Caring for those in Need

Reasons for the Rise in Childhood Obesity

For a variety of reasons, children and adults with special needs are more likely to be overweight or obese than their neurotypical counterparts. This commentary is intended to inform families on the extent of the obesity problem for children and adults, its causes, possible solutions and the risks it poses to children’s health and wellbeing if not addressed.

BY Mary Pittaway, MA, RDN | February 2022 | Category: Diet & Nutrition

Reasons for the Rise in Childhood Obesity

When parents and caregivers are empowered with obesity prevention tools, resources, and solutions, they are better equipped to help their children to become and stay fit and healthy. In this article, you’ll find tips on how to monitor your child’s weight using a tool that reveals the impact their current weight has on their overall health. This includes suggestions on home environment changes that can have a significant impact on the weight and health of your family members, including your child with special needs.

  • The increasing trend in obesity prevalence since the early 1980s poses a significant population health burden throughout the world. Many, if not most children with special needs face multiple challenges when it comes to maintaining a healthy weight. According to the Centers for Disease Control and Prevention (CDC), 20% of children 10 through 17 years of age who have special healthcare needs are obese compared with 15% of children of the same ages without special healthcare needs. Children and adults with mobility limitations and intellectual or learning disabilities are at greatest risk for obesity.
  • As a parent, it’s important to recognize the impact a healthy food and activity environment in your home will have for your whole family, and especially for your child. We have learned more about the unique risks that obesity presents to our children and realize how essential it is to address the causes to alter the trajectory to certain chronic diseases associated with obesity.
  • The set up for lifelong nutrition and activity habits begins in our homes. The answers will be found by parents who seek to find what works for themselves and their family. Thirteen percent of U.S. families have a child with a disability, yet children with disabilities are seldom included in the discussions about solutions. We know what a challenge it is for parents to help their children maintain a healthy weight. How can parents ensure their family makes healthy food choices and adequate opportunities for physical activity to replace sedentary pursuits? How can families create opportunities for more routine movement that’s fun, affordable and safe?

People with disabilities can find it more difficult to eat healthy, control their weight and be physically active. This might be due to:

  • A lack of healthy and affordable food choices and the over abundance of low-cost nutrient poor foods, that are high in fat, sugar, and salt.
  • Physical and mobility limitations that can reduce a person’s ability to exercise.
  • A lack of resources and social support from family, friends, neighbors, and community members.
  • A lack of accessible environments, for example, sidewalks, parks, and programs that support healthy nutrition and exercise.
  • Difficulty with chewing or swallowing food, or its taste or texture.
  • Medications that can contribute to weight gain, weight loss, and changes in appetite.
  • A lack of energy and/or pain.
  • And for some, genetics.

Obesity affects different people in different ways and increases the risk for other health conditions among people with and without disabilities. We know that there continue to be fewer chances for physical activity, because sedentary hobbies are more prevalent than ever.

So, what influence do parents play? Although research shows a link between parent and child weight, not all children of overweight parents are overweight themselves. The child inherits its genetic makeup, but parents also influence through parenting skills. In fact, parents may be able to protect their children from the impact of larger, environmental factors on whether a child becomes overweight.

Recent reports show that over 39% of adults in the world are overweight or obese and for many, problems with weight began as children and continue as they age. We have several tools to use to interpret a child or adult’s weight, including BMI, waist circumference, waist-to-hip ratio and DXA, a low dose x-ray process that measures body fat, including visceral fat that grows around organs.

A new tool, the waist-to-height ratio (WHtR) has been introduced, to help parents monitor theirs and their children’s waist size compared to height, and the risk of several chronic diseases represented in health disparities of children and adults with disabilities. Some of these non-communicable diseases are linked to and can be predicted by looking at person’s waist size compared to their height. These include diabetes, hypertension, heart disease, non-alcoholic fatty liver disease and even cognition problems like early onset dementia. The WHtR most accurately predicts both the percent of body fat, and visceral adipose tissue.

Visceral fat collects around organs, including the heart, liver, pancreas, arteries, and intestines and it is dangerous. It stimulates the release of proteins and hormones that cause inflammation which can damage tissue and impair organ function. For example, when it collects around and in the pancreas, the cells which store and release insulin so sugar can get to your cells are damaged, and it impairs how the body breaks down sugars.

Some people may have a “healthy” BMI of less than 25, but may not be fit, because BMI does not account for muscle mass. Some people with a BMI over 25 can be fit and healthy. The truth about a person’s risk of chronic disease is more accurately determined by their WHtR than their BMI. Studies show that central obesity or belly fat, is associated with higher mortality rates, even in individuals with normal BMI scores.

What is a healthy waist size for children? The answer depends on their height! Their waist should be no more than half their height. This is for both boys and girls, all ethnic groups and ages. And as luck would have it, it works the same for adults as well!

How to measure the waist: Measure waist and height accurately, because even small errors can cause the ratio to be inaccurate. When measuring waist and height, if possible, bring all family members into the activity. No need to “call anyone out” if their ratio is above .5. The measurement is appropriate for ages two and older. The beauty of starting to look at WHtR with younger children is that as they grow taller, if waist size remains, their ratio goes down.

  • Wrap a flexible tape measure around the waist slightly above the navel. Keep the tape measure level with the floor, exhale, and measure.
  • The height measurement: Remove shoes, stand straight with three points of contact including back of head, heels and seat touching the wall. Put a box or book (right angle), on person’s head and where item touches top of the head, mark the wall.
  • Divide the height in inches by the waist in inches. For example, if a person is 48 inches tall and his waist is 27 inches, 27 divided by 48 gives a ratio of .56. Ideally his waist will be 24 inches.

Excessive abdominal fat or a WHtR over .5 is linked with higher risk for type 2 diabetes, elevated cholesterol or triglycerides, high blood pressure, coronary artery disease and other health conditions.

If a person’s WHtR is higher than .5, take heart! Being physically active, eating well, and watching portion sizes can positively impact waist size and overall health. Discuss your or your child’s health risks and goals with your doctor.

Studies show that parents who engage in healthier eating and activity habits are more likely to have children who mimic these behaviors as they grow into adulthood. So, to get our children to develop healthier eating and activity behaviors, parents must first engage in these behaviors themselves.

When the balance of food intake and physical activity is disrupted, children gain excess weight and once children become overweight, their ability to self-regulate food intake may be altered and additional regulation or monitoring of food selection and quantities eaten may be needed.

Parents can shape their child’s food preferences and eating behaviors by making sure healthier options are readily available. For example, remove chips, cookies and candy from the cupboards and have fresh fruit or cut up vegetable sticks readily available and visible so that when children are hungry for a snack, their only option is a healthy one. The same process works to decrease sedentary time. 

Scaling Down:  Healthy Weight Strategies

Here are some great resources for parents interested in looking at healthy weight strategies for their children with special needs. 

Ability Path

Finding Balance Obesity and Children with Special Needs

An online resource and social community for parents and

professionals serving the needs of adults and children with disabilities. 

Special Olympics

How to measure your own waist and height 

BIOED: Baylor College of Medicine

Make body measurements fun for yourself and your children 


Fun Body Measurements with a piece of string 

A Healthy Approach:  Adult Waist to Height Ratio Resources and Readings

NIH National Library of Medicine

Waist-to-height ratio is more predictive of years of life lost than body mass index 

Waist-to-height ratio is a better screening tool than waist circumference and BMI for adult cardiometabolic risk factors: systematic review and meta-analysis 

A systematic review of waist-to-height ratio as a screening tool for the prediction of cardiovascular disease and diabetes: 0·5 could be a suitable global boundary value 

Center on Technology and Disability

A proposal for a primary screening tool: Keep your waist circumference to less than half your height 

Ashwell Associates

The Ashwell Shape Chart 

National Deaf Center

Evaluation of the impact of abdominal obesity on glucose and lipid metabolism disorders in adults with Down syndrome 

Establishing Habits:  Pediatric Waist to Height Ratio Resources and Readings 

NIH National Library of Medicine

Waist-to-height ratio as a risk marker for metabolic syndrome in childhood. A meta-analysis 

Body mass index classification misses to identify children with an elevated waist-to-height ratio at 5 years of age 

An exploratory study of the association between physical activity, cardiovascular fitness and body size in children with Down syndrome 

National Center for Biotechnology Information

Waist-to-height ratio index or the prediction of overweight in children 

American Academy of Pediatrics

Recent Trends in Waist Circumference and Waist-Height Ratio Among US Children and Adolescents 

Cardiometabolic Risk and Body Composition in Youth With Down Syndrome 

Springer Nature

Screening using Body Mass Index alone may miss every second preschooler with excess abdominal fat 

Sage Journals

Are there anthropometric and body composition differences between children with autism spectrum disorder and children with typical development? 

Studies show that children with a TV in their bedroom spend an extra 1.5 hours per day watching TV than children who don’t. Removing the TV from the bedroom reduces screen time and frees up time for more physical activity. Parents who are physically active and who include their children in these activities, can inspire a love of physical activity, games, being outdoors and play with others. Involving your child in Special Olympics can provide ample physical activity and healthy nutrition opportunities. And by adjusting the home environment, parents can shape their child’s behaviors, reduce temptations, and create a health-inducing space where good habits are formed for life.

However, certain behaviors can create negative effects. Encouraging children to clean their plate, whether they are hungry or full, teaches them to ignore their internal satiety cues leading to overeating and loss of self-regulatory ability regarding food intake. Prompting or encouraging children to eat may result in increased eating time and caloric intake. Allowing children to internally regulate their intake and stop eating when they are full may be beneficial. Once children become overweight, their ability to self-regulate intake may be altered and additional regulation or monitoring of how much and what they eat may be necessary.

Equally detrimental is criticizing a child’s weight, body shape and food choices. Afterall, when the environment supports health, and when parents and siblings practice healthy behaviors, everyone benefits. Instead of commenting, it’s far better to role model health food and activity choices and stock your kitchen with healthy foods and beverages, making the healthy choice the easiest choice for everyone in your family. 


Mary Pittaway has worked in public health nutrition for over 40 years. As a public health nutritionist, she’s managed senior nutrition programs, WIC, community gardens, vitamin D, osteoporosis prevention, breastfeeding education for health care providers, obesity and diabetes prevention and nutrition programs for people with intellectual and developmental disabilities. She serves as a Global Clinical Advisor for Health Promotion with Special Olympics International and teaches nutrition at the University of Montana. She can be reached at 

Read the article here.