Although Dr. Christy Boling Turer’s elementary school-age son’s weight nudged into the overweight range, his pediatrician didn’t mention it. Dr. Turer, a pediatrician herself who also specializes in weight management, asked to review her son’s growth chart.

“The challenge is that children don’t look overweight when they’re younger,” explained Dr. Turer, Assistant Professor of Pediatrics at UT Southwestern. “Adding to the problem is the prevailing belief that these children are just going to grow out of it.”

Most children with obesity will not grow out of it, according to studies that track childhood obesity. A 2017 report in the New England Journal of Medicine projected that almost 75 percent of toddlers identified with obesity at age 2 will continue to have obesity at age 35. The same study estimated that more than half – 57 percent – of today’s children will have obesity when they hit 35.

That could have devastating effects on public health – and health costs.

Health issues such as heart disease and Type 2 diabetes are expected to rise as obesity levels spike. And with more people developing obesity in childhood, those diseases will likely strike at younger ages, said Dr. Sarah Barlow, Professor of Pediatrics, who in 1998 wrote the first recommendations for preventing and treating childhood obesity for the U.S. Department of Health and Human Services’ Maternal and Child Health Bureau. 

Dr. Ian Neeland, a cardiologist and Assistant Professor of Internal Medicine, said he already sees patients in their 20s and 30s hospitalized for diabetes and heart failure. “People who weren’t obese in childhood tend to present in middle age with these complications instead,” he said.

Compared with a decade ago, Dr. Neeland said about twice as many of the adult patients he cares for now have had obesity since they were children. Even more worrisome, a growing number have severe obesity, which magnifies the health risks, he said.

Cancer specialists are concerned as well. “Obesity increases the risk of developing several cancers and is an especially significant risk factor for endometrial cancer in women,” said Dr. David Miller, a gynecologic oncology specialist and Professor of Obstetrics and Gynecology. “Obese and overweight women are two to four times as likely as normal-weight women to develop endometrial cancer, and extremely obese women are seven times as likely.”

Obesity also doubles the risk for liver and kidney cancer, according to the National Cancer Institute.

“The increase in cancer risk is likely related to increased levels of inflammation for some cancers and/or to changes in hormone levels for other cancers,” said Dr. Carlos L. Arteaga, Director of the Harold C. Simmons Comprehensive Cancer Center. “Whatever the mechanism, with childhood obesity becoming commonplace, we could expect the incidence of several types of cancer to rise in the coming years.”

Childhood obesity is defined as having a BMI (body mass index) at or above the 95^th percentile for children of the same age and sex, based on the Centers for Disease Control and Prevention’s (CDC) growth chart.

For adults, obesity means having a BMI of 30 or more – equivalent to 174 pounds or more for a 5-foot-4-inch woman, 203 pounds or greater for a 5-foot-9-inch man.

Already, more than 18 percent of U.S. children ages 2 to 19 are classified as having obesity, according to a study published earlier this year in Pediatrics. Meanwhile, adult obesity now affects 37 percent in the U.S., according to the CDC.

In addition to raising the risk for Type 2 diabetes, heart disease, stroke, and some cancers, childhood obesity poses still yet other concerns.

Girls with obesity tend to enter puberty sooner, potentially opening the door for earlier pregnancies. Boys, on the other hand, may have delayed puberty and develop breast tissue as their levels of estrogen, a female hormone, rise with their body fat, said Dr. Olga Gupta, Assistant Professor of Pediatrics. Dr. Gupta is also Medical Director of the Center for Obesity and its Consequences in Health (COACH) clinic, established to treat Dallas children at risk of developing diabetes and other obesity-related illnesses.

Fatty liver disease, which can lead to cirrhosis and liver cancer, is another concern, particularly for Texas’ large Hispanic population, which has a genetic predisposition to it, she said. Asthma, bone fractures, and even flat feet are linked to obesity, Dr. Gupta said.

There are psychological effects as well. Children who appear overweight are often targeted for bullying and body shaming, and subsequently suffer from depression or stress.

Obesity rates have risen since the 1980s, both in children and adults. Only 5.5 percent of children had obesity in the CDC’s 1976-1980 survey. That’s less than a third of today’s rate. Researchers and public health advocates say a number of changes have combined to cause this spike.

Time-strapped families with both parents working eat at restaurants more frequently, where the offerings (particularly at “fast food” restaurants) are often fried and laden with added salt, sugar, and fat, said Dr. Lona Sandon, Assistant Professor of Clinical Nutrition at UT Southwestern.

A Department of Agriculture study looked at trends in U.S. food consumption between 1970 and 2005 and found Americans were consuming 31 percent more calories than they did before. Meanwhile, children are spending more time on electronics and less time exercising.

Now there are adolescents undergoing bariatric surgery to lose weight, and Australia recently reported a case of Type 2 diabetes in a 3-year-old child. We are also seeing obesity-related diseases in children that previously were seen only in adults, Dr. Turer said.

Researchers are finding that adults with obesity have a difficult time shedding the weight and keeping it off. A brew of hormones circulating in the body push to return the body to its earlier “set point” weight, said Dr. Gupta.

So, for adults, avoiding weight gain in the first place, or reining it in early, is clearly the best approach. “Once obesity happens, it’s hard to turn it around,” said Dr. Sandon.

However, for kids, dieting is especially problematic. Pediatricians are reluctant to put growing children on restricted calorie diets, Dr. Gupta said. And focusing too much on body weight can increase the chances of an eating disorder, particularly among girls, she said.

The problem is often passed from one generation to the next, either because of genetics or family eating habits and the examples being set. If the trend continues, most Americans could one day be diagnosed with obesity – with most of the rest considered overweight.

“It makes me worry who will be available to be on the police force, in the fire department, or the Army,” said Dr. Gupta.             

Still, change is not impossible.

After Dr. Turer realized her son’s BMI was in the unhealthy range, she and her husband enrolled him in karate, got him to bed earlier, focused on healthier family meals with whole fruit for dessert, and changed their own habits. The boy is now at a healthy weight.

Dr. Turer recommends that parents ask their child’s pediatrician to show them the growth chart. If the child is 2 years or older, a healthy BMI percentile is less than the 85^th percentile BMI. She also recommends that if your child’s BMI is at or above the 85^th percentile for age and sex, ask if the child’s blood pressure is healthy and whether levels of cholesterol or other heart health markers should be checked.

Understanding the health of their child’s weight now, she said, “can empower families to make lifestyle changes that ensure their child has a healthy tomorrow.”