Obesity in Youth With and Without Disabilities
My 15-year-old nephew, Zeke, is a lean, mean, football-playing machine. The discipline he demonstrates daily to keep his specific conditioning up to remain a starting middle linebacker for the Gulf Shores High School Dolphins rivals that of many top athletes. At 5’11” and 180 pounds, he takes his health seriously and takes personal responsibility for it. This was not always the case. While in elementary school, like any other 7-year-old, Zeke liked - no, loved - double cheeseburgers and video games. During these earlier years he wasn’t very active. Concerned about Zeke’s apparent growth problem, his pediatrician was consulted and a lengthy battery of tests followed. Zeke was diagnosed with a growth disorder. A steady treatment regimen of hormone therapy coupled with an affinity to sports (encouraged by his favorite uncle - me) became a catalyst for Zeke to adopt a healthier and more active lifestyle and avoid adding to the discouraging youth obesity statistic.
Unfortunately, Zeke’s story seems to be the exception, not the norm. According to the latest data from The Centers for Disease Control and Prevention (CDC), about one in three American kids and teens is overweight or obese.1,2,5 “Obese” is defined as body weight at least 20 percent over the recommended weight for height, or a Body Mass Index (BMI) greater than the 85th percentile.2 This is alarming because the same data suggests that overweight children and teens tend to be overweight adults. Even more alarming is the fact that nearly two-thirds of American adults are overweight or obese across all races according to CDC.3,4
These statistics are staggering with nearly triple the prevalence of youth obesity compared to just 30 years ago.3 During the past three decades, the prevalence of obesity among adults and adolescents across all gender, race/ethnicity, and age groups has increased from 13 percent in the early 1960s to 32 percent in 2006.4
With good reason, childhood obesity is a major health concern among medical professionals both in the United States and around the world. The prevalence of obesity in children with disabilities is almost twice that of their peers without a disability.5 People with disabilities are particularly vulnerable to obesity. Children and adolescents with disabilities are more as well as chronically ill children and adolescents and are more commonly overweight and obese than children and adolescents without disabilities.6 Sadly, no effective, long-lasting interventions for obesity in children and adolescents with or without disabilities have been published.
Obesity is causing a broad range of health problems among children that previously weren’t seen until adulthood, including high blood pressure, type 2 diabetes and elevated blood cholesterol levels. For children and adolescents with disabilities, obesity primarily represents a crucial risk factor for the development and/or worsening of secondary problems arising from the underlying disability. For example, excess weight can cause fatigue and pain to the joints and muscles, which can lead to impaired mobility. In some cases, secondary conditions related to obesity can result in immobility, loss of independence, and restricted options for exercise and leisure activities. As a result, quality of life for these children - which is already lower than in their healthy peers - is reduced even further.12
A lack of physical activity is considered to be a major cause of childhood obesity. The average kid in America spends about 28 hours a week watching television.8 Of all forms of media, including television, texting and video games, total screen time is 55 hours.8 Children with disabilities are at an even greater risk for obesity because of this sedentary lifestyle. In view of the many barriers to exercise, it is hardly surprising that children with disabilities consume more television and computer games.8
Current strategies do little to stop the obesity epidemic in this country. To be effective in reversing the epidemic of obesity trends, we must identify the trigger to motivate people into adopting more active lifestyles and becoming more accustomed to making healthier eating choices.12
It is very important to encourage children of all abilities, like my nephew Zeke, to exercise. Parents can become positive role models by regularly exercising on their own and with their child. Parents can increase their child’s physical activity and reduce sedentary time by limiting the number of hours the child can watch television. It is also very important to make exercise fun and enjoyable to encourage a lifelong love of activity.
The lack of adaptive facilities for people with disabilities in fitness centers, on playgrounds, and in sports centers creates further barriers to exercise. Most sports coaches and fitness center staff are not trained to look after children with disabilities. Offering a health intervention in obese children and adolescents with disabilities is likely to have many benefits: if overweight and obesity are reduced successfully, its harmful results can often be reduced and many secondary conditions in disabilities can be avoided.
1. Reichard R, Holtus H, Fox MH. Health disparities among adults with physical disabilities or cognitive limitations compared to individuals with no disabilities in the United States. The Disability and Health Journal 2011;4(2):59–67.
2. Bandini LG, Curtin C, Hamad C, Tybor DJ, Must A. Prevalence of overweight in children with developmental disorders in the continuous national health and nutrition examination survey (NHANES) 1999–2002. J Pediatr 2005;146:738–43.
3. Centers for Disease Control and Prevention (CDC). Differences in Prevalence of Obesity Among Black, White, and Hispanic Adults --- United States, 2006—2008. MMWR, July 17 2009:58(27);740-44. Available at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5827a2.htm
4. Jones, G. C., & Sinclair, L. B. (2008). Multiple health disparities among minority adults with mobility limitations: An application of the ICF framework and codes. Disability and Rehabilitation, 30(12–13), 901–915.
5. Chen AY, Kim SE, Houtrow AJ, Newacheck PW. Prevalence of Obesity Among Children With Chronic Conditions. Obesity 2010;18:1,210–213.
6. Campbell, V. A., Crews, J. E., & Sinclair, L. (2002). State-specific prevalence of obesity among adults with disabilities—Eight states and the District of Columbia, 1998-1999. Morbidity and Mortality Weekly Report, 51(36), 805–808.
7. Ellis LJ, Lang R, Shield JP et al. Obesity and disability—a short review. Obes Rev 2006;7(4):341–345.
8. Reinehr T, Wabitsch M. (2011). Childhood Obesity Curr Opin Lipidol. Department of Pediatric Endocrinology, Diabetes and Nutrition Medicine, Vestische Hospital for Children and Adolescents, University of Witten/Herdecke, Datteln, Germany. 2011 Feb;22(1):21-5.
9. Patrick K, Norman GJ, Calfas KJ, Sallis JF, Zabinski MF, Rupp J, Cella J. (2004) Diet, physical activity, and sedentary behaviors as risk factors for overweight in adolescence. Arch Pediatr Adolesc Med. 2004 Apr; 158(4):385-90.
10. Liou, T. H., Pi-Sunyer, F. X., & Laferrère, B. (2005). Physical Disability and Obesity. Nutrition Reviews, 63(10), 321–331. 4. Finkelstein E, Trogdon J, Cohen J, Dietz W. Annual medical spending attributable to obesity: Payer- and service-specific estimates. Health Affairs 28, 5(2009):w822-31.
11. Child and Adolescent Health Measurement Initiative. National Survey of Children’s Health, 2007. Data Resource Center on Child and Adolescent Health website. Retrieved 10/23/2012 from http://www.nschdata.org
12. Kinne, S., Patrick, D. L., & Doyle, D. L. (2004). Prevalence of secondary conditions among people with disabilities. American Journal of Public Health, 94(3), 443–445.