Factors of Childhood Obesity: A Q&A through a HAES lens with Keeley Seymour, LCSW, CEDS-C, PMH-C

Childhood “obesity” is a growing concern that affects millions of families worldwide. With its complex interplay of genetic, environmental, and behavioral factors, understanding childhood obesity can be challenging for parents and caregivers. In this Q&A blog, we aim to address common questions about the causes, consequences, and prevention of childhood obesity.

1.     What factors contribute to Childhood obesity?

Childhood “obesity” is a complex issue influenced by various factors. While our society tends to blame the individual, we should look at childhood “obesity” systematically.  (“Obesity” in quotes as there are some challenges with the use of the word “obesity”). Some contributing factors:

1. Genetics: Genetic factors can influence a child’s susceptibility to “obesity,” affecting metabolism, appetite regulation, and how the body stores fat.
2. Environment and Food Insecurity: The availability and accessibility of food options and safe places for physical activity play a crucial role. Living in a “food desert” with limited access to fresh produce or a neighborhood without safe spaces for exercise can be problematic.
3. Lack of Proper Nutrition Education: Many areas lack proper nutrition education, focusing on “all foods fit” and including various foods instead of solely focusing on caloric intake. Labeling foods as “good” and “bad” tends to encourage a restrictive approach, which often leads to bingeing later. 
4. Socioeconomic Status: Families with lower socioeconomic status may face challenges such as limited access to a variety of food, lack of recreational opportunities, and higher stress levels, all of which can contribute to “obesity”.
5. Psychological Factors: Emotional stress, trauma, and mental health issues can often lead to overeating.  Emotional stress also impacts hormones and, in turn, metabolism, which affects how the body processes food.  
6. Marketing and Media: Exposure to unhealthy food and drink advertisements can influence children’s food choices and preferences.

While diet and exercise can assist in treating the issue, when a child faces all the above challenges, it is challenging for them to make changes.  We need to start looking at childhood “obesity” as a multifaceted societal issue instead of an individual issue.  At Evolve, we believe in a HAES (Health at Every Size) approach that considers the individual as a whole, not solely their weight or BMI.

2.     How does depression affect those suffering from childhood obesity?

Depression can have a significant impact on children suffering from “obesity,” influencing both the psychological and physical aspects of their well-being.  Depression can lead to changes in eating patterns, such as emotional eating or binge eating.  If a child has experienced trauma, often there is dissociation when eating where they are not connected to their body and struggle to honor hunger/fullness cues.

Depression can lead to elevated stress levels, which in turn can affect the body’s cortisol levels. High cortisol levels are associated with increased appetite and weight gain, and impact hormones and metabolism. Depression often disrupts sleep patterns, and poor sleep can impact weight and hunger hormones and lead to increased appetite.

3.     What role does trauma in and outside of the household play in childhood obesity?

Trauma plays a significant role, if not one of the most pervasive, in childhood “obesity.”  Children who score higher on the ACES (Adverse Childhood Experiences Scale) tend to have an increase in maladaptive coping skills such as substance use, eating issues, and mental health issues.

Children who experience trauma may turn to food as a way to cope with stress, anxiety, or emotional pain.  One symptom of childhood trauma is dissociation, a mental process that can occur in people with trauma when the mind can’t fully integrate aspects of identity, memory, and consciousness due to trauma. This can lead to a feeling of disconnection from oneself, and the environment can feel like an out-of-body experience and can also lead to overeating.  

Trauma can activate the body’s stress response system, leading to elevated cortisol levels, a hormone that can increase appetite and cravings for high-calorie foods.  Chronic stress from trauma can also affect metabolism, potentially leading to weight gain.

Trauma can be associated with economic hardship, which may limit access to healthy food options and safe recreational areas. Financial stress can also affect a family’s ability to prioritize and maintain consistent lifestyle practices.

Living in a household where there is trauma, such as domestic violence or substance abuse, can create a stressful environment that impacts a child’s eating behaviors and physical health.  If a child is consistently living in a “fight or flight response,” it would be extremely challenging to focus appropriately on connection to one’s body, maintaining structure in one’s lifestyle, and being aware of hunger/fullness cues.

4.     What is a food desert, and how does it affect childhood obesity?

A food desert is a geographic area where residents have limited access to affordable and nutritious food. This typically means that fresh fruits, vegetables, and other healthy food options are scarce or unavailable, often due to a lack of nearby grocery stores or supermarkets that offer these products.  

In these areas, residents often rely on convenience stores or fast-food restaurants, which usually offer a limited variety of foods. Restricted access to reliable transportation can also make it difficult for families to travel to stores that sell large quantities of food, further limiting their options.

Children in food deserts often have limited access to fresh fruits and vegetables, essential for a balanced diet. Deficiencies in important vitamins and nutrients can also impact physical health. 

5.     How can you prevent childhood obesity? 

Preventing childhood “obesity” involves a comprehensive approach that addresses various societal factors influencing a child’s health and lifestyle. Focusing heavily on the individual’s diet and exercise beyond primary education can harm the child. Weight stigma can provide barriers to treatment and also be internalized, resulting in shame.

We must advocate for policies that promote access to healthy foods, safe recreational areas, and quality healthcare, including mental healthcare.  We need more community programs focused on balanced living, such as nutrition workshops and community gardens.  Better access to mental healthcare is essential. 

Quality clinical providers often are not in-network with insurance due to low reimbursement rates from managed care companies.  In-network providers usually do not accept new clients, or there are long wait times to be treated. We need to focus on improving our systems to connect children with providers that will address childhood trauma. 

6. Why should we refrain from using the word “obesity”?

The term “obesity” is often a point of controversy for several reasons, reflecting broader debates about health, language, and societal attitudes.  The term “obesity” can carry negative connotations and contribute to stigma. People who are labeled as “obese” may face social discrimination, bullying, and bias, which can impact their mental health and access to care. The term can sometimes blame individuals for their condition rather than considering broader systemic and genetic factors.

“Obesity” is commonly defined using Body Mass Index (BMI), a calculation based on height and weight.  BMI is a limited measure that doesn’t account for factors like muscle mass, bone density, and overall body composition, potentially leading to misclassification.

Focusing on weight, as indicated by the term “obesity,” may overshadow a more holistic approach to health. Health should be evaluated based on various factors, including physical activity, diet quality, and overall well-being, rather than just weight.

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