As a group, young people in the United States today are considered the most inactive generation in history. They are also far more likely than other generations to eat fast food on a regular basis.

According to the Center for Disease Control, the rate of childhood and teenage overweight has tripled in the past 30 years. In fact, about one out of four US children is now overweight or obese, according to the National Center for Health Statistics.

As a result, a host of obesity-related diseases are plaguing children, including asthma, high cholesterol, elevated blood pressure, and an alarming spike in Type 2 diabetes -- a condition rarely seen in kids until the past decade. Obese children are also likely to suffer from depression and poor self-esteem as a result of prejudice and rejection by their peers.

Doctors now recognize that the causes of obesity go beyond simple over-eating: Obesity is a chronic, serious health problem. Effective prevention and treatment are possible, but experts stress that success usually requires families to commit to healthy changes in their way of life.

The Body Mass Index (BMI) is a charting tool used by doctors to define normal weight, overweight, and obesity. It's based on the ratio of a person's weight to the square of height (traditionally calculated in kilograms and meters).

For example if your child weighs 50 kilos and is 1.4 meters, your doctor would use this formula:

50 divided by (1.4) x (1.4) = X (i.e. kilograms per meters squared)

There is not one standard definition of overweight for children. However, according to the Centers for Disease Control, children and teenagers between the 85th and 95th percentile BMI are generally considered overweight and those at or above the 95th percentile are generally considered obese.

You may also want to check out http://www.cdc.gov/growthcharts for healthy bodyweights and BMI values that correspond to percentiles above.

Early recognition is one of the most important steps to preventing obesity and managing your child's weight.

Even if your child doesn't appear to be at risk for obesity, your doctor or pediatrician should calculate and plot his or her Body Mass Index once a year, checking to see that your child's weight gain isn't excessive relative to his or her growth in height, according to guidelines from the American Academy of Pediatrics Committee on Nutrition.

In addition, your doctor should help you identify whether your child is at risk for obesity, considering family history, birth weight, social, ethnic, cultural, and environmental factors.

If your child is overweight or obese, your doctor should note and keep close track of changes in related risk factors, which increase the likelihood of getting a disease for adult chronic conditions. These conditions include high blood pressure, high cholesterol, diabetes, and symptoms of obstructive sleep apnea syndrome.

First, feel free to ask your doctor as many questions as you have about your child's obesity. Remember, it's a medical matter, not a "private" matter or failure.

The best plans to prevent obesity combine a healthy diet and creating an active environment for your kids. The Obesity Society recommendations on childhood obesity encourage parents to:

•Make time for the entire family to participate in activities that everyone enjoys. Among other things, they suggest walking, bicycling, or rollerblading.

•Plan special, active family outings such as hiking.

•Start an active neighborhood program involving touch tag, football, or basketball.

•Assign active chores like washing the car to every member of the family, and rotate them to keep people from getting bored.

•Enroll your child in a structured activity that he or she really enjoys, such as gymnastics, swimming lessons, dance, or martial arts. (Many communities offer low-cost programs or scholarships through the YMCA or other community centers.)

•Talk with your child about the possibility of joining a sports team at school.

•Limit your child's TV watching. The American Academy of Pediatrics suggests a combined TV and video time of no more than two hours a day.

•Serve everyone a healthy diet rich in fruits, vegetables, and whole grains, not just for certain members of the family.

•Plan times when you prepare foods together.

•Eat meals at the dinner table at regular times, and avoid rushing through your meals.

•Avoid other activities during mealtimes, such as watching TV.

•Avoid portions that are too large, and foods that are high in calories, fat, or sugar.

•Serve tasty but nutritious snacks, such as fruits, vegetables, and yogurt.

•Avoid forcing your child to eat if he's not hungry.

•Avoid using food as a reward or lack of it as punishment.

Although the guidelines don't mention this, pay attention to what your kid eats at school -- pack a healthy home lunch so you can be sure what they are eating, and don’t let them buy soda or other sugary drinks from school vending machines. (In other words, don't send your kids to school every day with pocket change, if you think this is how they will spend it!)

The Obesity Society -- as well as federal health agencies -- also calls for nutritious meals, daily physical education, and daily recess in the schools. If your school doesn't have these, you and other parents may want to get involved in pushing your school district to offer PE and healthy school lunches.

The American Academy of Pediatrics committee guidelines include many of the same recommendations, and also recommend that your doctor help you plan:

•Modeling healthy eating choices for your children.

•Breastfeeding your baby if you are nursing, which offers your infant a well-balanced, nutritional food source.

Not only should obesity intervention begin early, but the family must be ready for change, according to the Department of Health and Human Services. According to the DHHS, "A weight-management program for a parent or an adolescent who is not ready to change may be not only futile, but also harmful, because an unsuccessful program may diminish the child's self-esteem."

Improving a child's eating and physical activity patterns can only mean change for the good. But it also definitely means change for the whole family.

The doctor will explain that it will be possible to treat your child's obesity if:

•You believe your child's overweight is a problem, and

•You and you child want and believe you're able to make the changes in your family's eating and lifestyle habits.

Studies have shown that for a child to have the best chance of losing substantial weight and keeping it off, the entire family must be ready for change. If only one family member is prepared to make changes, success is unlikely -- and a child can become only more discouraged by his or her failure, according to the DHHS expert committee recommendations.

The primary goal of a program to manage uncomplicated obesity (that is, obesity without related disease) is healthy eating and activity, not achieving an ideal body weight, according to the DHHS recommendations. The treatment program you decide upon with your doctor should encourage permanent changes, not short-term diets or rapid-weight loss programs. Steady, long-term changes are more successful than "instant" change programs. (Only in very rare cases of obesity that presents serious, immediate medical danger will a doctor recommend rapid weight-loss treatment.)

In terms of your child's diet history, if your doctor does not have time to assess it, the DHHS recommends that he or she refer you to a clinical dietitian to go over your family's eating habits. Your child will need to cut down on calorie intake that children often get from foods such as chips, granola bars, cookies, desserts, and high-calorie beverages like soda and juice. Your doctor should also be able to help identify "problem areas," such as depending on high-calorie food sources such as fast food.

Your doctor should also do a careful history of your child's physical activity, which will "uncover opportunities to increase energy expenditure," according to the DHHS recommendations. The expert committee also recommends that your doctor help you estimate how much time your child spends sitting still ("sedentary behavior," in doctor-speak) and recognize and work around deterrents to physical activity, such as a dangerous neighborhood.

As you design a treatment plan together for your child, your doctor should talk to you about medical complications that can result from obesity, including Type 2 diabetes, according to the DHHS expert recommendations. The experts also recommend, among other things, that your doctor counsel you to:

•Find reasons to praise the child's behavior. (Many experts believe it's very important to try to praise your child at least four or five times for every time you provide negative feedback.)

•Never use food as a reward.

•Offer only healthy options and remove tempting high-fat or high-sugar foods from the cupboards.

When your child begins treatment, the doctor should take down a complete history of your child's physical activity and monitor your child's physical condition with weight management tests.

Your doctor will also monitor your child's health for complications from obesity, as teens in particular are at risk of Type 2 diabetes, high blood pressure (or hypertension), and high cholesterol. According to the DHHS recommendations, he or she may refer your child to a specialist for one or more of the following conditions (which are fairly unusual):

•Orthopedic problems in the leg joints

•Gradual loss of visual fields or clarity

•Difficulty breathing (apnea) during sleep, which require immediate treatment, including a sleep study and tonsil exam

•Abdominal pain that might indicate gallbladder disease

•High blood pressure, cholesterol, and lipid levels

Maintaining regular contact with your child's clinicians will be very important in helping your child with obesity. Together, you can go over and strengthen your healthy diet goals and how you are making them work on a regular basis.

You also deserve a doctor who is sympathetic, supportive, encouraging, sensitive, shows understanding for feelings, and avoids being overly critical or judgmental, according to the federal expert committee. And he or she should support the positive changes you have made. If you express your concerns and follow up with your child’s doctor regularly, you are more likely to meet with success.

References

Last updated August 11, 2009
Copyright © 2004 Consumer Health Interactive

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