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
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
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.
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
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
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
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.