How to Treat and Prevent Childhood Obesity

Small changes in diet and exercise habits over time can help obese children achieve and maintain a healthy weight.

After school, Andrea, like many of her sixth-grade classmates, grabs a snack then checks out a few of her favourite television shows. After dinner, which often consists of take-out or convenience foods, she watches more television or does some homework. Before going to bed, her parents reward her for doing her homework or for cleaning her plate with a big bowl of ice cream.

Andrea gets good grades, gets along well with her parents, and has several close friends. But she is neither happy nor healthy. Andrea suffers from straining mental and physical hardships caused by obesity. Other kids at school tease her about her appearance. She is always picked last for sports teams. She has difficulty finding clothes she likes to wear. Worst of all, she feels ugly and defeated.

Andrea's mother, who is also overweight, tells her daughter that she has “inherited” obesity and will just have to accept it. But Andrea's mother is wrong. According to child health experts, small changes in the daily diet and exercise habits of obese children, continued over time, can have a profound impact on their weight and, ultimately, their physical and emotional well-being.

Andrea is not alone. Obesity now affects 20 percent of U.S. children, according to the National Center for Health Statistics (NCHS), a U.S. government agency. In 1997, the NCHS reported that since the 1970s, obesity among U.S. children ages 6 to 11 has climbed by 54 percent, while obesity among adolescents has risen by 39 percent.

And in a March 1998 report, the American Academy of Pediatrics (AAP) ranked obesity first of all nutritional diseases affecting children and adolescents in the United States and predicted that the current generation of children would grow into the most obese generation of adults in the U.S. history.

Childhood Obesity Definition

Obesity occurs when a person takes in more calories in the form of food than he or she burns for energy. Obesity can be calculated in several ways. Many pediatricians use a growth chart, which compares a child's height and weight with those of other children of their age. In general, children who are at least 20 percent or more above the average weight for their height are considered obese.

A newer, increasingly popular system for measuring weight is the body mass index, or BMI. BMI is calculated by dividing a person's weight in kilograms by height in meters squared. Children with a BMI at or exceeding the 95th percentile for those of the same age and sex are considered overweight, according to the NCHS's third National Health and Nutritional Examination Survey, conducted from 1988 to 1994. Experts caution, however, that because children usually grow in unpredictable spurts, parents should rely on their pediatrician for a diagnosis of obesity in a child.

Why Obesity Is Prevalent among children

Most health experts believe childhood obesity results from a combination of genetic, environmental, and psychological factors. (In rare cases, illness or drugs used to treat the condition may cause weight gain.) For example, numerous studies have shown that children with at least one obese parent have the most significant risk of becoming obese themselves. However, researchers are still unclear to what extent genetics predetermines obesity, and indeed, not all children with obese parents grow up to be obese adults.

Environmental factors that contribute to childhood obesity include activity level, diet, and eating habits. Emotional factors also play a role. Many people, including children, eat in response to negative emotions, such as boredom, sadness, or anger. Most child health experts attribute the jump in childhood obesity since 1980 to two environmental factors: the rise in the consumption of high-fat foods and the decline in leisure- and work-related exercise.

During the first few years of life, children gain fat rapidly—faster, in fact, than they do muscle. As the rate of fat storage increases, so too does the number of fat cells. According to the Mayo Clinic in Rochester, Minnesota, obese children may have three times the number of fat cells as do children of average weight. Children who become obese before age 6 have a 50 percent likelihood of remaining obese in adulthood. Among obese adolescents, the probability rises to 70 to 80 percent. After adolescence, the number of fat cells remains almost constant throughout life.

Lack of adequate physical activity may play a more significant role in childhood obesity than eating lots of high-calorie or high-fat foods, however. According to a 1996 report by the U.S. Surgeon General, nearly half of young people ages 12 to 21 are not vigorously active.

A study of more than 4,000 children ages 8 to 16 by a researcher at Johns Hopkins University School of Medicine in Baltimore, Maryland, showed a strong link between childhood obesity and television viewing time. Children in the study who watched more than five hours of television daily were five times more likely to be overweight than children who watched less than two hours per day. According to the American Heart Association, children in the United States watch 17 hours of television a week. This figure does not include time playing computer and video games.

Unfortunately, school-based physical education programs are not making up for children's exercise shortfall. Although these programs provide both immediate health benefits and aid in developing good health habits, fewer than half of schoolchildren receive daily physical education. According to the American College of Sports Medicine, by 1999, financial problems had forced two-thirds of U.S. schools to eliminate their physical education classes.

Childhood Obesity Effects

Overweight children face several health risks, the greatest of which is that they will grow into obese adults. Obese children who become obese adults are more likely to develop heart disease, diabetes, high blood pressure, high cholesterol, gallbladder disease, arthritis, and certain cancers, according to the Mayo Clinic. These conditions also may appear at a younger age. According to the American Medical Association, more than half of all U.S. adults were overweight in 1999, and obesity-related conditions were second only to smoking as a leading cause of preventable deaths in the United States. One 1993 study calculated that an estimated 300,000 Americans die prematurely each year because of obesity.

Overweight children are more likely to develop high blood pressure and blood cholesterol levels, mainly if there is a family history of these conditions. In young children, excess weight can lead to orthopedic complications such as the bowing of the central leg bones, the tibia, and femurs, according to the 1998 report by the AAP.

Often, however, the most severe and painful problems associated with childhood obesity are emotional. Overweight children are likely to suffer rejection from other children and other forms of social and emotional stress. Several studies have shown that children begin to express a preference for thinness at a young age. In one study, 10- and 11-year-olds ranked overweight children last among those they would like as a friend. Another study found that children ages 6 to 10 associated obesity with various negative characteristics, including laziness and sloppiness. Because of these attitudes, obese children often feel overwhelmed by their weight problem and may suffer from depression.

Childhood Obesity Treatment

Health experts stress that no one weight-control plan works for everyone. But the most successful programs include three common elements: changing the way an overweight person thinks about weight control, improving the diet, and increasing physical activity.

According to health experts, overweight children who can change the way they think about diet and exercise are much more likely to succeed in any weight-loss or weight-control plan. In this, family support is vital. Parents must be committed to helping their children develop healthy long-term diet and exercise habits.

Children's feelings about themselves are fundamentally affected by their parents' feelings about them. Once a child is aware that a weight problem exists, they may feel unhappy or depressed. Health experts stress that parents should help their children feel valued no matter how much they weigh. They should also encourage an overweight child to accept that a problem exists. They should demonstrate a genuine commitment to the child's success, offering constant support and encouragement. Also, the entire family should promote healthy living in a way that is fun and inviting to the child. Ideally, parents should teach by example.

Weight-control programs that minimize the sense of deprivation are likely to result in more long-term behavioral changes and a decreased likelihood of a return to unhealthy behaviors, according to health experts. Also, children who feel they have choices in the plan and control their weight-loss treatment are more likely to succeed.

Figuring out the environmental factors contributing to a child's weight problem is an essential first step. To do this, health experts recommend keeping a detailed record of daily food choices and activities. The food diary should include everything the child eats and drinks in a day—the type of food, the amount, the place the food was eaten (school, home, restaurant), what time it was eaten, and how the food was prepared. Noting how the child felt when he or she ate is also useful.

Parents and children should then review the food and activity record and identify behaviors that contribute to the child's weight problem. For example, are high-fat snacks more available to the child than healthful snacks? Are second and third helpings at meals a habit? Does the child get at least 30 minutes of exercise daily? Does the child eat because he or she is bored or upset?

A Nutritious Diet to Prevent Children Obesity

Child health experts stress that children should not be put on a low-fat diet. Children need a certain amount of fat for average growth. Those who eat too little fat risk developing nutrient deficiencies and impairing their growth. “The Dietary Guidelines for Americans,” issued by the Centers for Disease Control and Prevention in Atlanta, Georgia, recommend that after age 2, children gradually adopt a diet that, by about age 5, contains no more than 30 percent of calories from fat.

Instead of limiting the total amount of food overweight children eat, child health experts recommended that parents stress eating different foods. The government's dietary guidelines include six relevant dietary tips for children: eat a variety of foods; balance the food you eat with physical activity; eat plenty of grain products, vegetables, and fruits; limit the amount of fat, saturated fat, and cholesterol in your diet; limit the amount of sugar in your diet, and limit the amount of salt and sodium in your diet.

One dietary approach that has successfully treated childhood obesity is the “traffic light diet.” Designed for preschool and preadolescent children, this diet regulates nutritional and caloric requirements by grouping foods into categories. Green foods (go) may be consumed in unlimited quantities; yellow foods (caution) should be eaten in moderation; and red foods (stop) are to be avoided, if possible.

Studies have shown that children who followed the traffic light diet as part of a comprehensive treatment program that included exercise, behavioral counseling, and family support improved their diet and significantly improved their eating habits. In addition to these short-term effects, researchers observed long-term obesity changes extending from 5 to 10 years after the beginning of treatment.

Nutritional experts stress that parents should model good eating themselves and offer a variety of healthful foods. Involving children in menu planning also may encourage the development of good eating habits. In the guidelines, the CDC noted that children and adolescents often understand the importance of limiting fat, cholesterol, and sodium in their diet but are not aware of which foods are high in these substances.

Also, according to the CDC, children, and adolescents frequently decide what to eat without adult supervision. “The increase in one-parent families or families having two working parents outside and the greater availability of convenience foods and fast-food restaurants inhibited parents' monitoring of their children's eating habits,” the report said.

Exercise to Prevent Childhood Obesity

Physical activity is as essential as good eating habits in weight control. In July 1996, the U.S. Department of Health and Human Services issued the first Surgeon General's Report on Physical Activity and Health. It recommended 30 minutes of moderate to vigorous physical activity per day for children and adults. Although this goal may seem modest, child health experts note that many children fall short.

Experts caution that overweight children may be more prone to injuries of the joints than children of average weight because of the extra stress on their joints. The Mayo Clinic recommends that overweight children begin an exercise program gradually, starting with lower impact exercises such as swimming and biking rather than high-impact activities like running. Proper warm-up and cool-down exercises are especially important to prevent injuries.

In any weight-control plan for children, gradual change is best. In a five-year study of school-age children, researchers at the Mayo Clinic found that kids who were able to make small, progressive changes in their eating and exercise habits were more likely to lose and control their weight than those who attempted significant changes.

To begin, a child can identify a single specific change he or she is willing to make. For instance, rather than vowing to cut down on all snacks, a child may start by substituting a piece of fruit for a customary bowl of ice cream before bedtime. Or he or she can play outside or ride a bike after school rather than watching television. A child who reduces their total caloric intake by just 100 calories a day—a piece of bread, a cookie, or an extra half-bowl of cereal—will lose 10 pounds within a year.

Sometimes, obese children need more than family support, diet, and exercise to help them reach their goals. According to the Mayo Clinic, support groups made up of children of the same age may provide additional encouragement and offer a welcome opportunity to share feelings and discuss problems and possible solutions.

Child health experts note several factors that give them optimism about the chances of reducing obesity in children:

  1. Unhealthy eating and exercise habits are not as ingrained in obese children as they are in obese adults and so are usually easier to change.
  2. Families are more likely to make fundamental changes in their eating and exercise habits for the sake of an obese child than they are for an obese adult.
  3. Few overweight children need to lose weight, experts say.

Instead, parents should focus on appropriate changes to bring an obese child's height-weight proportions into balance. In reducing the prevalence of childhood obesity, the primary goals are to get children moving, cut out high-fat foods, and teach healthy fitness habits that will last a lifetime.

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