Childhood obesity is an American epidemic, affecting almost 1 in 5 children and adolescents. And while it’s well understood that unhealthy diets and a lack of physical activity contribute greatly to the problem, more research suggests that poor sleep influences obesity in kids, as well.
“There are lots of studies showing that kids who are not getting enough sleep tend to have more problems with being overweight,” says Heather Schramm, MD, PhD, a pediatrician at Oak Hill Hospital in Brooksville, Florida. And generally, the less dozing children and adolescents do, the higher their chances of developing obesity.
That’s an issue, Dr. Schramm says, because, “as a whole, Americans are not doing a good job of getting kids enough sleep.” The problem begins when children are young and grows worse as they age. A 2015 report from the Centers for Disease Control and Prevention (CDC), for instance, estimated that about 6 of 10 middle schoolers and 7 of 10 high schoolers didn’t sleep sufficiently on school nights.
So, how are sleep and weight linked, exactly? What’s keeping kids from getting adequate ZZZs? And what can we do to improve their chances of a good night’s rest?
How poor sleep affects weight
First, it’s important to understand how obesity affects kids’ health. Among other problems, it’s linked to high blood pressure, type 2 diabetes, difficulty breathing, digestive conditions, and musculoskeletal issues. Mental health disorders like anxiety and depression are more likely in obese kids, as are low self-esteem and social struggles. Obese children are also likelier to become obese adults, with a potential for serious health conditions, like heart disease and cancer.
Though the exact ways sleep affects weight aren’t known, there are a number of theories. Metabolically speaking, some research in adults suggests a lack of sleep is linked to lower levels of leptin—a hormone that curbs your appetite—and higher levels of ghrelin, a hormone that fires up your appetite.
Bad sleep habits may affect children’s dietary behaviors, too. First, kids who stay up late simply have more time to chow down. Then, those lost hours of sleep can affect what they eat the next day. “Kids who are tired tend to eat more and tend to have poor food choices,” says Schramm. She adds that sleepy children may be moody, making them prone to emotional eating, as well.
And just as regular exercise can help you sleep, a lack of sleep can also influence physical activity. The American Academy of Pediatrics (AAP) recommends kids get at least 60 minutes of exercise each day. But, says Schramm, “If kids are tired and fatigued, they’re not out being active and exercising, so they’re not burning off what they’re eating.”
Why kids aren’t sleeping
For optimum health, kids should get generally more sleep than adults, and the younger they are, the more they need. The American Academy of Sleep Medicine and AAP recommend the following amount every 24 hours per age group:
- 1 to 2 years: 11 to 14 hours, including naptime
- 3 to 5 years: 10 to 13 hours, including naptime
- 6 to 12 years: 9 to 12 hours
- 13 to 18 years: 8 to 10 hours
“Unfortunately, kids, even from a young age, are not getting the recommended amount of sleep,” says Schramm. A 2018 meta-analysis in the journal Sleep found that, on average, kids across all age groups were getting less sleep than even the recommended lowest levels.
The reasons for lost sleep depend partly on age. For younger children, some of it is related to poor sleep training and resistance to bedtime. “Sometimes that gets reinforced by them being allowed to sleep with the parents,” notes Schramm. “We end up in these cycles of bedtime taking two hours.”
For older children and teenagers, lifestyle factors in. Caffeine in soda and coffee contributes to poor sleep, as do increasingly hectic schedules. “They tend to have more homework and more extracurricular activities,” says Schramm. This may cause adolescents to sleep in on weekends to make up for lost time, further disrupting their sleep schedules, she adds, “and it’s just a never-ending cycle.”
And a big-time, common sleep issue for all kids: screen time. Whether it’s watching TV in their bedroom or texting friends late into the evening, nighttime use of electronics is strongly correlated to problems dozing. “Even in the younger children, media is a huge problem,” says Schramm. The devices worsen sleep by interrupting kids’ internal clock and stifling the production of melatonin, a hormone that helps us nod off.
How to help kids sleep
While poor sleep habits are connected to increased odds of obesity, the drawbacks don’t stop there. They’re also associated with a higher risk of injuries and hypertension, along with poorer attention, memory, behavior, and mood—all of which affect school performance, as well as quality of life. So, what can you do to help make sure kids get a good night’s sleep?
- Remove electronics from the bedroom, especially at night. Ideally, children shouldn’t have a TV, smartphone, computer, or video game system in their room at all. Turn off all devices at least one hour before bedtime.
- Keep regular sleep schedules. To address inconsistencies and help kids fall asleep faster, prioritize standard bedtimes and wake-up times. Schramm says a routine can help settle kids down and signal it’s time to hit the sack: “I take my shower, I read a book, I say good night, and I go to bed.”
- Practice what you preach. “Kids are going to do what they see you do,” says Schramm. So, if you stay up late watching TV or zoning out on social media, don’t be surprised if they mimic your behavior. Modeling good sleep habits sets a standard your children can follow for life.
- Get them outside and moving. It’s true, lots of exercise and fresh air helps kids get their ZZZs. It doesn’t have to be organized sports or a complicated, planned event, either. Just riding bikes and playing with friends around the neighborhood will do the trick.
Schools can help, too, by instituting start times later on in the morning for middle and high school students, whose sleep cycles shift after puberty. Organizations like the AAP and the American Medical Association recommend that districts kick classes back to 8:30 a.m. or later. This way, they mesh better with adolescents’ natural biological wake-up times and help them avoid sleep deprivation.
Ultimately, teaching kids healthy behaviors while they’re young provides a strong foundation for good health later on. And it can all start with a good night’s sleep.
Sourcing: CDC, Harvard Medical School, Nemours, National Sleep Foundation, American Academy of Pediatrics, National Institutes of Health
In June 2013, the American Medical Association declared obesity—defined as having a body mass index (BMI) of 30 or higher—as a disease requiring multiple interventions for treatment and prevention. These can include behavioral modifications, medications and possibly surgery.
The numbers are jarring. According to statistics from the Centers for Disease Control and Prevention, more than one-third (36.5 percent) of US adults are obese, with more middle-aged (40.2 percent) and older adults (37 percent) being affected compared to younger adults (32.3 percent). On a global level, the World Health Organization states that obesity has more than doubled since 1980.
People who are obese have a higher risk of numerous conditions, such as:
- Diabetes
- Stroke
- Cardiovascular issues, including high cholesterol, lower levels of HDL [good] cholesterol, high blood pressure and heart disease
- Multiple types of cancer, including that of the colon, rectum, endometrium, kidney, pancreas and gallbladder—as well as breast cancer in women who have been through menopause
You probably know that overeating and a lack of physical activity contribute to obesity—but there are other risk factors that may not be as apparent.
POOR SLEEP
Obesity is connected to inadequate slumber. One review of sleep studies published in The American Journal of Human Biology detailed the links between inadequate sleep (defined as less than six hours) and increased BMI. Researchers found that a lack of shut-eye disrupted two hormones: ghrelin, which increases appetite, and leptin, which signals you’re full. This disruption may lead you to eat more than you normally would, contributing to weight problems.
STRESS
While everyone gets anxious at times, ongoing mental and physiologic stress can cause the number on the scale to move in the wrong direction. A 2017 study published in the journal Obesity showed that chronic stress can lead to elevated levels of cortisol, a hormone that affects metabolism and helps the body manage stress. After taking a strand of hair that represented two months of hair growth from 2,527 adults aged 54 and older, scientists found that the volunteers with higher cortisol levels were also more likely to have a larger waist circumference, a higher weight and a higher BMI.
YOUR VIEWING HABITS
Medical researchers from Harvard first reported on the link between TV watching and obesity in children in the mid-1980’s. Over the years, they have found that the more television shows viewed by an adult, the higher the likelihood of obesity. The results from one investigation showed that for every two hours of daily TV watching, women had a 23 percent increased risk of becoming obese, as well as 14 percent higher risk of developing diabetes.
HEREDITY, BUT MAYBE NOT HOW YOU THINK
Genetics factors into obesity, though it’s debated just how much of a role it plays. We do know that people with at least one obese parent are more likely to be obese themselves, though this can be due to a combination of heredity and family behaviors—you learn a lot of weight-related habits from your loved ones.
Genes themselves, however, are thought to affect how you store fat and process calories, as well as how and what you choose to eat. For example, a 2012 study published in the American Journal of Clinical Nutrition reported that people with certain variations of the genes dubbed “obesity genes” may be inclined to eat an excessive amount of calories and opt for foods high in sugar and fat. These include FTO, or fat mass and obesity gene, and BDNF, or brain-derived neurotrophic factor gene. However, the study also pointed out that making a conscious effort to consume smaller portions of healthier foods can minimize this risk.
EARLY LIFE FACTORS
Your likelihood of becoming obese may have started in infancy—or even in the womb. Various studies have connected each of the following circumstances to a higher risk of obesity:
- A mother’s excessive weight gain during pregnancy
- A mother’s high blood sugar levels or high blood pressure while pregnant
- A mother who smokes when she’s pregnant
- High birth weight
- Rapid weight gain during infancy
- Poor sleep patterns
- Being bottle fed
WHERE YOU LIVE
We’ve all been there: You head to dinner with friends thinking you’re going to order a healthy entree. After your pals have placed their orders, you ask for the mile-high hamburger, too. It’s well-known that your family and friends can influence your healthy (or unhealthy) habits, but a recent study suggests the place you call home may have the same effect.
Results from a 2018 study of 1,519 military families stationed at 38 areas across the United States suggest where you reside may contribute to your obesity risk. Families who lived in areas with a higher prevalence of obesity were more likely to have a higher body mass index (BMI) and a greater likelihood of being overweight or obese. The longer you live in an area, the study suggests, the more you’ll resemble the local crowd.
Alternately, areas with lower rates of obesity may help lower a person’s risk for a high BMI and obesity.
WHAT YOU CAN DO
As for the promising news, there are some surprising—but proven—strategies to help you combat obesity.
- Get cooking. Avoiding added sugars and eating a balanced diet packed with fruits, vegetables, lean meats and whole grains are proven to help keep obesity in check. And cooking at home can help. One 2017 study from The Ohio State University stated that adults who eat home-cooked meals—and dine without watching TV—are less likely to be obese.
- Stand up. Regular physical activity has been shown to help combat extra pounds—and simply getting on your feet could be a good start. The American Cancer Society reported in 2015 that people who stand for at least one-quarter of each day are less likely to be obese.
- Stop, ponder and jot. A small 2015 mental health survey found that only 1 in 10 people believed psychological wellbeing played a role in weight loss. But experts say that identifying your emotional attachment to food—which can be done by journaling your food intake, cravings and mood—may help alleviate stress and anxiety, and in turn, reduce the number on the scale.
Sourcing: CDC, World Health Organization, American Cancer Society, Harvard Medical School, National Institutes of Health, Ohio State University
Getting regular mammograms, which are x-rays that check for any changes in breast tissue, is the key to early detection of breast cancer. But many women are confused by their mammogram results, especially when it comes to dense breast tissue.
One small 2018 study published in Patient Education & Counseling found that of 30 women who received notification that they had dense breast tissue, 81 percent of them recalled receiving the result, but didn’t understand what it meant. And, many of these women interpreted the results in ways that were much different than the medical explanation.
However, dense breast tissue is very common. In fact, half of women 40 and over who get mammograms have dense breasts. But how does it actually affect your health?
To put your mind at ease, here’s some information about dense breast tissue and how it relates to cancer.
What is dense breast tissue?
Breasts are made up of fibrous tissue, which impacts the size and shape of your breast and glandular tissue that produces milk. They also contain fatty connective tissue, as well as ducts that carry milk to the nipple. If breasts have more fibrous and glandular tissue than fat, they may be considered dense.
It’s important to know that there are many factors that contribute to your breast density, including, but not limited to, age, menopausal status, genetics, hormone use, menstrual cycle, chemotherapy treatments and body disposition.
How will you know if you have dense breast tissue?
Your breast density can only be seen through a mammogram. Dense breast notifications (DBN), or notifications provided by a radiologist or doctor after a mammogram if dense breast tissue is detected, aren’t provided in every state. However, many states in the US (34 to be exact, as of June 2018) require that women who have mammograms be notified in some way about breast density or their own breast density.
Many states also require that insurance cover any additional imaging tests like ultrasounds for women with dense breasts.
There are various density categories, according to the American College of Radiology, and they are classified into these four groups in the Breast Imaging Reporting and Data System (BI-RADS), or breast cancer and density risk results from your mammogram:
- A: Breasts are almost all fatty tissue, occurs in 10 percent of women
- B: Breasts have dispersed areas of dense glandular and fibrous tissue, occurs in 40 percent of women
- C: Breasts are mostly dense glandular and fibrous tissue, which can interfere with the detection of small tumors, occurs in 40 percent of women
- D: Breasts are very dense, which makes tumor detection within the tissue hard to spot, occurs in 10 percent of women
Your breasts are classified as dense if you have a C or D diagnosis.
If you live in one of the states that requires breast density information to be shared with patients, your mammogram report will also include BI-RADS results on cancer risk and density. Most breast density reports will use the A to D labeling system above. The language used in reports is required by law, and according to the American Cancer Society, usually reads something like this:
“Your mammogram shows that your breast tissue is dense. Dense breast tissue is common and is not abnormal. However, dense breast tissue can make it harder to evaluate the results of your mammogram and may also be associated with an increased risk of breast cancer. This information about the results of your mammogram is given to you so you will be informed when you talk with your doctor. Together, you can decide which screening options are right for you. A report of your results was sent to your primary physician.”
How do dense breasts affect your mammogram results?
Regardless of the state you live in or your breast density, your radiologist will compile your mammogram results using the BI-RADS. This report classifies your breast cancer risk into the following categories:
0: Additional information is needed
1: Negative
2: Benign
3: Probably benign
4: Suspicious abnormality
5: Highlight suggestive malignancy
6: Biopsy-proven malignancy
Dense breast tissue is very common, and although research shows that dense breast tissue may be linked to a slightly higher risk of breast cancer, the reason is not completely understood. One June 2018 Norwegian study, published in Radiology, found that mammograms detected 6.7 cancers per 1000 exams for women with dense breasts and 5.5 per 1000 for those with non-dense breasts. The study also revealed that of the 107,949 women involved, those with dense breasts were more likely to need further testing because of suspicious mammogram findings, and they were also more likely to have larger tumors when cancer was actually found.
Because breast tissue looks white, as do masses and tumors, it’s possible that dense breast tissue can prevent radiologists from detecting cancer during mammograms. As a result, your mammogram may not be as accurate as it would be if you had more fatty tissue.
Are there any steps you can take if you have dense breast tissue?
Many women understandably become stressed and anxious when they learn they have dense breast tissue, but the diagnosis doesn’t always mean you should be concerned.
While dense breast tissue is an individual risk factor for cancer, it’s not associated with a higher risk of dying from breast cancer when compared to women with breast cancer and fatty tissue.
If you have dense breast tissue, the most important thing to know is that you should talk with your doctor. He or she can discuss what breast density really means, how your dense breast tissue affects your breast cancer risk specifically and whether or not other screening options like ultrasounds or magnetic resonance imaging tests are necessary in your situation.
Sourcing: American Cancer Society, National Cancer Institute, UptoDate