You only have to go back 40 to 50 years to find a time when childhood obesity was rare. As recently as a few decades ago, a significantly overweight child in a U.S. grade school was an anomaly.

Today, childhood obesity is a serious national problem, affecting as many as 18 percent of children and adolescents. Even more disturbing, the amount of excess weight those youth are carrying has increased.

The highest percentage of obesity (31 percent) is found in the Midwest and South, and childhood obesity tends to be linked with poor economics. Minority populations and preschoolers are the two groups seeing the greatest increase.

Researchers first began documenting childhood obesity in the 1980s. Trends toward obesity in children have increased since the 1990s and then leveled off around 2011. But from 2014 to 2017, there was a dramatic increase in obesity in children age 3 to 5.

“Obesity is increasing at an alarming rate in preschoolers. This is a train that’s not stopping,” observes Melinda S. Sothern, Ph.D., CEP, a licensed clinical exercise physiologist who currently serves as professor with tenure at the Louisiana State University Health Sciences Center, Schools of Medicine and Public Health in New Orleans. Sothern began researching childhood obesity in 1989 and is best known for her work in promoting active play as a means of preventing and treating childhood obesity.

According to recent studies, the likelihood of a child being obese is three times higher if one parent is obese. This jumps to 10 times higher if both parents are obese.

“As the weight of an overweight mother goes up, the health of the infant goes down,” Sothern notes. “When a woman is overweight while pregnant, the excess weight creates an environment that is harmful to the developing child. If the pregnant woman develops gestational diabetes during pregnancy, the child is more likely to develop both obesity and diabetes. If mothers are overweight when they deliver, their children will likely be overweight.”

Sothern adds that a small percentage of children are born with macrosomia, meaning the baby is born with obesity and already has related metabolic problems.

If the trend to childhood obesity is not reversed, experts fear the current pediatric population may be the first generation not to exceed their parents’ lifespan.

Research proves that making changes early in a child’s life is key. The CDC reports that while 20 percent of obese 4 year olds will become obese adults, a staggering 80 percent of obese teens will have an obese adulthood.

Problems Multiplied

Children with obesity are bullied more often than healthy weight youth and are more likely to suffer from depression and social isolation, but the effects of obesity are more than emotional and mental.

Children with obesity are at higher risk of chronic health conditions, including:

asthma, bone and joint problems, high cholesterol, high blood pressure, increased risk of heart disease, metabolic syndrome, non-alcoholic fatty liver disease, sleep apnea/sleep disorders and type 2 diabetes.

And because children with obesity tend to become adults with obesity, the health problems can follow them into adulthood.

Although genetics and metabolism contribute to childhood obesity, most of the factors leading to obesity are issues that can be modified and changed. These include unhealthy food choices, excessive calorie intake, prevalence of sugar-added beverages and fat-laden “fast food” in the diet, lack of physical activity, over-use of devices, excessive screen time and sleep deprivation.

Don’t underestimate the value of sleep. Many children aren’t getting enough, and most children with obesity are sleep deprived. Ask your pediatrician, but on average, young children need nine to 11 hours of sleep a night.

Determining Obesity

The American Academy of Pediatrics (AAP) says obesity in children cannot be defined unless there is a trend over a 12-month period.

For example, it’s normal for weight to increase due to rapid growth and hormonal changes as a child enters adolescence. That child might seem overweight for a period of time but will grow into it.

“Overweight” is defined as a body mass index (BMI) at or above the 85th percentile and below the 95th percentile for children and teens of the same age and sex. Obesity is defined as a BMI at or above the 95th percentile for children and teens of the same age and sex. Growth charts from the Centers for Disease Control and Prevention (CDC) are commonly used to measure size and growth patterns in children and teens.

“BMI is a great tool for measuring, but parents still have a challenge understanding this. One of the strongest tips I give parents is to sit down with your pediatrician and ask them to explain the charts to you,” advises Sothern, adding that your pediatrician or family doctor is the only one who can diagnose obesity. This is another reason to schedule an annual well-child checkup.

Parents As Role Models

As a parent, your own eating and physical activity habits scream much louder than your words.

“Parents don’t have to be Ken and Barbie or at the perfect weight, but their behaviors are highly predictive of what their kids will do. If parents have unhealthy eating habits and don’t exercise, the kids likely will, too. You have to model healthy behaviors for your kids,” says Sothern.

Nagging kids about their food choices only draws attention to negative behavior. Instead, praise them when they make healthy food choices and are physically active.

Focus on food for nutrition and never use food as a reward. Don’t over-emphasize weight alone or put negative connotations on food.

“Research shows that moms who are overly concerned about their own weight and their child’s weight increase the risk for eating disorders, such as binge eating or bulimia, in their children,” says Sothern.

“When a child develops obesity, this is a sign that the body’s metabolism is not healthy. Parents should not approach food from a calorie and weight standpoint only but discuss the benefits of being at a healthy weight. The focus should be on eating nutritious food and being physically active—not on weight.”

Sothern says with young children, you can refer to healthy food as “grow tall” foods. With adolescents, let them know that the right food choices can lead to better skin, more energy and clearer thinking.

Screen Time Overload

Researchers say that only 20 percent of children get more than two episodes of vigorous play per week, and 30 percent of those same kids watch more than two hours of television per day. (Don’t give in to your child’s or teen’s plea for a TV in his or her bedroom; the presence of a TV in the bedroom is a strong predictor of childhood obesity.)

It can be hard for parents to limit their kids’ screen time when they themselves spend too much time staring at a device. But restricting the time spent with any screen device (yes, this includes television) is crucial if children are going to learn healthy habits at an early age.

“The American Academy of Pediatrics (AAP) says that babies should not have ANY screen time (TV, smart phone, iPad, computer, etc.) until 18 months of age, except for video chatting with relatives, and, after that, no more than one hour a day until 5 years of age,” notes Sothern. After age 5, parents are encouraged to place consistent time limits on media, ensure that the media is high quality and does not take the place of adequate sleep, physical activity and other health behaviors.”

Limiting the use of media devices requires changes to the household environment and family routine. The good news is that a child with healthy family routines isn’t likely to develop obesity.

Rethinking Food Habits

Sothern points out that research has also linked sugary beverages to obesity in children. This includes any beverage with added sugar, from soda to fruit drinks. Pure fruit juice contains natural sugars and is allowed but not in excess and only if a child is not already overweight.

One 20-ounce soda can contain a whopping 16 teaspoons of sugar. At that rate, just one soda far exceeds the recommended amount of sugar kids should consume per day. The American Heart Association (AHA) guidelines for children up to age 8 advise no more than three to four teaspoons of added sugar daily and no more than five to eight teaspoons for older kids and teenagers.

It’s up to parents to improve their home’s “food atmosphere,” and although you can’t do it overnight, it is possible over time to make powerful changes for the entire family’s health. Sothern recommends working these tips into your daily routine:

Never use food as a reward or bribe.

Don’t label food as good or bad.

Drink water for thirst, not high sugar beverages or sports drinks.

Discourage eating in front of the TV or computer. (Parents, this includes you.)

Include kids in food preparation.

Sit down to dinner as a family—no media devices allowed!

Dish out appropriate portions (typically 1/2 cup of each food item) on each person’s plate in the kitchen rather than bring serving bowls to the table.

Discourage snacking after dinner so kids will be hungry for a healthy breakfast the next morning.

Limit fast food consumption to once a week or less.

Plant a garden, and let kids help grow their own food.

Involve kids in shopping for healthy food.

Encourage them to pick out a new fruit and vegetable to try.

Limit unhealthy snacks in the home.

Make healthy snacks (grapes, baby carrots, cucumber slices, string cheese, hummus, etc.) readily available.

Get Moving!

Sothern encourages parents to pay attention to their child’s opportunity to have physical activity. Unfortunately, some families live in neighborhoods where it’s not safe for kids to play at the park or ride bikes around the block.

“If your neighborhood’s not safe for play, then you need to make your home and backyard safe,” she notes.

“Outdoor play—a minimum of one hour per day—is essential and is linked to lower obesity rates and better grades,” says Sothern. “Exercise trains the metabolism and makes muscles calorie-burning machines. If muscles aren’t exercised, the body can’t properly process the calories taken in and the excess is stored in the stomach. Fat cells around the stomach area are full of inflammation, and this leads to heart disease, diabetes and even cancer later during adulthood.”

Make exercise a family activity. Walk together, ride bikes, make up silly dances, play tag and other games in the yard or visit the neighborhood pool. Let kids try different sports programs. And when you do watch TV, make it a habit to get up and stretch or dance during commercials.