A small percentage of overweight cases in childhood are due to hormonal abnormalities, but the vast majority of childhood overweight is due to over-eating.  It is pretty simple:  if children take in more calories than they burn up, they will gain weight. Some kids may have "higher metabolism rates" and burn up food faster, but even if a child's metabolism rate is high, if they eat excessively, they will gain weight.  

Weight problem vs. Eating Problem

Children who are overweight generally refer to themselves as having a "weight problem", but in actuality what they have is an "eating problem."  They eat more than they burn up by physical activity.  Lack of activity can contribute to overweight.  Kids today are not as active as in the past.  But over-eating is by far the biggest contributor to gaining weight.  For example, walking several miles is required in order to burn up just one ice cream cone.  The reasons for excessive food intake are not that complex.  Depression, anxiousness, low self-esteem, stress, or just boredom are commonly relieved by food.  We do not feel pleasure and emotional pain at the same time.  Unfortunately, the emotional pain returns as soon as the food is consumed.  

Using food as a way to neutralize emotional pain can actually result in a psychological dependence on food.  The child becomes psychologically "hooked" on food to keep from feeling emotional discomfort, very similar to a drug addiction.  Resisting overeating to begin with takes "will power", but breaking psychological food dependence takes heavy duty will power.  Tolerating life's pains, finding alternative comforting things, and distracting oneself by fun activities is necessary to avoid psychological food dependence.  There is also the "Vicious Circle Effect." 

Once a child gains excessive weight, the decrease in self-esteem and social isolation associated with being overweight causes more depression, anxiety, and stress, so that seeking comfort in food and overeating increases even more, with more weight gain, worse self-esteem, and so on.  This is referred to as a "vicious circle".  And the heavier a child becomes, the less he/she is able to move around to burn calories, further increasing weight gain, i.e. a second vicious circle.  To lose weight requires breaking these vicious circles.  The child must realize that overeating and gaining more weight will just increase the unhappiness and problems with exercise and make it even more difficult to do something about the weight.  Finding other comforting things that don't involve food, distracting fun activities, and support groups can help break the vicious circle.

Children who do not receive emotional comfort at home may turn to food for comfort.  A nurturing relationship with parents can turn off the emotional appetite for food.  Unfortunately, overweight in their child tends to upset parents, so that the relationship becomes strained, which causes the child to seek more comfort in food, which upsets the parents further, i.e. another vicious circle.  And parents may feel that overweight in their child is the parents' fault.  But it is no one's fault, just misunderstanding.  Breaking the vicious cycle by loving and nurturing your overweight child is the key.  Talk to your child about his/her feelings, what feelings are being numbed by food, and help the child to learn to find comfort and stress relief in things other than food.  Again, if you have not read it, please see How Do I Lose Weight?

Hunger is what we feel when our body is lacking in the nutrition of food.  A craving is what we feel when we want the pleasure of food.  If your child eats for pleasure rather than for nutrition, excessive weight gain is usually the result.  Help your child to learn how to eat for nutrition rather than for pleasure.

The size of food portions in our culture is set by people who want to sell food.  Eating the "standard size" portions in most restaurants on a regular basis will cause most people to gain weight.  One of the best ways to control your children's weight is to let them eat whatever they like, just less of it.  To help them lose weight, it helps to cut whatever they normally eat by half or a third and save the remainder for later.  Once the weight loss has occurred, to maintain it, the portions are then made just a small amount less than they used to eat. Portions can be adjusted to keep your child's weight in the healthy range.

The problem with obesity in children and teens is not just the cosmetic and self-esteem issue of looking "fat".  Obesity can seriously harm your child's health.  If there is excessive fat on the outside of the body, there is also excessive fat on the inside, i.e. in the body's organs.  Fat build up in organs such as the heart, the arteries, the liver and pancreas causes these organs to function poorly.  

Diabetes (Type 2) is on an alarming rise in the adolescent population.  Type 2 diabetes is intimately related to being overweight.  Type 2 diabetes was rare in kids 20 years ago, but the rate of type 2 diabetes in kids has increased by one percent every year since 1980, in parallel with the increase in obesity in kids¹³.

High blood pressure is also increasing at an alarming rate in children.  Similar to type 2 diabetes, high blood pressure in children is likewise related to being overweight.  And if a teenager has high blood pressure and is overweight, they have a 90% chance of having high blood pressure as an adult, with a high risk of an artery breaking in the brain (stroke).¹⁴.

Overweight children have more bone and joint problems, simply because of the mechanical stress which the extra weight puts on bone and joint structures.  

The high fat, high sugar foods which overweight kids and teens eat cause fatty deposits called "plaque" (pronounced "plack") to form on the inside of the arteries supplying organs like the heart, the brain, and the kidneys.  This plaque, shown in the lower artery on the left, eventually blocks normal flow of blood to those organs (the upper artery is normal).  Moreover, pieces of plaque can suddenly break off and totally block the blood flow downstream.  This results in a "heart attack" in the case of the heart or a "stroke" in the case of the brain.  Plaque deposits also cause "hardening of the arteries", which results in high blood pressure, kidney failure, and broken arteries in the brain, another form of stroke.

"Medically overweight" is different than "socially overweight."  "Socially overweight" means that a child is embarrassed about their weight and gets teased about it.  The term "medically overweight" means that a child's weight is a risk to their health.  Doctors use what is called the "Body Mass Index" or BMI to determine if a child is medically overweight.  The BMI is also used for adults and indicates how much fat a person has on their body.^3,4  The BMI changes normally with a child's age.  For example children less than 3 years old and teenagers have more fat normally on their bodies than children 4 to 12 years old so their BMI is higher.  

The BMI is simply a number that shows how a person's weight relates to their height, in other words whether their weight is proportionate to their height.  The BMI is the weight divided by height multiplied by itself.  BMI's for children in the typical U.S. population are listed on the National Center for Health Statistics website.  A thing called the BMI "percentile" is used to compare how a child's BMI relates to other children their age and sex.  For example, if your child's BMI is at the 75th percentile, that means that his or her BMI number is greater than seventy-five out of a hundred kids their age and sex.  If a child has a BMI higher than the 85th percentile they are considered "medically overweight", and if greater than the 95th percentile then they are considered "medically obese."  How was that percentile picked?  It was determined by a committee of experts on obesity in kids.⁹  Actually it is Mother Nature that determines what a healthy BMI is, because a child's BMI percentile is related to health risks.

Three out of five children and teens with a BMI above the 95th percentile have at least one risk factor for cardiovascular disease.  One out of five children with with a BMI above the 95th percentile have two or more risk factors for cardiovascular disease. ⁵

Overweight children are likely to become overweight adults. ^1,6

The extremes in BMI-for-age that raise concern in children 2 to 20 years of age:

BMI-for-age <5th percentile: Medically underweight

BMI-for-age >85th percentile: Medically overweight

BMI-for-age >95th percentile: Medically obese

You can find out your child's BMI percentile and whether they are medically overweight and at health risk by using the percentile calculator on our site.  This calculator uses the recently released height, weight, and BMI percentile charts of the U.S. National Center for Health Statistics.