Is Childhood Obesity Really a Big Problem?
“I Didn’t Even Know That Was a Specialty…”
I was out to dinner recently with a new group of friends and a very familiar conversation began.
“Oh — you’re a pediatrician?”
“Yes. I specialize in pediatric obesity medicine or weight management.”
Pause.
“I didn’t even know that was a specialty.”
Followed quickly by:
“Is it really that big of a problem?”
“And aren’t the parents usually to blame and overweight too?”
These are fair questions. And they reflect how misunderstood childhood obesity still is.
Let’s talk about it.
Yes — Pediatric Obesity Medicine Is a Real Specialty
Pediatric Obesity Medicine is a real specialty within the field of pediatrics. Physicians in this field complete additional training focused specifically on:
The biology of weight regulation
Growth and development
Nutrition science
Physical activity physiology
Behavioral health
Obesity medications
Obesity-related medical complications
In children, obesity is defined using growth charts that take height, age, and sex into account. We also use body composition tools to better understand the proportion of lean tissue and adipose (fat) tissue, because weight alone does not tell the full story.
This is not about appearance.
It is about health.
Is Childhood Obesity Really a Big Problem?
Yes.
Childhood obesity is common, and it is increasing in severity. Nearly 1 in 5 children and adolescents ages 2 - 19 have obesity. Severe obesity affects approximately 1 in 14 youth. These rates have increased substantially over the past several decades, and the rise in severe obesity is particularly concerning given its strong association with early cardiometabolic disease.
More importantly, we are now seeing medical conditions in children that used to be considered “adult diseases,” including:
Prediabetes and type 2 diabetes
Liver disease
High blood pressure
Abnormal cholesterol
Sleep apnea
And beyond physical health, obesity significantly affects mental health. Many children struggle with:
Low self-esteem
Social isolation
Bullying
Anxiety
Depression
When people ask whether this is “really that big of a problem,” I often explain that we are not just talking about weight.
We are talking about long-term health trajectories.
“Isn’t It Just What the Family Eats?”
Another frequent question:
“How often are the parents also obese? Aren’t they all just eating the same bad stuff?”
This question reflects a common misconception.
Yes, family patterns matter. Environment matters. Food access matters.
But obesity is not simply a matter of willpower or parenting.
Weight regulation is biologically driven. It is influenced by:
Genetics
Hormones that regulate hunger and fullness
Brain signaling pathways
Sleep
Stress
Medications
Neurodevelopmental conditions such as ADHD and autism
Socioeconomic factors
Some children are biologically more vulnerable to weight gain than others — even within the same household.
Two siblings can eat the same meals, play the same sports, and have very different body compositions.
That is biology.
Should We Talk More About the Biology?
When we understand obesity as a chronic, biologically influenced medical condition — rather than a character flaw — we open the door to compassionate, evidence-based care.
I sometimes debate how much science to explain in casual conversations. But the truth is, the biological basis of obesity matters.
The brain defends a weight set point.
Hormones like leptin and ghrelin regulate appetite.
The brain’s reward pathways respond powerfully to certain foods.
For some children, these systems are dysregulated in ways that make weight gain easier and weight loss much harder — regardless of effort.
Understanding that shifts the conversation from judgment to support.
“Aren’t Teens Just Lazy?”
This is another comment I hear — sometimes said directly, sometimes implied:
“Teenagers just don’t want to exercise.”
“They’re on their phones all day.”
“They just aren’t motivated.”
I understand why it can look that way from the outside.
But what I see in my office tells a very different story.
Many adolescents with obesity are not lazy.
They are self-conscious.
They are uncomfortable in their bodies.
They are afraid of being judged.
Gym class can feel humiliating.
Sports teams can feel intimidating.
Even walking into a fitness center can feel overwhelming.
When a teen has experienced teasing — or even subtle comments about their body — movement stops feeling like something healthy and enjoyable. It starts feeling like exposure.
And when you feel exposed, you protect yourself.
Sometimes that protection looks like avoiding physical activity.
The Emotional Weight of Weight
Weight stigma is real — and it starts young.
Children and teens who live in larger bodies are more likely to experience:
Teasing
Social exclusion
Negative assumptions about their character
Being labeled as lazy or unmotivated
Over time, those messages can become internalized.
Instead of thinking, “My body has a medical condition,” they begin to think, “There is something wrong with me.”
That self-blame carries emotional weight.
And food can temporarily soothe that.
Highly palatable foods stimulate dopamine and other reward pathways in the brain. They can briefly reduce feelings of sadness, loneliness, boredom, or stress.
For a teen who feels judged or isolated, food may become one of the most accessible coping tools available.
Not because they lack discipline.
Not because they don’t care.
But because they are trying to regulate difficult emotions.
Why This Work Matters
I didn’t even know this was a specialty.
That’s something I still hear often.
Childhood obesity affects physical health, emotional well-being, and long-term outcomes. And children deserve medical care that takes all of that seriously — without shame, without blame, and without oversimplification.
This is why pediatric obesity medicine exists.
And this is why I do what I do.
As a board-certified pediatrician and obesity medicine specialist in St. Louis, I work with children, teens, and young adults to address the medical, emotional, and metabolic aspects of weight gain — without blame and without shame. If you are concerned about your child’s weight, risk of prediabetes, fatty liver, sleep apnea, or other obesity-related conditions, early evaluation can make a meaningful difference. Learn more about pediatric weight management services at Evora for Kids and schedule a free 15 minute consultation. Your child deserves support that is grounded in science — and centered in compassion.
