Despite educational programs, social stigma, and a plethora of popular diets, many American children—and their parents—remain far too heavy. The number of obese children has more than tripled since 1980.¹ The good news is that obesity levels appear to be leveling off or even declining in some groups.² The bad news is that many of our children are still severely overweight. If we do not change things now, experts predict that American children may have shorter lifespans than their parents, in large part because of poor dietary and physical activity habits.³

The implications of this new reality are staggering. According to a 2009 report from the Robert Wood Johnson Foundation, obese children cost the nation up to $14 billion each year.⁴ The costs will be even higher when they become adults, as we continue to pay for earlier onset of chronic diseases (eg, diabetes, heart disease) and perhaps an entire generation that is less healthy and far less productive than its predecessors and is destined to pass down health habits to yet another generation.

Although providers play a critical role, employers and health plans must also bear the responsibility for finding ways to address the obesity epidemic. This will require an intense, coordinated effort that brings together healthcare, business, and community leaders to ensure the wellbeing of our children and our nation.

The Scope of the Problem
To start combating childhood obesity, we must recognize the scope of the problem, and more important, we must fully understand the demographics of the population that we target. Who does it include? What socio economic and environmental factors have influenced their obesity? What obstacles do they face?

Obesity cuts across socioeconomic lines, but it largely affects those Americans who are underserved by healthcare programs. According to a landmark study, almost 45% of poor children were overweight or obese compared with 22.2% of children living in households with incomes above 400% of the poverty level.⁵

Obesity is increasing at particularly alarming rates among minority children. A recent study showed that obesity rates among white, Asian, and Hispanic girls and boys peaked in 2005 and dropped in 2008.⁶ Obesity levels were stable for black boys during that period but increased for black girls, who were 3 times more likely to be severely obese than white girls. The heaviest children—those in the 99th percentile—have seen no decrease in weight over the most recent study published this year.⁶ In short, we still have not found ways to help those in greatest need.

Of greatest concern is the increase in earlyonset diabetes and heart disease resulting from childhood obesity. Emotional problems, including low selfesteem, depression, and suicides, are also more prevalent among these children. Clearly, an entire segment of our population is at risk for a substandard quality of life if steps are not taken.

Barriers, Lack of Access to Care
Tackling weightloss challenges has not been easy. Children who are bombarded daily with messages of highcalorie, tempting foods—with little counteradvertising for healthy options—find it difficult to make good choices. Many studies show that increasing hours of television watching and video games have an adverse effect on children’s weight.^7,8 In addition, many parents and caregivers are in denial about their children’s weight problems. They see overly dramatized stories on the news about obese children and tell themselves, “My child is not like that.”

The majority of overweight children—up to 80%— have overweight parents.⁹ Many adult caregivers, unwilling or unable to change their own habits, create an environment in which children have no role models or options for improving health. And again, the socioeconomic factors cannot be overlooked. Many lowincome families have little to no access to affordable fresh fruit and vegetables or safe, attractive places to be physically active.

One of the most difficult challenges for obese patients of any age is the lack of health insurance coverage and reimbursement for antiobesity drugs and behavioral treatments. In many cases, obese patients must pay for treatments out of pocket, whether it is to see a nutritionist, get a prescription for a medication, or in extreme cases, have bariatric surgery. With the prevalence of obesity in lowincome families, this lack of support makes it almost impossible for some people to get the help they need.

A study comparing the prices of 384 foods sold at supermarkets in the Seattle area showed that foods with the most calories and fewest nutrients per gram were far less expensive than healthier foods, such as fruit and vegetables.¹⁰ Many people who want to improve their health do not know how to change dietary habits that have been ingrained for generations.