Commentary
How Parents Can Fight the Obesity Epidemic
We hear a lot in the news about children and the "obesity epidemic" lately. You may be wondering what it's all about. We have general notions about obesity and overweight being unhealthy, but what exactly are the concerns?
Being obese increases a child's risk for some serious childhood medical problems. These include pre-diabetes, diabetes, heart disease, hyperlipidemia (too much fat in the blood, which can clog the arteries), sleep apnea, bone conditions, gastro-intestinal diseases, and psychological problems [1] [2] [3] [4] [5] [6] [7] [8] [9] [10] [11] [12] [13] [14]. These obesity-associated health problems tend to continue into adulthood [2]. In addition to the risks to kids in childhood, research over the last 40 years tells us that overweight kids are at greater risk of becoming obese adults [15] [16] [17] , with all the health problems associated with obesity lasting through the lifespan.
The good news is that parents have influence over their child's lifestyle and weight. Research has given us lots of information about how parents can help their child stay at or get to a healthy weight.
Here’s some general advice on what parents can do:
- Pay attention to your child. Show them you care. Kids who are not tended to by adults have higher rates of obesity. [18]
- Don’t use food as a comfort measure [19] .
- Don’t closely monitor the amounts your child eats or nag your child to eat at mealtime. This can interfere with your child’s response to hunger and feeling full. These two responses are an important basis for healthy eating behaviors [19].
- Watch your own weight. Kids under age three who are overweight, but whose parents are not overweight, have a low risk for becoming overweight adults [20] . If one parent is obese, it doubles a child’s risk for adult obesity.
- Don’t focus on the weight. Instead, focus on healthy living: good eating habits and physical activity. Girls whose moms were worried that their daughter would be overweight were more likely to have abnormal eating behaviors [21] .
- Limit television-viewing time. There is a direct relationship between the amount of time spent watching TV and degree of overweight [22] .
- TV-viewing can directly cause obesity through replacing physical activity, increased eating while watching, and reduced metabolism while watching.
- Television can also have an indirect effect; advertising can influence kids to increase their calorie intake by eating and drinking more junk food/beverages.
- Find out healthy ways to manage television in your family.
- If your child shows signs of becoming overweight or has risk factors, work with your pediatrician to start prevention as early as possible for the best results for your child [21] [23] [24] [25] [26] [27] [28] .
- For more parenting tips and resources, see YourChild: Obesity and Overweight
What the research tells us about good nutrition to prevent overweight and obesity:
Pre-conception:
- If you are a woman in the childbearing years, you should maintain a healthy weight, which helps prevent obesity in your future children. Entering into pregnancy with a healthy weight also helps prevent gestational diabetes and lowers kids’ risks of developing diabetes.
Prenatally:
- Mothers-to-be do not actually need to “eat for two.” Overeating in pregnancy and gaining excessive weight can put both mother and child at risk for obesity [29] [30] .
- On the other hand, good nutrition is critical in pregnancy. Undernourished fetuses are also at increased risk of later obesity. [31]
- Get good prenatal care.
- Work with your midwife or obstetrician, and also with a nutritionist, if recommended, to maintain healthy eating habits and a healthy weight all through your pregnancy.
Infants:
- Breastfeed [32] for at least a year. Breast milk alone is the only food needed for the first four to six months or so, and nursing should continue for at least a year. Human milk is the perfect food for human babies.
- Babies need a higher percentage of their calories as fat. The best fats for infants are the fats found in mother’s milk.
- Breastfeeding is a mother’s first experience with paying attention and responding to baby’s feelings of hunger and fullness. There is no bottle to measure your baby’s intake, so it’s all based on your baby’s cues.
- If your baby is bottle-feeding, it’s important not to focus on the number of ounces, but rather baby’s cues about hunger and fullness.
Introducing solid foods:
- Eating habits started in infancy continue through the lifespan [33] , so emphasize grains, vegetables and fruits and regular family meals at the table.
- Your baby can start eating solids at around 4-6 months of age. Your pediatrician can talk to you about how to tell whether your child is ready. If your baby gags or chokes at the first feeding, wait a week or so before trying again.
- Children learn by imitation. Consider your family’s eating patterns (parents, siblings, and extended family). Is your baby learning what you want them to learn about eating?
- Focus on your child’s cues about their hunger and fullness, rather than on how much is left in the jar of baby food..
- For more on starting solids, see YourChild: Feeding Your Baby and Toddler (Birth to Age Two).
Second year (one year old):
- One-year-olds can transition from formula or breast milk to whole cow’s milk (or, ideally, continue breastfeeding). If your child may be at risk for obesity or is growing in weight too fast, your pediatrician may recommend reduced fat milk.
- One-year-olds still need more of their calories to come from fat. This will gradually reduce over the first two years, until at age two, they should be eating lower fat diet, similar to adults.
- Kids this age are on the move, and need to eat frequently. Use snacks as a chance to get super-healthy foods into your child.
- Avoid the typical snack diet of juice, processed crackers and cookies and sugary yogurt and granola bars. These foods can be eaten as an occasional treat. They are high in calories and low in nutrients and fiber. They are also often high in the most-unhealthy kinds of fats.
- Instead, opt for fruits and vegetables, and minimally processed grain products, such as whole-wheat crackers, and keep juice intake to less than four ounces (half a cup) a day.
- Remember to avoid foods that can cause choking.
Preschool (ages 2-5):
- Continue to emphasize fruits and vegetables, and keep following the guidelines above.
- Protein can come from beans, grains, lean meat, fish, poultry, and tofu. (Nuts can be introduced after age four—to prevent risk of choking.)
- Choose 2% milk unless your pediatrician advises milk with more or less fat for your child.
- Kids develop food habits and preferences by age 2-3—mainly thru the family environment. They will have their habits formed by following your role modeling, and through your positive and negative responses to their choices.
School-age:
- Eating in front of the TV is associated with greater risk of obesity, so don’t let your kids do it. This also goes for eating in front of any screen, such as video games and the computer.
- Keep unhealthy foods out of the house or out of your kids’ control
- Set firm rules about healthy snack choices.
- Don’t allow eating in bedrooms.
- Children home alone after school need guidelines for snacks and food safety
- Consider soda pop an occasional treat rather than a regular beverage. Water should be the beverage of choice.
- Choose 1% or 2% milk for your child unless your pediatrician advises milk with more or less fat for your child.
Adolescents:
- Teens are growing fast, and may need more calories—so try to keep it high in nutrients, and low in saturated fats, cholesterol and sodium [34] .
- Teach your adolescent about nutrition—they are making more choices for themselves.
- Choose healthy foods for family meals and keep unhealthy foods out of the house.
- Make sure your teen eats breakfast.
- Guide your teen in choosing the healthier options at fast food restaurants and convenience stores.
- Encourage your teen to choose bottled water from the vending machine at school rather than soda pop.
- Milk continues to be an excellent source of protein, calories and calcium. Choose skim milk unless your pediatrician advises milk with more fat for your child.
For more information, please visit these topics on YourChild:
- Obesity and Overweight
- Feeding Your Child
- Food Safety
- Eating Disorders
- Choking Prevention
- A Guide to Managing Television: Tips for Your Family
Programs at UMHS:
- The Michigan Pediatric Outpatient Weight Evaluation and Reduction (MPOWER) program, for kids ages 7-18, is a comprehensive program that helps young people motivate, build confidence, and create new lifestyle habits.
~Sheila Gahagan, MD and Kyla Boyse, RN
October 2003
Updated August 2011
References
U-M Health System Related Sites:
U-M Pediatrics
