Overweight or Obesity - Youth in Delaware

Delaware

According to the National Center for Health Statistics, the prevalence of childhood obesity has more than tripled since the 1970s. Childhood obesity is defined as a body mass index (BMI) value at or above the 95th percentile based on age and sex, while overweight is defined as a BMI value at or above the 85th percentile, but below the 95th percentile. 

Children who have obesity are more likely to have obesity as adults. Overweight or obesity in childhood is associated with physical, social and psychological health issues during adolescence and adulthood. These health issues include increased risk of substance misuse in adulthood, disordered eating behaviors, chronic diseases and poor self-esteem. 

While BMI can serve as an easily accessible proxy for population health, it has its limitations. BMI does not distinguish between excess fat and muscle or bone mass. Further, it does not capture the complexity of human health. For example, individuals can have a high BMI and good cardiovascular health, while others can have what is categorized as a “healthy” or “normal” BMI and poor cardiovascular health. The American Medical Association adopted a new policy in 2023 addressing the shortcomings of BMI as a clinical measure of health, suggesting that it be used in conjunction with other valid measures, such as body composition. 

Additionally, weight stigma, also known as weight-based discrimination or weight bias, can have many negative impacts, including mood and anxiety disorders and exercise avoidance. Weight stigma is pervasive in health care, with reports of medical professionals spending less time with higher-weight patients, engaging in less education and even being reluctant to perform certain procedures on patients with a higher BMI. Weight stigma in the clinical environment can make individuals feel uncomfortable or marginalized, resulting in avoidance of seeking health care.

According to America’s Health Rankings analysis, the prevalence of overweight or obesity is higher among:

• Boys compared with girls. 
• Hawaiian/Pacific Islander, Black and Hispanic children compared with Asian and white children.
• Children whose parent or caregiver did not graduate college compared with those with a parent or caregiver who graduated college.

According to the World Health Organization, the two most important means of preventing childhood obesity are healthy eating and regular physical activity. These behaviors have many different societal influences, including families, schools, health care providers and communities, as well as government agencies, media, and food and beverage industries. Private and public organizations both play a role in ensuring healthy environments and diets are affordable and accessible. 

The Community Preventive Services Task Force (CPSTF) recommends digital health interventions to help youths ages 12-18 who are overweight or have obesity with weight management. These interventions involve setting goals and tracking progress through mobile apps or wearable devices under the supervision of a trained moderator and health care provider. Additionally, the CPSTF recommends school-based interventions that combine healthy snack initiatives with physical activity programs among elementary school students. Research indicates that such interventions help reduce the prevalence of obesity among children.

The Centers for Disease Control and Prevention (CDC) provides information about evidence-based healthy weight programs for the whole family and early care and education programs. The CDC also provides tips for parents to help children maintain a healthy weight at home. State licensing scorecards, an assessment tool from the CDC, measures how well the early care and education programs meet obesity prevention standards. Additionally, the Department of Agriculture provides resources on weight management for youth.

Healthy People 2030 has an objective to reduce the proportion of children and adolescents with obesity.

Fryar, Cheryl D., Margaret D. Carroll, and Joseph Afful. “Prevalence of Overweight, Obesity, and Severe Obesity Among Children and Adolescents Aged 2–19 Years: United States, 1963–1965 Through 2017–2018.” NCHS Health E-Stats. National Center for Health Statistics, December 2020. https://www.cdc.gov/nchs/data/hestat/obesity-child-17-18/obesity-child.htm.

Gong, Wei Jie, Daniel Yee Tak Fong, Man Ping Wang, Tai Hing Lam, Thomas Wai Hung Chung, and Sai Yin Ho. “Late-Onset or Chronic Overweight/Obesity Predicts Low Self-Esteem in Early Adolescence: A Longitudinal Cohort Study.” BMC Public Health 22, no. 1 (December 2022): 31. https://doi.org/10.1186/s12889-021-12381-5.

Gutin, Iliya. “In BMI We Trust: Reframing the Body Mass Index as a Measure of Health.” Social Theory & Health 16, no. 3 (August 2018): 256–71. https://doi.org/10.1057/s41285-017-0055-0.

Rundle, Andrew G., Pam Factor-Litvak, Shakira F. Suglia, Ezra S. Susser, Katrina L. Kezios, Gina S. Lovasi, Piera M. Cirillo, Barbara A. Cohn, and Bruce G. Link. “Tracking of Obesity in Childhood into Adulthood: Effects on Body Mass Index and Fat Mass Index at Age 50.” Childhood Obesity 16, no. 3 (April 1, 2020): 226–33. https://doi.org/10.1089/chi.2019.0185.

Simone, Melissa, Laura Hooper, Marla E. Eisenberg, and Dianne Neumark-Sztainer. “Unhealthy Weight Control Behaviors and Substance Use among Adolescent Girls: The Harms of Weight Stigma.” Social Science & Medicine 233 (July 1, 2019): 64–70. https://doi.org/10.1016/j.socscimed.2019.05.047.

Stabouli, Stella, Serap Erdine, Lagle Suurorg, Augustina Jankauskiene, and Empar Lurbe. “Obesity and Eating Disorders in Children and Adolescents: The Bidirectional Link.” Nutrients 13, no. 12 (November 29, 2021): 4321. https://doi.org/10.3390/nu13124321.

Tomiyama, A. Janet, Deborah Carr, Ellen M. Granberg, Brenda Major, Eric Robinson, Angelina R. Sutin, and Alexandra Brewis. “How and Why Weight Stigma Drives the Obesity ‘Epidemic’ and Harms Health.” BMC Medicine 16, no. 1 (December 2018): 123. https://doi.org/10.1186/s12916-018-1116-5.

Tomiyama, A. Janet, J. M. Hunger, J. Nguyen-Cuu, and C. Wells. “Misclassification of Cardiometabolic Health When Using Body Mass Index Categories in NHANES 2005–2012.” International Journal of Obesity 40, no. 5 (May 2016): 883–86. https://doi.org/10.1038/ijo.2016.17.

World Health Organization. Population-Based Approaches to Childhood Obesity Prevention. Geneva, Switzerland: WHO Press, 2012. https://apps.who.int/iris/bitstream/handle/10665/80149/9789241504782_eng.pdf.