Child and adolescent obesity: Epidemiology and developmental perspectives

doi:10.1016/j.physbeh.2007.11.016

Physiology & Behavior

Volume 94, Issue 1, 22 April 2008, Pages 8-16

https://doi.org/10.1016/j.physbeh.2007.11.016 Get rights and content

Abstract

From infancy through adolescence, more and more children are becoming overweight. National prevalence data show that more than 17% of youth have a body mass index (BMI) above the 95th percentile of the US age and sex-specific reference. Particularly alarming are rates in children as young as 2 years of age, and among minority children. Periods of heightened vulnerability to weight gain have been identified, and research supports the notion that obesity has its origins in early life. This paper focuses on susceptibility to increased adiposity during the prenatal period, infancy, mid-childhood and adolescence, and how factors operating in each of these periods influence risk of becoming overweight. Prenatal exposure to over or undernutrition, rapid growth in early infancy, an early adiposity rebound in childhood, and early pubertal development have all been implicated in the development of obesity. The persistence of obesity from young ages emphasizes the importance of understanding growth trajectories, and of developing prevention strategies to overcome strong influences of obesigenic environments at young ages.

Section snippets

Prevalence

In the United States, the National Health and Examination Surveys (NHANES) document steady increases from the late 1970s to 2004 in the prevalence of overweight (having a body mass index – BMI – above the age and sex-specific 95th percentile of the US growth reference) and at risk of overweight (a BMI between the 85th and 95th percentile) among children and adolescents, ages 2 to 18 years. The percentage of overweight youth increased sharply from 1999 to 2004, so that by 2004, 17.1% of American

The prenatal period

Fetal nutrition and prenatal growth and body composition reflect the supply of energy and nutrient from the mother's diet and nutritional stores and depend on efficient placental functioning. It is hypothesized that in addition to the flow of nutrients, the developing fetus is exposed to chemical signals which provide information about the mother's nutritional status, and possibly the quality of the postnatal environment that the infant is likely to encounter [18]. Thus, fetal nutritional

Infancy

Biologically, infancy is a period of rapid growth, and thus high susceptibility to environmental influences including feeding, care, and morbidity. One main focus of research on the development of obesity in infancy is on breastfeeding, and on the timing of introduction and quality of weaning foods. This work is challenging for several reasons. Many studies are retrospective, rely on maternal recall of breastfeeding duration, and have limited ability to account for factors associated both with

Rapid growth in infancy and later risk of obesity

Rapid growth during infancy has received a great deal of attention lately as a factor contributing significantly to overweight during infancy and at later ages, and several reviews on this topic have been published recently [53], [54], [55].

Rapid growth in infancy and childhood has been defined in different ways, but the most common definition is an increase in weight Z-score (WZ) exceeding 0.67 SD, which represents upward crossing of major percentile lines of a usual growth reference [56]. The

Childhood: the role of adiposity rebound

BMI normally increases from birth to about 1 year of age, declines to a nadir at about 5–7 years of age, and then begins to increase again. The age at which the nadir in BMI is reached is identified as the beginning of adiposity rebound. Rolland-Cachera et al. proposed that an early age at adiposity rebound predicts adult fatness [16]. Critics of this theory argue that early adiposity rebound predicts later adiposity because it reflects a higher BMI prior to and during rebound period, or a

Adolescence

Adolescence is characterized by large changes in body size and composition. Much biological research on obesity development in adolescence has focused on the role of puberty. However, the extent to which pubertal timing is a cause and/or consequence of obesity remains a subject of debate. Higher pre-pubertal BMI and other indicators of adiposity in early childhood are associated with earlier maturation. For example, in a sample from Pennsylvania, girls with more body fat at age 5 and larger

The importance of growth trajectories

There is strong evidence of tracking of overweight. For example, one longitudinal study of more than 1000 children found that any early childhood experience of being above the 75th BMI percentiles was a strong predictor of obesity at age 12 [91]. The wide range of studies showing the development of obesity risk at young ages, the ability of rapid growth or early overweight to predict later overweight, and the persistence of obesity through adolescence into adulthood highlight the importance of

Acknowledgement

Thanks to UNC student research assistant Kari Riggle for assistance in all aspects of manuscript preparation.

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