In the United States, childhood obesity is a big concern — and it’s growing bigger.

Children are at a greater risk of being obese than ever before. A recent study found that lack of exercise, fast food, and number of hours spent watching television are all factors contributing to the epidemic.

However, Dr. Joseph Galati, author of “Eating Yourself Sick: How to Stop Obesity, Fatty Liver, and Diabetes from Killing You and Your Family,” suggests another element is partially to blame: parents.

The root problem, he tells Heathline, is that parents aren’t paying enough attention to what they feed their kids. Families aren’t eating enough home-cooked meals and parents aren’t serving healthy snacks.

Galati, a liver specialist in Houston, says parents need to step up and take responsibly. He also urges doctors to be more forceful with their assessments.

“Most physicians do not have the spine to tell the entire family, you’re all in trouble, you’re all going to die early,” he says.

Galati may have a point. But the American Academy of Pediatrics (AAP) counsels a gentler approach.

“Obesity is a medical diagnosis with real health consequences, so it is important for children and families to understand the current and future health risks,” a 2017 policy statement notes. “But the information should be given in a sensitive and supportive manner.”

“Guilt and blame don’t motivate long-term healthy changes, they just make people feel bad,” Texas pediatrician Stephen Pont, co-author of the AAP statement, says. He encourages children and families to make small changes as a family that stick and “keep it positive.”

It’s a way of life

Obesity is a risk factor of the current American lifestyle and that’s heavily reflected in the habits of our children.

American kids are less likely to bike or walk to school than ever before.

From ages 8 to 18, they also spend an average of 7.5 hours a day wrapped up in TV, computers, video games, cell phones, and movies. During those hours they tend to snack as well.

About 1 in 5 American children/teens cope with obesity, compared to about a third of adults.

Recently, obesity rates among young children seemed to be dropping, but a study in the journal Pediatrics in March, using 2016 data, reported that this wasn’t true.

In fact, severe obesity among children ages 2 to 5 has jumped since 2013.

Among 16 to 19 year olds, 41.5 percent live with obesity. More than 4 percent fall into the heaviest group, “class III.”

Some parents dismiss plumpness as “baby fat,” but kids tend not to shrink. In a study of almost 4,000 public school students, nearly all 10th-graders with obesity were above normal weight in 5th grade.

Instead, experts advise a more realistic approach. They suggest concerned parents use tools such as the Centers for Disease Control and Prevention’s calculator, which includes healthy standards for different ages and heights, to assess their child’s risk.

Frank Biro at the Cincinnati Children’s Hospital Medical Center offers this rule of thumb: if after the age of 1 a girl’s waist is more than 60 percent of her height, both measured in inches, she’s “at risk of having the metabolic complications of overweight.”

Recent research shows childhood obesity may become an even bigger health concern in the future.

According to projections in a 2017 study, close to 60 percent of today’s American children could be living with obesity by the time they’re 35.

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The risk to your child’s health

As a liver specialist, Galati tends to see adults with obesity who have been diagnosed with fatty liver disease. When those patients tell him they have children, he starts asking questions. Often, he finds that the kids of those patients are also heading into obese territory. That’s when Galati warns them that their kids are likely to die sooner than they would if they lost weight.

Much evidence backs up Galati’s claim that childhood obesity can shorten a person’s life, upping their chances of heart disease, stroke, liver disease, and cancer.

Modern medicine and a growing economy pushed U.S. life expectancy up rapidly for more than a century, but that increase began to slow when more Americans became overweight.

Research shows U.S. life expectancy at birth has actually dropped in the last two years.

The problem is worse in areas of the South and Midwest where more people are obese, notes David Ludwig, an endocrinologist and obesity specialist at Boston Children’s Hospital.

Ludwig, who is also author of the cookbook “Always Delicious,” argues that the “downward trend in longevity will almost certainly accelerate as the current generation of children — with higher body weights from earlier in life than ever before — reaches adulthood.”

Health problems we associate with middle age are showing up earlier. Galati has begun to see teenagers complaining of fatigue and nausea. Then their bloodwork shows they have a fatty liver.

Up to 40 percent of obese children have nonalcoholic fatty liver disease (NALD), which can progress to cirrhosis of the liver.

One group’s clinical guidelines recommend screening obese children for NALD between ages 9 and 11, and screening overweight children with prediabetes, a big belly, or sleep apnea. NALD seems linked to the size of your waistline as much as your overall weight.

Starting early

A mother’s responsibility for a child’s weight may begin as early as the womb. According to one large 2012 German study, expectant mothers who gain too much weight during pregnancy increase their child’s chances of being overweight by 28 percent before they turn 6 years old.

Minimizing antibiotics for babies and toddlers may help. Evidence in mice and children under 2 suggests that antibiotics can alter gut bacteria in an unhealthy way.

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Fighting the trends

How can you help your kids steer clear of this unhealthy trend?

Family dinner is a good start, according to much research.

In a study of 8,550 4-year-olds, findings showed that those who regularly ate dinner as a family — and also had limited screen-time and enough sleep — were 40 percent less likely to be obese.

Children who eat with their families also have better grades, family relationships, and overall health, Galati points out.

The American Academy of Pediatrics (AAP) advocates for “screen-free” zones in children’s bedrooms, no TV during dinner, and only one or two hours a day of TV or video games.

Tapping fingers on a keyboard or jiggling a mouse doesn’t count as exercise. The CDC suggests a target of doing at least an hour of physical activity a day, most of it aerobic, and muscle and bone-strengthening activities like skipping rope, gymnastics, and pushups at least three days a week.

Look into game-oriented activity and step trackers. You might also use point systems attached to rewards. For example, if your son is active for a half hour a day four or five nights a week, he might get to pick a family movie night. “It’s ideal if the reward is not an unhealthy food,” Pont says.

Stick to bedtimes and keep electronics away from bed. Fatigue leads to overeating and can prime the body for weight gain. Overweight children may need treatment for sleep apnea as well.

“When you do not sleep enough, your inflammatory markers go up, it raises blood pressure, insulin and cortisol,” Galati says.

When you eat out, you might talk about how portion sizes have grown bigger than in the past. Make it a rule to share entrees or have a child eat an appetizer as their main course. Turn down the bread basket, order salads, avoid rich sauces, and share or skip dessert.

But cooking food at home is the best way to control fat and sugar, Galati says. “When parents pick up the kid from an activity, they say, ‘I don’t have time to cook dinner, let’s go to the drive through, let’s go to Cheesecake Factory and take something home.’ So they’re consuming high-calorie, high-fat food three or four times a week,” Galati said. “Naysayers say to me you’re living in a fantasy world if you think parents are going to start cooking dinner again. I say, we have to get back to the basics.”

Galati argues that children like home-cooked healthful food. He recalls his mother serving soups and fruit salad to his friends growing up on Long Island. “The kids would come over looking for the cookies and chips,” but they’d love his mother’s food. “My mother would invariably get a phone call from the other kid’s mother asking for the recipe,” he said. “At her funeral, they were telling me they remembered what she made for them.”

Galati believes in teaching kids to think of food in two categories: “Earth food came from the ground or had a mother. Man food comes in a box or can.”

“It’s time parents start educating themselves and their children about food and start making better choices,” Galati says. “Otherwise the consequences will be a lot direr than what most parents probably realize.”

Pont, who is medical director of the Office of Science and Population Health for the Texas Department of State Health Services, urges doctors to avoid any kind of fat-shaming. A number of studies have documented “anti-fat bias” among medical professionals.

He points out that shame, guilt, and blame backfire.

A team at Johns Hopkins did a national survey of 600 higher-than-normal weight adults to test that thesis. The result: If your primary care doctor had talked to you about your weight and you felt judged, you were more likely to try to lose weight, but less likely to actually succeed. About 13.5 percent of those who felt judged in that conversation went on to lose at least 10 percent of their weight year. But among those who didn’t feel judged, a bigger group — more than 20 percent — reached that goal.

Pont, who struggled with his own weight as a boy, argues that parents should avoid judgment as well.

“Parents should be empathic and say that there’s no perfect shape or size,” he said.

The goal would be to slowly make healthy changes, rather than adopt an extreme diet that won’t last.

Parents can also set an example, improving their own eating habits. “If a parent does something then it is important; if a parent doesn’t do something then it means it is less important,” Pont says. “When parents lead the way and create a supportive environment for a child then they are all far more likely to be successful.”