Leading Risk Factors Associated with Childhood Obesity: A Primer for Practitioners

We often get asked about the rising obesity epidemic in children, what is the cause, and what can we do to help change this trend. While there is evidence suggesting COVID-19 has exacerbated the problem, there are many contributing factors including our food environment, endocrine modulators in food packaging and other products, increased reliance on processed food (and more sugar in it), and rising sedentary behavior related to screen time.

However, 2 other key factors stand out: low socioeconomic status (SES) and adverse childhood experiences (ACEs).

The connection between SES and pediatric obesity has been well documented. Among children aged 2-19 years in the US in the highest income group, obesity rates remain at 10.9%, compared to 18.9% in the lowest income group and 19.9% for the middle-income group.

The US Department of Agriculture’s Supplemental Nutrition Assistance Program (SNAP) subsidizes foods that are high in sugar, saturated fat, and sodium at a much higher rate than unprocessed, nutrient-dense groceries. More than half of SNAP benefits are redeemed by retailers for sweetened beverages, prepared foods and desserts, cheese, salty snacks, candy, and sugar. Yet only 23.9% of benefits go toward fruit, vegetables, grains, and nuts. Given this reality, a child in a food-insecure household is 5-times more likely to develop obesity as one living in a food-secure households.

Emotional drivers also contribute to childhood obesity in low SES populations and include mood disorders, such as anxiety and depression, stress, low self-esteem, and negative belief patterns, all of which are associated with excess weight. Children from food-insecure households are more likely to eat past satiation and in the absence of hunger.

ACEs compound obesogenic forces. ACEs include maltreatment, abuse (psychological, physical, or sexual), neglect, witnessing crime, living with parental conflict, or parental substance abuse.

ACEs have been implicated not only in obesity but also in hypertension, cardiovascular disease, and substance use disorders. Childhood trauma can lead to chronic stress, with increased levels of cortisol and ghrelin, and chronic inflammation. Stress has been associated with decreased sleep duration, which evidence shows can contribute to obesity. High stress levels have also been linked with decreased physical activity, increased food wanting, and increased food intake.

Programs that improve economic support for children at greatest risk, and screening and services for ACEs throughout childhood can go a long way to address the obesity epidemic. For these types of public health initiatives to succeed, a collaborative approach between communities, the health system, and the government is needed.

For more information on pediatric obesity,the Obesity Medicine Association (OMA) provides resources for health care providers and their patients. Comprising clinical leaders in obesity medicine, OMA offers webinars, online articles, study guides, speaker contacts, and in-person events.

Practitioners may be particularly interested in OMA’s Pediatric Obesity Algorithm, a set of guidelines to help healthcare professionals make informed decisions. The algorithm includes age-specific recommendations and a staged treatment approach.

Modern life may promote obesity from several directions at once, but it also gives us the means to combat this disease. To learn more about OMA’s mission or to become a member, visit www.obesitymedicine.org.


Abby Bleistein, MD, is the founder and director of Healthful Life MD, where she currently practices obesity medicine in Golden, Colorado. Healthful Life MD is a comprehensive, multi-disciplinary medical weight loss practice that helps people with sustainable lifestyle change.

In 2016, Dr Bleistein was recognized by the OMA as Candidate of the Year. She has served on the Pediatric Committee and the Advocacy Committee of the OMA.