In the United States, the percentage of children and adolescents affected by obesity has more than tripled since the 1970s.1 In 2017–2018, about 1 in 5 school-aged children were affected by obesity (20.3% of all 6-11 year olds, 21.2% of all 12-19 year olds)1 . The prevalence of obesity among 2-19 year old children was 25.6% for Hispanic children, 24.2% for Black children, 16.1% for White children, and 8.7% for Asian children.1 Many factors contribute to childhood obesity, including:2-6
- Metabolism—how your body changes food and oxygen into energy it can use.
- Eating and physical activity behaviors.
- Community and neighborhood design and safety.
- Short sleep duration.
- Negative childhood events.
Genetic factors cannot be changed. However, people and places can play a role in helping children achieve and maintain a healthy weight. Changes in the environments where young people spend their time—like homes, schools, and community settings—can make it easier for youths to access nutritious foods and be physically active. Schools can adopt policies and practices that help young people eat more fruits and vegetables, eat fewer foods and beverages that are high in added sugars or solid fats, and increase daily minutes of physical activity. 3, 7-9 These kinds of school-based and after-school programs and policies can be cost-effective and even cost-saving.10,11
The COVID-19 pandemic has disrupted students’ routines and access to the school environment. Children gained weight at a faster rate during the pandemic (June 1-November 2020) compared to pre-pandemic, with younger school-aged children (6-11) experiencing a rate of BMI change that was 2.5 higher than before the pandemic. 15
Schools are a priority setting for obesity prevention efforts because they reach the vast majority of school-aged youth, provide regularly scheduled opportunities for physical activity, and offer nutritious foods through school meal programs. 3
With a widespread return to in person learning, children can have consistent access to physical activity opportunities, healthy meals, and services provided by school nurses and counselors.
A comprehensive approach is effective at addressing childhood obesity in schools, especially for elementary and middle school students.13-15 Scientists know less about what school-based obesity prevention approaches are effective for teenagers.13-15 A comprehensive approach means directing attention to nutrition and physical activity in schools and even involving school nurses, parents, caregivers, and other community members (e.g., pediatricians, after-school program providers) in the process. This approach aims to support the health and well-being of all students. It does not single out students according to their weight status or body size. Overweight and obesity are sensitive issues for students and families and must be addressed with compassion, understanding, and care.16 School-based programs to promote physical activity and improved diet quality do not appear to contribute to increases in depression, anxiety, or body-dissatisfaction; however, many studies do not collect information about these unintended effects.15 To avoid embarrassing or shaming students, schools should not emphasize physical appearances or reinforce negative stereotypes about obesity.17
School nurses play an important role to prevent and reduce student overweight and obesity prevalence. School nurses can address the complex physical, social, and health education needs of children and adolescents who are overweight or who have obesity.15, 16 School nurses have the knowledge and skills to do the following:
- Create a culture of health and wellness in school.
- Promote and implement school-based policies and strategies for healthy eating and physical activity.
- Coordinate care with families and health care professionals.
- Lead the school community to influence policy changes that reinforce healthy eating, physical education, and physical activity before, during, and after school.
For more information about childhood obesity, visit Child & Teen Healthy Weight and Obesity.
- Fryar CD, Carroll MD, Afful J. Prevalence of overweight, obesity, and severe obesity among children and adolescents aged 2–19 years: United States, 1963–1965 through 2017–2018. NCHS Health E-Stats. 2020. https://www.cdc.gov/nchs/data/hestat/obesity-child-17-18/overweight-obesity-child-H.pdf
- Swinburn BA, Sacks G, Hall KD, et al. The global obesity pandemic: shaped by global drivers and local environments. Lancet. 2011;378(9793):804–814.
- Institute of Medicine. Accelerating Progress in Obesity Prevention: Solving the Weight of the Nation. Washington, DC: National Academies Press; 2012.
- Eisenburg LK, can Wijk KJE, Liefbroer AC, Smidt N. Accumulation of adverse childhood events and overweight in children: a systematic review and meta-analysis. Obesity. 2017;25(5):820–832.
- Danese A, Tan M. Childhood maltreatment and obesity: systematic review and meta-analysis. Mol Psychiatry.2014;19:544–54.
- Fatima Y, Doi SAR, Mamun AA. Longitudinal impact of sleep on overweight and obesity in children and adolescents: a systematic review and bias-adjusted meta-analysis.Obes Rev. 2015;15(2):137–149.
- US Department of Health and Human Services. The Surgeon General’s Vision for a Healthy and Fit Nation. Rockville, MD: US Dept of Health and Human Services; 2010.
- Micha R, Karageorgou D, Bakogianni I, et al. Effectiveness of school food environment policies on children’s dietary behaviors: A systematic review and meta-analysis. PLoS ONE2018;13(3):e0194555.
- The Community Guide. Interventions to Increase Healthy Eating and Physical Activity in Schools. 2019. Retrieved from https://www.thecommunityguide.org/content/interventions-increase-healthy-eating-and-physical-activity-schoolsexternal icon.
- Gortmarker SL, Want CY, Long MW et al. Three interventions that reduce childhood obesity are projected to save more than they cost to implement. Health Affairs.2015;11(34):1932–1939.
- Cradock AL, Barrett JL, Kenney EL. Using cost-effectiveness analysis to prioritize policy and programmatic approaches to physical activity promotion and obesity prevention in childhood. Prev Med.2017;95(S):S17–27.
- Lange SJ, Kompaniyets L, Freedman DS, et al. Longitudinal Trends in Body Mass Index Before and During the COVID-19 Pandemic Among Persons Aged 2–19 Years — United States, 2018–2020. MMWR Morb Mortal Wkly Rep 2021;70:1278–1283. DOI: http://dx.doi.org/10.15585/mmwr.mm7037a3external icon
- Wang Y, Cai L, Wu Y, Wilson RF, Weston C, Fawole O, Bleich SN, Cheskin LJ, Showell NN, Lau BD, Chiu DT. What childhood obesity prevention programmes work? A systematic review and meta‐ Obes Rev. 2015;16(7):547-65.
- Sobol‐Goldberg S, Rabinowitz J, Gross R. School‐based obesity prevention programs: a meta‐analysis of randomized controlled trials. 2013;21(12):2422–2428.
- Brown T, Moore THM, Hooper L, Gao Y, Zayegh A, Ijaz S, Elwenspoek M, Foxen SC, Magee L, O’Malley C, Waters E, Summerbell CD. Interventions for preventing obesity in children. Cochrane Database of Systematic Reviews 2019. DOI: 10.1002/14651858.CD001871.pub4.
- National Association of School Nurses. Overweight and obesity in children and adolescents in schools -The role of the school nurse (Position Statement). Silver Spring, MD: Author. 2018. Retrieved from https://www.nasn.org/advocacy/professional-practice-documents/position-statements/ps-overweightexternal icon. Accessed November 9, 2021.
- Brownell KD, Schwartz MB, Puhl RM, Henderson KE, Harris JL. The need for bold action to prevent adolescent obesity. J Adolesc Health. 2009;45(suppl 3):S8–S17.
- Schroeder K, Travers J, Smaldone A. Are school nurses an overlooked resource in reducing childhood obesity? A systematic review and meta-analysis. J Sch Health. 2016;86(5):309–321. doi: 10.1111/josh.12386