Heavy in High School

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With the Trump Administration promising the dawn of a new political era, the future of the Healthy, Hunger-Free Kids Act, long championed by Michelle Obama, is uncertain.

For the last few years, the Act has attempted to transform nutrition in schools across the country by reducing portion sizes, increasing fruit and vegetable servings, and improving access to meal programs. The initiative is a direct response to the fact that there are now four times more obese teenagers across the United States than in 1980, and a growing concern that teens are using unhealthy methods to lose weight.

To understand how the problem has quadrupled in size, we visually charted the rise of teen obesity using historical data and the latest figures from the Centers for Disease Control and Prevention.

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The graphic above gives a visual impression of how the body of an average 15-year-old girl has changed over the last 40 years. The data come from the Centers for Disease Control and Prevention, which, through various large-scale surveys since 1966, has tracked the heights and weights of adolescents in the United States.

Between 1966 and 1970, the average 15-year-old girl was 5 feet 4 inches and weighed 124.2 pounds. The figures were almost identical between 1971 and 1974. But between 1988 and 1994, she weighed 6.7 pounds more, despite being the same height. By 1999–2002, another 6.6 pounds were added to her weight, followed by 7.3 pounds by 2011–2014 (the most recent survey period and when the Healthy, Hunger-Free Kids Act began). Put simply, the average 15-year-old girl stayed the same height between 1976 and 2014 but gained 20.6 pounds – ­just shy of the average weight of a one-year-old child.

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The weight of an average 15-year-old boy increased between 1976 and 2014 a bit more than the average girl: 22.6 pounds versus 20.6 pounds. Unlike girls, teenage boys are now a bit taller than they used to be; they’ve gained about an inch in stature over the last 40 years. However, this isn’t enough height to account for the significant increase in their weight, which – based on the standard BMI height-to-weight ratio – typically increases by 5 to 7 pounds per inch of height. In other words, the additional inch added to the average 15-year-old boy’s stature fails to account for 70 percent of the weight he’s gained over the last four decades.

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Graphing the weights of teenage boys and girls aged 14 to 17 across the last five decades reveals the teen obesity epidemic for what it has been and still is. Across both genders and all ages, there was a drastic increase between the late ‘80s and early 2000s. Over the last 10 years, teen obesity has continued to increase among girls aged 15 to 17 and boys aged 14 to 15, while also falling slightly among girls 14 years old and boys aged 16 to 17.

One specific category of teen obesity that’s clearly on the rise is Class III Severe Obesity. In April 2016, researchers at Duke University identified an increase in the number of young people with BMIs of 40 or more, from 2.1 percent in 2011–2012 to 2.4 percent in 2012–2014.

Youth who experience severe obesity are at a highly elevated risk for health problems, such as psychological stress, depression, high blood pressure, and type 2 diabetes. Additionally, their discomfort or insecurity with their body shape or size can lead to extreme eating behaviors, such as binge-eating episodes (or binge-eating disorder as classified by DSM-5) or anorexia nervosa, and these serious conditions can have dangerous consequences for their health.

Examining the Factors Behind Teen Obesity

While we know nutrition in schools plays a major role in teen obesity, its causes are complex. Recent research has hinted that even a young person’s genes can play a part. A variation in the location of the FTO gene can make a teen 20 to 30 percent more likely to binge eat. The other known factors at play are easier to quantify and potentially improve. We examined several of them using CDC’s latest survey data from 2015.

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Research from Harvard University linked watching television to obesity more than two decades ago. In 1999, 42.8 percent of teens watched more than three hours of television per day. Fortunately, in the past two years television activity is dropping.  We found that the percentage of 9th–12th-graders who watched three or more hours of television per day on school days in 2015 was significantly lower than in 2013, having fallen from 32.5 percent to 24.7 percent.

In some states where obesity rates are higher, television watching rates are still above 30 percent. Teens  in Mississippi ( with the highest obesity rates in the nation), Arkansas, Alabama, and North Carolina all reported higher rates of television watching.

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While watching television has fallen among teens in recent years, computer use has increased. In 2015, 41.7 percent of 9th–12th-graders used a computer or played video games for three or more hours per day on an average school day (excluding school work), up from 21.1 percent in 2005.

The increase in video game activity among teens is worrying from a health perspective, as this can present many of the same risks as watching television. Many adolescents spend several hours daily on smartphones, tablets, and computers, all of which can heavily feature games. This is often accompanied by more time indoors, a lack of physical activity, and even a tendency toward increased food intake.

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Aside from watching television, computer use, and other similarly sedate activities, diet is undoubtedly the most significant factor at play in teen obesity.

A 2015 study of 100 overweight and obese children used the Yale Food Addiction Scale to determine what foods they found most addictive. Topping the list was chocolate, followed by ice cream, and carbonated drinks.

The CDC’s data allow us to take a close look at several specific food habits, including the consumption of carbonated drinks, which for a long time have played a significant role in teen obesity, as a typical 20-ounce soda contains up to 18 teaspoons of sugar and 240 calories.

The good news is that soda consumption by teens has fallen in recent years. The percentage of 9th–12th-graders who consumed a non-diet soda one or more times per day in the past seven days dropped from 33.8 percent in 2007 to 20.4 percent in 2015.

Boys are a lot more likely to drink soda than girls (24.3 percent versus 16.4 percent in 2015 drank one or more a day) and soda consumption, despite dropping nationally, is still very high in certain states. The chart below contrasts the heavy consumption of non-diet sodas, as well as three other food habits, with teen obesity levels for every state that submitted data to the CDC in 2015.

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The connection between excessive soda consumption and teen obesity is undeniable. Southern states, including Mississippi, Tennessee, and Kentucky, have high rates of both, while only a few states have a high rate of one but a low rate of the other. For instance, in 2015, California had a teen obesity rate just above the national average, but an excessive soda consumption that was considerably lower.

Correlations between low consumptions of fruit and vegetables and high teen obesity are noticeable in many of the Southern states as well, but not to the same extent as soda. Given that between 7 and 15 percent of sugary drink calories are consumed at school, it’s of vital importance that proper nutritional standards are followed, including those set out in the USDA’s Smart Snacks in School regulation.

What’s also important is that teens are able to assess their own eating behaviors accurately and independently and adjust their food consumption accordingly. To find out where in the United States teens’ perception of their weight is most accurate, we compared two metrics from CDC’s data: overweight teens versus teens who consider themselves overweight.

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Previous research has shown that nearly 3 in 10 overweight teens do not consider themselves overweight. This mismatch between how young people perceive their weight and the actions they subsequently take (or do not take) in controlling it, is a significant concern in the fight against teen obesity.

Our chart, which contrasts states’ actual levels of overweight teens with how many perceive themselves to be overweight, shows that the states with the highest rates of overweight teens have among the lowest rates of teens who perceived themselves as overweight.. Louisiana, which between 2009 and 2015 had the highest average rate of overweight 9th–12th-graders among the states for which data were available, ranked 27th for teens who considered themselves overweight. Alabama ranked 2nd and 35th respectively. In contrast, the states where teens were most concerned about their weight despite ranking low for overweight levels included South Dakota, Vermont, and Hawaii. Colorado and Utah (which have among the lowest levels of adult obesity in the country, at 51st and 45th respectively) showed perfect alignment for actual and self-perceived levels of overweight teens.

Based on a nationally representative sample of the CDC’s Youth Risk Behavior Survey in 2015, researchers found that teens who perceive themselves as overweight have a stronger intention to lose weight than those who do not. Still, they do not necessarily develop better eating and exercise habits (such as consuming less soda and eating more vegetables and fresh fruit) compared with peers of the same weight who don’t perceive themselves as overweight.

In other words, for an overweight teen, recognizing the fact that they aren’t the ideal weight isn’t enough to spur them into improving their eating behavior. However, the research also showed that normal-weight adolescents who considered themselves overweight are more likely to attempt weight loss and frequently do so using health-compromising weight loss methods.

These facts , combined with the additional information related to the mismatch in self-perceived weight and reality  , establish two important goals:

  1. We must help normal-weight teens feel better about their bodies to prevent them from using drastic diets to achieve an unhealthy body ideals.
  1. We must help overweight teens recognize that their eating behavior isn’t ideal but is improvable.

Conclusion

Although agriculture Secretary Tom Vilsack recently said “I don’t think that any administration, coming in, following this administration, would be able to roll back everything that’s been done in the nutrition space,” there is nevertheless no plan currently in place for the future of the Healthy, Hunger-Free Kids Act. The responsibility to keep child nutrition moving in the right direction therefore falls more than ever on parents and teens themselves.

Among the evidence-based strategies recently put forth by the American Academy of Pediatrics are simple measures, such as parents eating regular, well-balanced meals with their children, and avoiding “weight talk” (e.g., talking excessively about their own weight in front of their kids).

When unhealthy eating behaviors become a disorder that seriously affects a person’s life, comprehensive expert treatment can be necessary. Those suffering from eating disorders, obesity, food addiction, and other related conditions may require help from medical clinics that specialize in these issues. If you or someone you know is facing these struggles, Rehabs.com can assist you in finding professional help and treatment that’s tailored to your needs and lifestyle. Visit Rehabs.com today and learn more about eating disorders and how to take action for your health.

Sources

Data were extracted through the CDC’s Youth Online portal for 1999 through 2015. Other data were collected from the National Health Examination Survey (NHES) I, II, and III.

  1. Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of childhood and adult obesity in the United States, 2011-2012. Journal of the American Medical Association 2014;311(8):806-814.
  2. http://pediatrics.aappublications.org/content/pediatrics/early/2016/08/18/peds.2016-1649.full.pdf
  3. National Health Examination Survey (NHES) I, II, and III & NHANES 1999–2014
  4. http://www.livescience.com/54549-childhood-obesity-rise.html
  5. https://www.healthychildren.org/English/ages-stages/toddler/Pages/Physical-Appearance-and-Growth-Your-1-Year-Old.aspx
  6. Calculated using https://nccd.cdc.gov/dnpabmi/calculator.aspx
  7. http://www.livescience.com/54549-childhood-obesity-rise.html
  8. https://www.ncbi.nlm.nih.gov/pubmed/26193063
  9. Dietz WH, Jr., Gortmaker SL. Do we fatten our children at the television set? Obesity and television viewing in children and adolescents. Pediatrics. 1985;75:807-12.
  10. https://www.hsph.harvard.edu/nutritionsource/sugary-drinks-fact-sheet/
  11. http://www.changelabsolutions.org/publications/SSBs-school-wellness
  12. https://www.ncbi.nlm.nih.gov/pubmed/20142281
  13. http://stateofobesity.org/adult-obesity/
  14. https://www.ncbi.nlm.nih.gov/pmc/blog/category/PMC4045298/
  15. http://www.politico.com/story/2016/12/tom-vilsack-trump-healthy-eating-232410

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