Obesity or Overweight Now Affect 1 in 3 Youth: How Experts Are Responding

One in three youth ages 10 to 17 expe­ri­ence obe­si­ty or over­weight, accord­ing to new­ly updat­ed data in the Annie E. Casey Foundation’s KIDS COUNT^® Data Cen­ter. The lat­est 33% fig­ure in 2020–2021 rep­re­sents an increase of 2 per­cent­age points in five years and cor­re­sponds with an increas­ing share of youth who do not exer­cise reg­u­lar­ly (55% in 2020–2021).

Obe­si­ty alone affects 14.4 mil­lion chil­dren and teens nation­wide and has become a lead­ing chron­ic dis­ease among kids, accord­ing to the Amer­i­can Acad­e­my of Pedi­atrics (AAP). Obe­si­ty also increas­es the risk of oth­er seri­ous phys­i­cal and men­tal health con­di­tions, including: 

• Heart dis­ease
• Type 2 diabetes
• Asth­ma
• Anx­i­ety
• Depres­sion

The Med­ical Field’s Evolv­ing Views on Obesity

Defined as hav­ing a Body Mass Index at or above the 95^th per­centile for age, obe­si­ty is no longer con­sid­ered a result of indi­vid­ual choic­es but, instead, a com­plex dis­ease result­ing from socioe­co­nom­ic, envi­ron­men­tal and genet­ic fac­tors, as described in new clin­i­cal guide­lines from the AAP. In par­tic­u­lar, adver­si­ty dur­ing child­hood, such as pover­ty and racism, can affect health in crit­i­cal ways and increase the risk for obe­si­ty. The AAP now rec­og­nizes the cen­tral role that social deter­mi­nants of health play in child­hood weight — that is, children’s expe­ri­ences, social con­texts and access to resources great­ly influ­ence their like­li­hood of hav­ing an unhealthy weight.

Dis­par­i­ties in Youth Obe­si­ty and Overweight

Giv­en the influ­ence of struc­tur­al inequities and socio­cul­tur­al fac­tors on health, over­weight and obe­si­ty do not affect all chil­dren equal­ly. For instance:

• The 2023 KIDS COUNT Data Book reports that rates of obe­si­ty or over­weight were sub­stan­tial­ly high­er for Lati­no (43%) and Black (40%) youth com­pared to white (27%) and Asian and Pacif­ic Islander youth (24%) in 2020–2021. Over the past three years, rates jumped by 6 per­cent­age points for Asian and Pacif­ic Islander youth and 5 per­cent­age points for Lati­no youth, the largest increas­es of all racial and eth­nic groups with data.

• The AAP states that over­weight and obe­si­ty are more preva­lent among kids liv­ing in pover­ty, low-resource com­mu­ni­ties and immi­grant fam­i­lies, as well as those who have expe­ri­enced dis­crim­i­na­tion or stigma.
• Look­ing across the coun­try in 2020–2021, the high­est rates of youth obe­si­ty or over­weight were gen­er­al­ly found in south­ern states, with 41% in Ken­tucky, Mis­sis­sip­pi and West Vir­ginia, while Col­orado and Wyoming had the low­est rates in the nation, at 24%. Notably, rates increased in 35 states over the last five years, with some rates ris­ing by an alarm­ing 9 or 10 per­cent­age points.

• When exam­in­ing nation­al rates by gen­der, males ages 10 to 17 con­sis­tent­ly had high­er rates of obe­si­ty or over­weight than their female peers over the last five years — reach­ing 36% ver­sus 31%, respec­tive­ly, in 2020–2021. Poten­tial rea­sons for this dif­fer­ence: Male youth typ­i­cal­ly spend more time on dig­i­tal devices and may be more vul­ner­a­ble to food and bev­er­age mar­ket­ing than females, accord­ing to the AAP.

Body Mass Index (BMI) Is a Lim­it­ed Measure

While most indi­ca­tors of child­hood obe­si­ty or over­weight come from BMI, it is impor­tant to rec­og­nize that this sim­ply mea­sures body size and weight, rather than actu­al health based on meta­bol­ic or oth­er mea­sures. Being a larg­er size does not nec­es­sar­i­ly mean one is unhealthy, and label­ing chil­dren as over­weight or obese based on their BMI can cause psy­cho­log­i­cal harm.

Fur­ther, as described in a recent report by the Robert Wood John­son Foun­da­tion, BMI is based on Euro-Amer­i­can body types and does not take into account race or eth­nic­i­ty. The report states, ​“There is no uni­ver­sal ide­al body nor a sin­gle size for good health. We need to move beyond a weight-cen­tered view of health, and avoid sham­ing and blam­ing those liv­ing in large bod­ies.” Going for­ward, it will be crit­i­cal to improve meth­ods of assess­ing children’s weight and health.

Chang­ing Approach­es to Child­hood Obe­si­ty Pre­ven­tion and Treatment

Increas­ing­ly, many lead­ers and sec­tors are using sys­temic solu­tions to tack­le the deep-root­ed, struc­tur­al forces behind the rise in child­hood obe­si­ty and the dis­par­i­ties by race and socioe­co­nom­ic sta­tus. Exam­ples include improv­ing access to nutri­tious and afford­able food, espe­cial­ly in low-income com­mu­ni­ties, and ensur­ing that all fam­i­lies have ade­quate resources to sup­port their children’s health. Oth­er solu­tions involve mak­ing improve­ments in schools and built envi­ron­ments, includ­ing increased oppor­tu­ni­ties for exer­cise, as well as address­ing food and bev­er­age mar­ket­ing to young people.

The AAP has respond­ed to this con­cern­ing trend with new clin­i­cal prac­tice guide­lines for pedi­atric obe­si­ty treat­ment, based on the lat­est evi­dence. Fun­da­men­tal­ly, the guide­lines state that treat­ment should be com­pre­hen­sive, long-term and in the con­text of a med­ical home, using a chron­ic care mod­el with fam­i­ly-cen­tered and non-stig­ma­tiz­ing approach­es. More spe­cif­ic rec­om­men­da­tions dif­fer by age group:

• For ages 2 and old­er: Treat­ment can include inten­sive behav­ioral, nutri­tion and phys­i­cal activ­i­ty sup­port, with active parental and fam­i­ly engagement.
• For ages 12 and old­er: Treat­ment can include weight loss phar­ma­cother­a­py, in addi­tion to behav­ioral and lifestyle support.
• For ages 13 and old­er with severe obe­si­ty: Physi­cians can refer teens for eval­u­a­tion for meta­bol­ic and bariatric surgery, in addi­tion to the above options.

Unfor­tu­nate­ly, many chil­dren can­not access or afford evi­dence-based treat­ment or high-qual­i­ty health care gen­er­al­ly. Giv­en this, the AAP also rec­om­mends pro­mot­ing ​“sup­port­ive pay­ment and pub­lic health poli­cies that cov­er com­pre­hen­sive mul­ti­com­po­nent obe­si­ty pre­ven­tion, eval­u­a­tion, and treat­ment, includ­ing pol­i­cy changes with­in and beyond the health care sec­tor.” Ensur­ing that all fam­i­lies have access to afford­able, com­pre­hen­sive health insur­ance and care has long been a pri­or­i­ty among those work­ing to improve children’s health. Addi­tion­al AAP rec­om­men­da­tions include com­bat­ting struc­tur­al racism and expand­ing access to effec­tive com­mu­ni­ty pro­grams and resources.

As child­hood obe­si­ty rates con­tin­ue to increase, and dis­par­i­ties endure, much more work is need­ed to advance pre­ven­tion, treat­ment and data col­lec­tion efforts. 

More About Child Health and Equi­ty Issues

• Read the 2023 KIDS COUNT Data Book, which tracks the over­weight or obe­si­ty indicator.
• See all data on the KIDS COUNT Data Cen­ter, includ­ing health, demo­graph­ic, eco­nom­ic and fam­i­ly indicators.
• Explore the Casey Foundation’s equi­ty and inclu­sion resources.
• Vis­it the Robert Wood John­son Foundation’s State of Child­hood Obe­si­ty web­site.

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