Is my child overweight?

Obesity has become America's #1 health risk. More than 15% of American teens are overweight. Your child is overweight if:

• your child appears overweight
• your child's weight is more than 20% over the ideal weight for his or her height
• your teen's skin fold thickness of the upper arm's fat layer is more than 1 inch (25 millimeters) when measured with a special instrument.

Obesity is defined as a weight per height ratio (body mass index or BMI) that is above the 95th percentile. Obesity occurs in 10% of American children ages 2 to 5 and in 15% of those ages 6 to 19.

What is the cause?

The tendency to be overweight is usually inherited. If one parent is overweight, half of the children have the potential to be overweight. If both parents are overweight, most of their children have the overweight gene. If neither parent is overweight, the children have a small chance of being overweight.

Heredity alone (without overeating) accounts for most mild weight problems, Moderate weight problems are usually due to a combination of heredity, overeating, and underexercising. Some overeating is normal in our society, but only those who have the inherited tendency to be overweight will gain significant weight when they overeat. The family environment (how much the family exercises and watches TV and what foods are served) is equally important.

Less than 1% of obesity has a medical cause. Your child's healthcare provider can determine whether your child's obesity has a physical cause with a physical exam and a review of your child's growth chart.

There are health risks as well as social problems that may occur in overweight children. These include high blood pressure, type 2 diabetes, obstructive sleep apnea from severe snoring, exercise intolerance, lower self-esteem, and depression.

When is the best time to lose weight?

Losing weight is difficult. During the first 2 years of life, it is not healthy to lose weight, but slowing down the rate of weight gain is helpful. After age 2, anytime is a good time to start losing excessive weight. Under 5 years of age, the parents have control over what foods are served. Weight control is in the parents' hands. After age 5, weight loss is more difficult because children, especially teens, have access to many foods outside the home. The easiest time to lose weight is often when a child becomes concerned about her/his appearance and has the willpower to change to healthier eating. This may not happen until the teenage years.

How do I help my older child or teen lose weight?

• Readiness and motivation

  Teenagers can increase their motivation by joining a weight-loss club such as TOPS (Take Off Pounds Sensibly) or Weight Watchers. Sometimes schools have classes for helping children lose weight. A child's motivation often can be improved if the whole family focuses on healthier eating and an exercise programs. A cooperative parent-child weight loss program with individual goals is usually more helpful than a competitive program focused on who can lose weight faster.

• Protecting your child's self-esteem

  Self-esteem is more important than an ideal body weight. If your child is overweight, he is probably already disappointed in himself. He needs his family to support him and accept him as he is. A child's self-esteem can be reduced or destroyed by parents who become overconcerned about their child's weight. Avoid the following pitfalls:

  • Don't tell your child he's fat. Don't discuss his weight unless he brings it up.
  • Never try to put your child on a strict diet. Diets are unpleasant. Dieting should be your child's decision.
  • Never deprive your child of food if he says he is hungry. Offer your child a healthy snack. Not letting a healthy child eat eventually leads to overeating.
  • Don't nag your child about his weight or eating habits.
• Setting weight-loss goals

  Pick a realistic target weight dependent on your child's bone structure and how overweight your child is. The loss of 1/2 pound a week is usually an attainable goal for a teenager. However, your child will have to work hard to lose this much weight every week for several weeks. Your child should weigh himself no more than once each week. Daily weighings generate too much false hope or disappointment. When losing weight becomes a strain, have your child take a few weeks off from the weight-loss program. During this time, help your child stay at a constant weight.

  Once your child has reached the target weight, the long-range goal is to try to stay within 5 pounds of that weight. Staying at a particular weight is possible only through a permanent moderation in eating. Your child will probably always have the tendency to gain weight easily and it's important that she understand this.

• Healthy eating program: cutting calories

  Your child should eat 3 well-balanced meals a day of average-sized portions. There are no forbidden foods. Your child can have a serving of anything family or friends are eating. However, there are forbidden portions. While your child is reducing, she must leave the table a bit hungry. Your child cannot lose weight if she eats until full. Encourage average portions instead of large portions and discourage seconds. Shortcuts such as fasting, crash dieting, or diet pills rarely work and may be dangerous. Liquid diets are safe only if they are used according to directions. Calorie counting is helpful for some people, but it is usually too time-consuming. Consider the following guidelines on what to eat and drink:

  • Fluids: Mainly use low-calorie drinks such as skim milk, fruit juice diluted in half with water, diet soda drinks, or flavored mineral water. Because milk has lots of calories, your child should drink no more than 16 ounces of skim, 1%, or 2% milk each day. He should drink no more than 8 ounces of fruit juice a day. Soft drinks (soda) are a common cause of rapid weight gain and must be limited to 1 can (12 ounces) per day. If your teen can't give up soda, offer diet soda. All other drinks should be either water or diet drinks. Encourage your child to drink water when thirsty.
  • Meals: Serve fewer fatty foods (for example, eggs, bacon, sausage, and butter). A portion of fat has twice as many calories as the same portion of protein or carbohydrate. Trim the fat off meats. Serve more baked, broiled, boiled, or steamed foods and fewer fried foods. Serve more fruits, vegetables, salads, and grains, because they are usually low-calorie and filling.
  • Desserts: Encourage smaller-than-average portions of desserts. Encourage more Jell-O and fresh fruits as desserts. Avoid rich, fatty desserts, such as ice cream. Do not serve second helpings.
  • Snacks: For snacks serve only low-calorie foods such as raw vegetables (carrot sticks, celery sticks, raw potato sticks, pickles, etc.), raw fruits (apples, oranges, cantaloupe, etc.), popcorn, or diet soft drinks. Your child should have no more than 2 snacks a day.
  • Vitamins: Give your child one multivitamin tablet daily during the weight-loss program.
• Eating habits

  Most overeating is due to bad habits. To counteract the tendency to gain weight, your youngster must be taught eating habits that will last for a lifetime. You can help your child lose and keep off unwanted pounds by doing the following:

  • Discourage skipping any of the three basic meals.
  • Encourage drinking a glass of water before meals.
  • Serve smaller portions.
  • Suggest chewing the food slowly.
  • Offer second servings only if your child has waited for 10 minutes after finishing the first serving.
  • Don't purchase high-calorie snack foods such as potato chips, candy, or regular soft drinks.
  • Do purchase and keep available diet soft drinks, fresh fruits, and vegetables.
  • Leave only low-calorie snacks out on the counter--fruit, for example. Put away the cookie jar.
  • Store food only in the kitchen. Keep it out of other rooms.
  • Offer no more than two snacks each day. Strongly discourage your child from continual snacking ("grazing") throughout the day.
  • Allow eating in your home only at the kitchen or dining-room table.
  • Discourage mindless eating while watching TV, at the movie theater, studying, riding in a car, or shopping in a store. Once eating becomes associated with these activities, the body learns to expect it.
  • Discourage eating alone.
  • When eating fast food, avoid value meals and "super-sizing.".
  • Help your child reward herself for hard work or studying with a movie, TV, music, or a book instead of food.
  • If your child approves, have him post some reminder cards on the refrigerator and bathroom mirror that state "EAT LESS" or "STICK TO THE PROGRAM."
• Physical activity: using more calories

  Daily physical activity can increase the rate of weight loss as well as the sense of physical well-being. The combination of healthy eating and physical activity is the most effective way to lose weight. Try the following forms of physical activity:

  • Walk or ride a bicycle instead of riding in a car.
  • Use stairs instead of elevators.
  • Learn new sports. Swimming and jogging are the sports that burn the most calories. Your child's school may have an aerobics class.
  • Spend more time outdoors.
  • Walk at least 30 minutes per day, for example, take the dog for a long walk.
  • Limit TV sitting time to 2 hours or less each day. When children watch less TV, they automatically become more active.
  • Dance to music on TV.
  • Use exercise equipment while watching TV.
• Social activities: Keeping the mind off food

  The more outside activities your child participates in, the easier it will be for her to lose weight. Spare time fosters nibbling. Most snacking occurs between 3 and 6 PM. Help your child fill after-school time with activities such as music, drama, sports, or scouts. A part-time job after school may help. If nothing else, encourage your child to call or visit friends. An active social life almost always leads to weight reduction.

When should I call my child's healthcare provider?

Call during office hours if:

• Your child has not improved his eating and exercise habits after trying this program for 2 months.
• Your child is a compulsive overeater.
• You find yourself frequently nagging your child about his eating habits.
• Your child is trying to lose weight and doesn't need to.
• You think your child is depressed.
• Your child has no close friends.
• You have other questions or concerns.