This month’s OBSSR Director’s Spotlight focuses on the challenge of childhood obesity. Katrina B. Goddard, Ph.D., Director of the Division of Cancer Control and Population Sciences (DCCPS) at the National Cancer Institute (NCI), co-authored this spotlight on the wide-ranging health consequences and the coordinated NIH efforts to advance prevention and treatment of childhood obesity.
Achieving and maintaining a body weight that enables us to play, learn, and thrive is a key public health goal. Although the advice commonly prescribed to achieve this objective—eat a healthy diet, engage in regularly physical activity, and get a good night’s sleep—seems simple, many children find achieving a healthy weight to be anything but. Why is it so difficult to create an environment that supports healthy weight in children and their families?
The scope of the concern is notable. Approximately 20% of U.S. children ages 2 to 19 have a body mass index (BMI) that meets the definition of childhood obesity (i.e., at or above the 95th percentile for age and sex) (CDC, 2024). There are distinct disparities in the burden of obesity, with higher obesity rates among Hispanic children, non-Hispanic Black children, and children from families with lower levels of income. Reducing the proportion of children and adolescents with obesity is recognized as a national public health goal through its inclusion as one of the Healthy People 2030 objectives.
Obesity has numerous consequences for children’s health. It is linked to an increased risk of developing many chronic conditions: high blood pressure, diabetes, asthma, sleep problems (e.g., apnea), and depression. It is particularly important to address obesity in childhood, because childhood obesity is a predictor of adult obesity and is linked to elevated risk of additional health challenges in adulthood, including cardiovascular disease and many obesity-related cancers. Indeed, obesity is the second leading modifiable risk factor for cancer, and with current trajectories it could overtake smoking in the coming decades to become the leading modifiable risk factor for cancer. Moreover, obesity generates an enormous economic burden through elevated medical costs and lost productivity.
The stigma surrounding obesity is harmful and can compound the negative impacts of obesity itself. Children and adolescents with obesity are often subject to poor interpersonal treatment, ranging from peer bullying to societal level barriers that impact health and well-being. Weight-based victimization of children with obesity is detrimental to mental and socioemotional health, and research has demonstrated that weight stigma in children and adolescents can lead to psychological distress, poorer academic and social outcomes, maladaptive eating behaviors, substance use, and weight gain.
Obesity is the result of multiple interconnected factors at biological, behavioral, social, commercial, environmental, policy, and systems levels that together influence weight gain. Individual or group behavioral approaches for childhood obesity prevention—primarily focused on dietary modification and increases in physical activity in a school or home-based setting—have demonstrated small benefits. However, behavioral weight loss is difficult to achieve and maintain over time without significant support in place.
The scientific consensus is that engaging multiple, multilevel approaches simultaneously and over the long term is the most effective way to reduce obesity. For example, the National Heart, Lung, and Blood Institute (NHLBI)–supported Healthy Communities Study (HCS) recruited nearly 5,000 children and families in 130 communities across the United States to conduct a rigorous assessment of policies attempting to impact childhood obesity. The findings provide strong support for engaging multiple policy systems and environmental approaches to address childhood obesity. The CDC-supported 2-year controlled trial Shape Up Somerville tested a multilevel community-based intervention that modified household, school, and community environments. The study demonstrated the potential of sustainable multilevel community interventions for preventing childhood obesity and produced additional positive spill-over impacts on parent weight status.
Metabolic bariatric surgery (or weight loss surgery) is an effective but extreme approach for significant weight loss among youths with obesity. More recently, anti-obesity medications have revolutionized the field of obesity treatment and are beginning to be used among children. However, little is known about the long-term sustainability or effects of these medications for life-long obesity management, and a recent modeling study suggested that although medications could lead to decreased overall prevalence, they may exacerbate disparities in obesity rates for racial and ethnic groups due to unequal access.
Given the high prevalence of childhood obesity, surgical and pharmacological approaches are insufficient, and it is vital to address the policies, systems, and environments (PSE) that cause obesity. Examples of PSE approaches include introducing sugar-sweetened beverage taxes, implementing point-of-sale nutrition labeling, investing in the built and natural environment, promoting active transportation, modifying school policies to improve food quality, establishing policies to address food security, and addressing food deserts. It will be crucial to integrate individual behavioral and pharmacological approaches to obesity along with PSE approaches to maximize impact. Implementation of such audacious programs will require coalitions of community and neighborhood leaders, local health and transportation departments, health care delivery systems, elected representatives, and others.
At NIH and the U.S. Department of Health and Human Services, obesity is a major area of focus because of its association with numerous chronic conditions and diseases. NIH is part of the National Collaborative on Childhood Obesity Research (NCCOR), a partnership of major funders that address obesity and health. NCCOR recently hosted a workshop on Obesity-Related Policy, Systems, and Environmental Research in the United States.
NIH also has funded research to investigate contextual causes through the Time-Sensitive Obesity Policy and Program Evaluation funding opportunity (view projects funded through this opportunity). Grants funded through this opportunity focus on the impact of the COVID-19 pandemic and school closures on children’s weight, evaluation of a healthy restaurant kids meals policy, the promotion of nutrition and physical activity in family-based child care settings, and a large-scale quasi-experimental evaluation of added sugar warning labels in restaurants. Current funding opportunities can be found on NCI’s Obesity Policy Research webpage.
Alongside our NIH institute, center, and office partners, OBSSR is dedicated to supporting efforts to advance the science of obesity prevention and treatment to ultimately advance healthy development for all children and their families.
