Treating and Preventing Childhood Obesity

 

Currently about 25% of children in the United States are overweight and another 11% are obese.  These figures are even more severe for children of some minorities.  For example, over 42% of Mexican-American males and over 40% of African-American females are overweight or obese, and as a whole, children of minorities tend to be more overweight than non-Hispanic or non African-American children.  Perhaps even more alarming is the fact that the number of obese children in the US has either doubled (children under five and aged 12-19) or tripled (ages 6-11) over the past 30 years.  This suggests that while genetic factors are one of the major causes of obesity, cultural and environmental factors are as or perhaps even more important than some of these innate conditions.  Of course, the positive side to this is that many environmental conditions may be modified or changed while genetic factors are much more intractable.

 

How do you know whether your child is overweight or obese? The conditions depend on age, gender, percentage of body fat and the child’s height/weight ratio.  A commonly used measure for both children and adults is called the Body-Mass Index or simply the BMI. BMI is the ratio of a person’s weight to the square of their height, and is a good indicator of body fat.  BMI is widely used to define overweight and obesity because it correlates well with more accurate measures of body fatness and is derived from commonly available data. In children, the BMI between the 85th and 95th percentile for age and sex is considered at risk of being overweight, and BMI at or above the 95th percentile is considered overweight or obese.  A simple to use BMI calculator for children is located here.

 

Being overweight is a risk factor in many physical diseases for both children and adults. These include type II diabetes, hypertension, osteoporosis, digestive and cardiovascular problems, asthma, sleep apnea and certain types of cancer. In addition, overweight children are often targets from teasing by their peers,  social isolation and other emotional consequences that may lead to a lower self-esteem, anxiety, depression, eating disorders or perhaps even substance abuse disorders. Fortunately, not all overweight children grow up to be overweight adults.  Although the results of studies vary widely, between 40 to 80 percent of overweight adolescents maintain this condition into adulthood.  However, the longer the child is overweight, the greater the chance that this will persist into adulthood and thus it is important to address eating behaviors at an early age. Currently, about two thirds of adults in the US are either overweight or obese (One third of adults are overweight and another third are obese) and this number is likely to rise to perhaps 90% over the next 30 years unless steps are taken to reduce it.

 

The cause of obesity in children as well as adults is multi-faceted and complicated.  As Americans in general have become wealthier over the last several decades, the concept of eating has changed from simply satiating one’s appetite to one of society’s major form of entertainment and celebration. At the same time, studies have shown that the size of food servings both at restaurants and in the home have dramatically increased, while overall physical activity has decreased. A good way to summarize this situation is that it is a bio-psycho-cultural process with many interacting conditions.  However, in the end, treating and preventing childhood (as well as adult) obesity involves modifying the inter-related functions of food intake, physical activity and metabolism.  Note that while exercise by itself is good thing and should be encouraged, it cannot be the sole intervention for treating obesity.  Consider that only one typical children’s meal at a fast food restaurant would require the child to engage in vigorous activities for several hours in order to offset its effects.  The key to reducing or preventing childhood obesity is to have a well planned, realistic, balanced and consistent family involved process.

 

As a beginning, consider using some of the recommendations that I have labeled MOM.  MOM stands for Monitor  (behavior), Offer (alternatives) and Modify (behaviors).  Despite this acronym, I am not suggesting that mothers have the sole responsibility of treating or preventing childhood obesity. On the contrary, this process should always be considered a family affair and include mothers, fathers, siblings and other immediate family members. However, in many if not most households, moms still have the major responsibility of feeding their families so their participation is critical to a successful plan.

 

Another important concept to remember is this: think low/go slow.  What I mean by this is that your goals should be modest and realistic, and any successful intervention must include permanent changes and not any quick fix solutions.

 

The following are some suggestions that can help get you started on your own program. Note that none of these suggestions are written in stone, and you do not have to follow all of them all of the time. They are simply provided to give you some ideas for a framework. Another good source of information can be found on the fact sheet from Lifetime TV.

 

Monitor

 

If the child is old enough, have him or her keep a log of all the types and amount of food, snacks and drinks that they consume per day. Include the time of day and what activity they are doing. Do the same for the child’s physical activities. This can then be used to help draw up a plan to help monitor and modify food intake, and increase activity.

 

Try to reduce the number of soda, high caloric fruit juice or sports drinks that your child drinks every day. Instead encourage them to drink plain water, watered down fruit juice, lemonade, or unsweetened powered drinks that you can add small amounts of sugar (e.g., Kool-Aid). You should also avoid low or no calorie soda as its use has been correlated with obesity in children.

 

Depending on age, health conditions, and level of development (e.g., prior to the stage of puberty), DO NOT encourage weight loss unless you are directed to do so by your treatment professional. Instead make it a goal to maintain the child’s weight at a steady level.  The child will naturally start to slim down as he or she becomes taller.

 

Encourage children to eat only when they are hungry, and do not use food as an emotional crutch. In a similar vein, don’t force your children to “clean their plates” if they are not hungry. This will not solve the starvation problem in Africa.

 

Reduce the number of hours the child spends watching TV.  For example, remove the  TV from their bedroom so you can monitor this behavior more closely.  This will have the added benefit of reducing the number of high caloric food or snake food commercials that the child is exposed to. Children that watch more than five hours of TV a day are four times more likely to be overweight than children who watch less TV.

 

Do not let children snack while watching TV (or control the type and amount of snacks they eat).  Avoid snacking yourself while watching TV so you can model appropriate behaviors for your child.

 

Do not use or let your child use drugs or herbal remedies to lose weight unless they are prescribe by your physician.

 

Offer Alternatives

 

Limit the time that your child plays video games or spends on the computer for non-educational activities. If you live in a safe environment, encourage children to play more active games outside with their friends, or organize a supervised neighborhood activity group. Children should spend at least one hour per day in active age appropriate activities. However, make sure that these activities are fun and not a chore.

 

Model good eating and exercise behaviors for children. Remember that the old saying “do what I say not what I do” does not work very well with children. If time permits, exercise together by going on walks, biking, swimming, cross country skiing or other active and fun activities such as volleyball, basketball or skating. If you have a dog, make it the child’s responsibility to walk it on a daily basis. More suggestions can be found here.

 

Do not criticize or make fun of your children for being overweight.  If they are being teased for being overweight at school, encourage them to talk to you about how they feel and discuss possible ways of dealing with this.

 

Allow children to take an active role in any type of eating program that you plan to use and encourage them to take ownership over it so they don’t feel it’s something you are “making them do.”

 

Whenever possible, encourage a more active life style by having your children walk to school, stores, their friends houses or other places rather than driving them every where (of course, you must ensure that doing so is safe).

 

Do not keep high fat or caloric snack food in the house. Instead have a plentiful supply of alternatives such as fruits and vegetables to be used for snacking. Make sure that you have a supply of already cut up fruit or vegetables available for snack time. However, make sure that you vary these widely so your child doesn’t get tired of the same old snacks.  If your child insists on buying high caloric foods when you go food shopping, do not bring the child with you.  Make a list of appropriate foods and food products you need prior to going shopping and stick to this list. Also, try not to go shopping yourself over meal time, or when you yourself are hungry (you’ll be more likely to stick to your meal plan this way).

 

If you are not satisfied with the type of food served at your child’s school cafeteria, have them pack a lunch. Do not allow your child to buy candy or soda after school. Also, try to get your school district to remove candy and soda machines from school property, or at least offer some healthy alternatives.

 

Modify

 

Modify your cooking style in order to provide a more healthy diet. For example, broil more and fry less. Reduce the amount of fat or sweeteners called for in recipes. Avoid high calorie desserts.

 

Restrictive diets should be avoided as this often makes matters worse. Instead, the child’s total food intake should be moderately reduced and exercise increased until a steady state is achieved where the child’s weight is stable. A free menu planner available here should help.

 

Rather than diets, focus on long term sound and healthy eating habits that will continue into the child’s adulthood. Try to reduce the amount of fats and sugars in the family’s diet as a whole rather than targeting the child’s diet separately.

 

Do not eat dinner in front of the TV. Eat at the kitchen table . Along the same lines, try to limit the number of places that you child eats food. For example, make it a rule for your children not to eat in their bedroom or even the family room.

 

Try to eat meals as a family. Studies show that families that eat together have less problems with childhood obesity than those who do not.

 

Do not use food as a reinforcer for your children. However you can money that you save from not buying junk or fast food to fund special trips or events or to buy new clothes for your children as they begin to shape up. In a similar manner, try to think of some creative alternatives to high caloric foods for various celebrations such as birthdays or other special events.

 

If your child is old enough and physically able, have them help with the more vigorous household chores such as weeding or shoveling snow.

 

These are just some of the ways you start helping your children lead a more healthy and perhaps more satisfying lifestyle.  Encourage your family to come up with some other ways that are especially suited for your own values, living environment and unique circumstances.