in the world." And James claims the problem has its origins not in changed societal conditions, or in decreased levels of physical activity among children, but in the West's food industry. "They're being bombarded like they are in the West to eat all the wrong foods," James fulminated. "The Western world's food industries without even realizing it have precipitated an epidemic with enormous health consequences."

Are fat kids fat because of the Western world's food industry? Well, before answering that question it would be well to untangle the strands of fact from fiction and fear behind the scary headlines that claim half of American kids will soon be overweight.

The scary story about childhood obesity is really made up of four linked claims:

  1. The number of overweight and obese children continues to grow at staggering rates everywhere in the world, but particularly in the West.

  1. Children who are overweight and obese are more likely to be overweight or obese adults.

  1. As overweight adults, they will likely die prematurely.

  1. The practices of the food industry are what lead to overweight and obese children, and thus early morbidity and mortality among adults.

In the first part of this series we look at the key first claim, and in the second the rest.

An Epidemic of Childhood Obesity?

The scary claims about childhood obesity always start with the idea of an epidemic -- that the weight of American and European children is simply out of control. But is it?

According to the most recent U.S. data (A. Hedley et al, "Prevalence of Overweight and Obesity Among US Children, Adolescents, and Adults 1999-2002," Journal of the American Medical Association, 2004, 291: 2847-2850), the prevalence of overweight and obesity in U.S. children showed no statistically significant increase from 1999-2002. In fact, caloric intake for U.S. children and young people has not changed significantly in recent years, according to Richard P. Troiano et al ("Energy and fat intakes of children and adolescents in the United States: data from the National Health and Nutrition Examination Surveys," in the American Journal of Clinical Nutrition, 2000).

And this is not just true of the American children. The Health Survey for England, published by the United Kingdom Department of Health in December 2004, found that the average weight of boys aged 3-15 in 2003 was 31.9 kilograms (70.2 pounds) compared with 32 kg (70.4 lbs.) in 1995. Girls weights were 32.4 kg (71.28 lbs.) in 2003 compared with 32 kg (70.4 lbs.) in 1995. In 2003 the average 15 year old boy weighted 60.7 kg (133.5 lbs.) compared with 58.8 kg (129.4 lbs.) in 1995. Again, from 1995-2003 there was an increase in average BMI's for boys of 0.5 kg (1.1 lbs. and 0.6 kg (1.3 lbs.) for girls.

These findings have been confirmed by other studies. For example, in a 2003 study by E. Georgiades et al. which looked at BMI changes in adolescent British girls, researchers found "no evidence of an increase in average BMI across the 10 year period of data collection, which incidentally coincided with an epidemic of childhood and adolescent obesity in the UK."

This finding so confounded the study's authors, that instead of abandoning their claim about a pediatric obesity epidemic, as good science might require, they instead resorted to an ideological explanation by claiming that the "absence of change in BMI may have masked real changes in body composition over the study period."

A similar instance of the data diverging from the alarmist claims about pediatric obesity was found in a 2004 report, "Healthy Weights, Healthy Lives," signed by Sheela Basur, the Chief Medical Officer of Health for Canada's largest province, Ontario. The report declares "Childhood Overweight and Obesity is Increasing" yet noted on page 25 that the "proportion of children who are overweight or obese remained relatively stable through the 1990's"

According to a survey in the report, there was an uptick in obesity among boys from 4.2% to 5.2% in the decade, but those classed as overweight declined from 19.3% to 19.1% and those who were under or normal weight remained relatively stable at 75.7% in 2000 versus 76.3% in 1990. Among girls, meanwhile, the percentage of girls who were overweight increased from 10.8% to 11.1%, while the percentage of obesity declined slightly, from 3.4% to 3.3%, and again the level of under and normal weight was stable, at 85.6% in 2000 versus 85.8% in 1990.

Where's the epidemic? In the three countries most often cited as the center of the pediatric obesity epidemic, the evidence, based on children's BMIs does not support the claims of a staggering increase in fat children, despite the rhetoric by health officials.

Other problems

There are significant problems in the way children are determined to be overweight, obese or "at risk for overweight or obesity."

As Jon Robison from Michigan State University has noted, the basis for the BMI for children is a series of growth charts by the Center for Disease Control published in 2000 that are based on earlier cohorts of U.S. children who were both smaller and thinner. As Robison observed in a white paper "The 'Childhood Obesity Epidemic': What Is the Real Problem and What Can We Do About It?",

"While children have been growing taller and heavier and maturing earlier for over a century, the growth charts do not reflect these changes. ... [I]nstead of 5% of children plotting at or above the 95th percentile (cutoff for overweight) 15% of children currently do."

The decision to call children who are at or above the 95th percentile overweight and obese is purely arbitrary. There is no scientific reason obesity begins here or indeed at any other point There is nothing magical about the 95th percentile as if children's weights follow a normal distribution -- that is, a bell shaped curve in which a few children weigh more or less than average. More important is the fact that even with the arbitrary BMI determination of overweight and obesity, between 85 to 90% of American children are NOT overweight or obese. Indeed, the studies of childhood obesity consistently show that children of normal weight have not experienced statistically significant BMI gains. If there has been an increase in BMI -- and that is a big "if" -- it has been confined to a small segment of obese children.

Thirdly, considerable evidence indicates the BMI does not provide a true picture of whether children are genuinely fat. For instance, E.P. Whitlock et al. in a study from last year in Pediatrics noted that BMI was an unreliable obesity/overweight indicator since "BMI measures cannot differentiate between increased weight for height attributable to relatively greater fat-free mass (muscle, bone and fluids) and that attributable to greater fat." In short, BMI as a tool for determining adiposity is essentially useless.

This confirmed the findings of a 2004 study by G. Rodriguez et al. in the International Journal of Obesity which found 42% of males and 32.1% of females classified as overweight or obese according to the BMI did "not have really high adiposity."

The facts reported in these studies suggest that the fears about a growing number of overweight and obese children and adolescents are overblown. Even using something as arbitrary, flawed and unreliable as the BMI to determine children's weights, there is no evidence of a huge increase in the numbers of overweight and obese children, and certainly nothing justifying the term epidemic.

NEXT: Do overweight and obese children grow up to be obese adults who die prematurely?

John Luik is writing a book about health policy.



Why is the author trying to deny a real trend?
Overweight-ness and obesity are a real problem. You do not need statistics to see that. Just look at any group of people: half of my female coworkers are as big as dinosaurs (nothing personal, Sharon, Shanika, Wendy, etc., I still love you)! Most kids around me are chuuby. In my youth these kids would have been called names, now they look normal among the rest. Why hide your head in the sand?

Moreover, one of the arguments (the paragraph about British children) is just confirming the weight-increase trend: from 5 parameters, 4 increased (significantly, given the large sample), 1 decreased. And that is only over 8 years (95-03)! I myself was surprized that a statistically significant change could be recorded over such a short period.

Now, does overweight-ness and obesity lead to morbidity and mortality? I am pretty sure, but they certainly degrade quality of life: joint problems, immobility, shortness ob breath, diabetes, you name it. I will only mention - not being to fit in an airplane seat is no fun.

Sorry, I may have sounded a little harsh, but I just do not understand the point of this article.

Wow... how wrong
I wonder if the author knows who chaulk full of holes his analysis is. I am going to disect it on my blog:

Classic example
"You do not need statistics to see that. Just look at any group of people: half of my female coworkers are as big as dinosaurs..."

The above is a classic example of anecdotal bias.

Whereas you believe "Most kids around me are chuuby." I observe that most of the kids around me are about normal.

Neither of us is right.

When I look at hard numbers on all the "epidemics" we are told exist, (cancer, pollution, diseases, yada yada,) the actual numbers belie the commonly held beliefs.

Follow the money. How much money can be made selling exercise machines, diet foods, weight loss drugs, etc?

The fear-mongers are alive and well, and living in the USA.

You are wrong
Some of this depends, as it always has, on where you live, ethnicity, genetics, etc. I live in a rural area (as to about half of all Americans) The average kid is is much taller than they were 20 years ago and the average kid here is in better physical shape (a lot more 6' 175 pound boys running around who are just ripped and a lot more 5'8" 140 pound girls that are just as solid).

The problem is in those who are not. We have fewer chunky kids, but more obese ones; especially in the 12-18 age range. For instance, of the 125 kids age 13-18 in the school this year, 54 of them are low body fat index and in very good shape, 40 are in good shape or "about average" in every respect, 18 are slightly to moderately overweight and the remaining 13 are significantly overweight to obese. This falls below the numbers given in this article, but exercise and living habits probably account for the slight decrease.

An interesting note: of the 31 overweight kids, 12 of them have been put on drugs for ADD/ADHD and they are 12 of only 17 who have/are on such treatments.

Secondary note: This has become a major issue only since the 80s; the time of major recognition of anarexia. Schools have been especially dilligent in wathcing for the signs and pushing kids to "eat normally". I believe this has helped really created an obesity problem, especially among girls.

The fact is genetics, exercise and enviroment/stress have more to do with weight than what we eat. Diet has some effect on health, but studies have also shown that fat is not the "killer" we once thought it was.

Worried about the fat kids? Get them outside and on the playgrounds and playing fields.

Some truth to your sentence
But, none-the-less, the point is correct. BMI shows a slight increase when kids in these countries are getting taller. Since height is not taken into account, this is very worth noting. It is possible that, as a whole, kids these days are actually less fat.

As for adults, that is a different matter entirely. Without a doubt, Americans over 30 are getting huge. Why? Lack of exercise is probably the biggest factor, but stress and diet also play a major role.

In America, about half of the population lives in small cities and rural areas. I find kids there tend to get more exercise, are more involved in activities and, as a whole, are probably in better shape now than they were 20 years ago. But the ones who aren't, aren't in a bigger way. I see a much more defined divide between the "average kid" and the "fat kid", there are a lot fewer "slightly chubby" kids; especially in the 12-18 age group.

Excuse me ...
But will someone then explain to me the rapid increase of Type II diabetes among younger people --- a condition that is directly related to obesity?

Good question
First off, type II diabetes is related to obesity, but not directly. I.E. not every type II diabetic is obese and not every obese person gets type II diabetes.

Type 2 diabetes is rising in American kids, especially African Americans, Latinos, and Native Americans. Your child is at risk if your child is overweight or has a family history of diabetes.

There are things you can do to help prevent type 2 diabetes. Encourage active play, lots of exercise, and healthy meals.

No matter how much certain organizations want to push the "fat" button, genetics and exercise have more to do with both obesity and type II diabetes than diet. This is especially true in children. Also, the increase is not that large, not when you consider the increase in population, especially large increase in the Latino population which is more genetically inclined to have this problem.

Get all the facts, especially when looking at these agenda driven medical scares. Most don't stand up to their onw studies.

in order to treat a problem
You must first understand the problem.
The first task in understanding a problem is to get accurate statistics.

If the statistics are bad, then any solution based on those statistics will be at best, mistargeted, at worst, counterproductive.

Why do you have so much problem with accurately defining the true scope of the problem of obeisity.

Several doctors (Eades, Atkins, for example) have written about human intolerance to glucose.
People who deviate from traditional aboriginal (not reservation)diets suffer type II in greater numbers, like the Pima Indians.
Substituion of high fructose corn syrup for sucrose may be a factor, but if your ancestors, pre-agriculture, did not eat cake, cookies, or soda, maybe you should cut back.
It is interesting that of the tree major food groups, humans can thrive without carbohydrates.

Futher Reading
Metabilic Typing Diet, Wolcott and Fahey and a link to Dr. Bernstein diabetes solution:

You're excused.
Ignoring, for the moment, that the link between Type II diabetes and obesity is not nearly so direct as you've been led to believe, you really need to look a little deeper to understand that the 'rapid increase' might not be as telling as it seems at first blush.

Much as with the supposed increase in obesity, the not-so-rapid increase in Diabetes has primarily been a by-definition problem. The definition of what exactly constitutes diabetes has been lowered several times since the mid-90s, each time that happens the diabetes rate makes an overnight jump -- yesterday you were healthy, today you have diabetes. 'Pre-diabetes' (IGF and IGT) also complicate the matter as they're often lumped in with the diabetes numbers. In an age where any self respecting desease must make itself a political matter to be 'solved' by government, it helps if do everything possible to inflate your numbers. I suspect most people would be stunned by how depressingly common that has become in medicine.

Ummm... You are aware that the human body is essentially powered by glucose, right? And that every sugar you ingest is converted by your body into glucose? And that few cakes, cookies, or soda contain glucose?

Just wondering...

Why are you trying to deny real trends?
Obesity is a real problem? Wrong, it's being too skinny that's a problem! One doesn't need statistics to see that, just look around. Everywhere I look I see skinny people, My god, do you know what the health risks are of being too thin? I can tell you from my observations that it's a national epidemic and the government needs to deal with all of these skinny people right now!

Hey, it makes as much sense as what you're saying.

I don't need your pardon ---
I've written THREE books and several articles on diabetes and its complications --- including trends in the US, major European countries and Japan. What are your qualifications? You have no idea of how when and why diabetic criteria are established nor the difference between criteria-related effects and epidemiology.

Excess Sugar Converted to FAT
"Conversion of excess glucose to fat
Sustained high glucose intake in the diet leads to increased fat synthesis.
If glucose intake continues after muscle and liver glycogen stores are saturated, the glucose is not excreted or wasted. It is converted to a fuel storage form which has an unlimited capacity i.e. triglycerides stored in adipose tissue.
Glucose is converted to pyruvate by glycolysis. The pyruvate is converted to acetyl CoA, which is the starting material for the synthesis of fatty acids. This synthesis occurs in the liver followed by conversion of the fatty acids to triglycerides (also in the liver) and then transport to adipose tissue for storage. Triglycerides (fat) form the major energy store in the body. The mechanism of fatty acid synthesis will be discussed under the heading of fat metabolism."

Fats and proteins can be used instead of carbohyrdrates for energy.

"Most authorities believe that the amount of protein converted to glucose is quite small, except under conditions of intense exercise or metablic starvation. Under these conditions amino acids produce the major source of glucose for blood sugar maintenance."

But not everyone is exactly the same.

Is it true?
If the pancreas is continually pumping insulin to get rid of sugar in the blood, will it eventually not function properly leading to type II?

anyone can write a book, what are your educational qualifications.

I have heard that obesity is becoming a problem in Indain and China and I think that this is good ne
I have heard that obesity is becoming a problem in Indain and China and I think that this is good news. Paul Erlich and the Club of Rome where are you now. Oh I see you are over there now fretting about Globesity.

story is right on
the problem is not whether there is a obesity problem or not. the problem lies in the definition of what the proper weight is for a given height without regard to body composition.

i am obese based on the BMI. the picture that you receive is that i am some kind of fat blob gorging on chips and twinkies. far from it.

let's take some real world examples. let's say college football:

AJ Hawk, the top linebacker in the draft is 6'1" and weighs a whopping 240. his BMI is 31.7, obese.

Vernon Davis, regarded as the best athelete is 6'3"/250 lbs. his BMI is 31.2, obese again.

both of these athletes has a low body fat percentage.
there are countless examples (NBA has a bunch). the bottom line is that BMI gives NO information of whether you are a couch potato, a world class athlete or somewhere in between.

common sense tells you that if tool identifies athletes of the caliber listed above as obese (and in a danger zone), there is something wrong with the tool.

That is exactly right
Even using slightly more complex methods (height, weight, neck measurement, waist measurement) I've seen this farce come out the same. I knew a guy who was a bodybuilder type with a measured 4% body fat. But, when he was measured in this way, he came out at a much higher percentage and was pronounced "seriously overweight"; we all laughed.

This whole thing is pretty much a joke.

Again, there is truth to the statement we are getting fatter; especially as adults. Exercise and genetics are the biggest culprit however.

famine feast
I find it amazing that no one has investigated the famine feast cycle as the cause of obesity.

Those pima indians and such are easily put on this cycle. Once they came from an enviroment of famine feast cycles, their bodies took advantage of the so called excess once the food became available. And their bodies didn't all of a sudden realize that food is now available all the time just because they flutuations of food stopped, their bodies have already were programmed by genetics and experiences of famines that famines happen better prepare for them by storing excess.

It can take years of eating enough, eating well and such for those whose bodies have endured famines feast cycles in the past to know the famines are over (think food restriction, dieting efforts for weight loss as a famine as far as the body is concerned.)I don't believe fat setpoints are arbitrary but trained through actual expereinces of famines to prepare for them by eating and storing excess when enough food becomes available. I understand the mechnisms that cause setpoints to go up but not down.

I however don't agree that the body automatically stores excess calories as fat if fat storage is not wanted or needed as far as the brain/body connection is concerned.

One mechnism I have seen in myself, and others who are not weight conscious or dieting or restricting for any reason, is that if your at setpoint and eat more than you need your body increases metabolism, you move more without realizing, your appetite drops, desire for exercise also increases 10 fold etc, (all the reverse of what happens when you lose below that setpoint).

Now instead of making eating and weight issues a moral issue we have to realize it has nothing to do with moral character but everything to do with biology and our lack of understanding of why the body does what it does and what to do about it. Eating and weight control is the domain of the body, it was never ever meant to be a consciously controlled thing. We are designed to live life without worrying about that, only listening when our bodies ask for something, whehter water, sleep food or movement. Any tampering with this through fears and conscious control only leads to disease and disorders.

Unless there is actual disease, your body can handle the weight itself. If your facing periodic food restriction such as dieting, or working at job and can't eat right away or stranded without food and you get really hungry but can't eat due to fear of eating, desire to lose weight or because you are in a situation where food is not avialble, don't be surprised after enduring such an enviroment over time that you binge on all the so called wrong foods and gain weight. Your body made you do it.

So instead of looking to old cures (that are centuries old) to deal with obesity, they need to focus on what the real problem is biologically and even psychologically, so that a real cure can be found. No more of this you can't control your food that is why your are fat. That doesn't fly anymore in the face of research.


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