Weight Problems and Obesity in Children

Weight Problems and Obesity in Children

Helping Your Child Reach and Maintain a Healthy WeightThe number of children who are obese or overweight is growing at an alarming rate. Extra pounds put kids at risk of serious health problems, including diabetes, heart disease, and asthma. Childhood obesity also takes an emotional toll. Overweight children are frequently teased and excluded from team activities, which can lead to low self-esteem, negative body image, and depression. However, with the right support, encouragement, and positive role modeling, you can help your child reach and maintain a healthy weight.

Diagnosing weight problems and obesity in children

Overweight and obese children are at a greater risk of developing serious health problems such as:

type 2 diabetes high blood pressure high cholesterol bone and joint problems

asthma restless or disordered sleep patterns liver and gall bladder disease depression and low self-esteem

Kids who are unhappy with their weight may also be more likely to develop eating disorders and substance abuse problems. Diagnosing and treating weight problems and obesity in children as early as possible may reduce the risk of developing these and other serious medical conditions as they get older. Whatever your children’s weight, though, let them know that you love them and that all you want to do is help them be healthy and happy.

Is your child overweight?

Children grow at different rates at different times, so it is not always easy to tell if a child is overweight. Body mass index (BMI) uses height and weight measurements to estimate how much body fat a child has, and can be used to screen for weight and obesity problems from the age of 2. However, while BMI is usually a good indicator, it is NOT a perfect measure of body fat and can be misleading in some situations. For example, BMI can be difficult to interpret during puberty when children are experiencing periods of rapid growth.
If your child registers a high BMI-for-age measurement, your health care provider may need to perform further assessments to determine if excess fat is a problem. These assessments may include skinfold thickness measurements, plus evaluations of diet, physical activity, family history, and other appropriate health screenings. The doctor may also decide to screen for some of the medical conditions that can be associated with obesity.

Causes of weight problems and obesity in children

Understanding how children become obese or overweight in the first place is an important step toward breaking the cycle. Most cases of childhood obesity are caused by eating too much and exercising too little. Children need enough food to support healthy growth and development. But when they take in more calories than they burn throughout the day, the result is weight gain.
Many factors contribute to this growing imbalance between calories in and calories out:

• Busy families are cooking less and eating out more.
• Easy access to cheap, high-calorie fast food and junk food.
• Food portions are bigger than they used to be, both in restaurants and at home.
• Kids are consuming a huge amount of sugar in sweetened drinks and hidden in an array of foods.
• Kids spend less time actively playing outside, and more time watching TV, playing video games, and sitting at the computer.
• Many schools are eliminating or cutting back their physical education programs.

Myths and Truths about Weight Problems and Obesity in Children

MYTH: Childhood obesity is genetic, so there’s nothing you can do about it.
TRUTH: While a person’s genes do influence weight, they are only one small part of the equation. Although some children are more prone to gaining weight than others, that doesn’t mean they’re destined for weight problems. Most kids can maintain a healthy weight if they eat right and exercise.
MYTH: Children who are obese or overweight should be put on a diet.
TRUTH: Unless directed by your child’s doctor otherwise, the treatment for childhood obesity is not weight loss. The goal should be to slow or stop weight gain, allowing your child to grow into his or her ideal weight.
MYTH: It’s just baby fat. Children will outgrow the weight.
TRUTH: Childhood obesity doesn’t always lead to obesity in adulthood, but it does raise the risks dramatically. The majority of children who are overweight at any time during the preschool or elementary school are still overweight as they enter their teens. Most kids do not outgrow the problem.

Weight problems and obesity in children tip 1: Get the whole family involved

Healthy habits start at home. The best way to fight or prevent childhood obesity and weight problems is to get the whole family on a healthier track. Making better food choices and becoming more active will benefit everyone, regardless of weight. And with the whole family involved, it will be much easier for your overweight child to make lasting changes.

Leading by example

The most effective way to influence your child is by your own healthy example. If your children see you eating your vegetables, being active, and limiting your TV time, there’s a good chance that they will do the same. These habits will also have the happy side effect of helping you maintain a healthy weight.

• What you eat: Tell your child about the healthy food you are eating, while you are eating it. You might say, “I’m eating broccoli with garlic sauce. Want a bite?”
• When you cook: Cook healthily in front of your children. Better yet, give them an age-appropriate job in the kitchen. Tell them about what you are making and why it’s good for your body.
• How you move: Exercise in some way, every day. Be authentic—do things you enjoy. Tell your kids what you’re doing, and invite them to join you.
• Your free time: Avoid the television or too much computer time. Kids are much less likely to turn screens on if they are off and you are doing something they can get involved in.

Strategies for Real Life

• Recognize that you have more control than you might think. You can turn off the TV, computer, or video game. You can choose to get off the bus one stop earlier than usual and walk the rest of the way, especially when you are with your kids. You can give your family more vegetables for dinner.
• Think about the immediate benefits. If reducing the risk of future heart disease seems abstract, focus on the good things that can happen right now. You won’t feel uncomfortably full if you have a smaller portion or skip dessert. Going hiking with your teenager might lead to a wonderful talk that neither of you anticipated. A fruit salad tastes great and looks beautiful. Dancing or playing with your kids is lots of fun and can give you a great workout.
• Make small, easy changes over time. Suggesting that family members take a run together every day will probably get you lots of eye-rolling and “no-thank-you’s.” It’s easier and more appealing to start out with some new approaches to nutrition and physical activity that the whole family is really willing to try. For example, take a walk after dinner a couple of nights a week instead of turning on the TV. And, instead of chocolate cake with frosting, enjoy sliced strawberries over angel food cake.

Source: We Can! Families Finding the Balance, U.S. Dept. of Health & Human Services

Weight problems and obesity in children tip 2: Encourage healthy eating habits

Begin eating right today, as a family. Remember the importance of role modeling: there should be emphasis on what you do so that your child can follow. It is crucial to get the whole family in on the idea of eating healthily at home and away.

Making healthier food choices

Helping your child beat obesity begins with helping him or her forge a healthy relationship with food. You may need to make major changes to your eating lifestyle.

• Eat the rainbow. Serve and encourage consumption of a wide variety of fruits and vegetables. This should include red (beets, tomatoes), orange (carrots, squash), yellow (potatoes, bananas), green (lettuce, broccoli) and so on—just like eating a rainbow.
• Make breakfast a priority. Children who eat breakfast are less likely to be overweight or obese than those who skip the first meal of the day. It’s important to focus on healthy choices, though, like oatmeal, fresh fruit, whole grain cereal high in fiber and low in sugar, and low-fat milk instead of sugary cereals, donuts, or toaster pastries.
• Look for hidden sugar. Reducing the amount of candy and desserts you and your child eat is only part of the battle since sugar is also hidden in foods as diverse as bread, canned soups and vegetables, pasta sauce, margarine, instant mashed potatoes, frozen dinners, low-fat meals, fast food, and ketchup. Your body gets all it needs from sugar naturally occurring in food—so anything added amounts to nothing but a lot of empty calories. Check labels and opt for low sugar products and use fresh or frozen ingredients instead of canned goods.
• Schedule regular meal times. The majority of children like routine. If your kids know they will only get food at certain times, they will be more likely to eat what they get when they get it.
• Limit dining out. If you must eat out, avoid fast food if you can and make the healthy choices you are trying to make at home.

Weight problems and obesity in children tip 3: Don't go no fat, go good fat

For years, nutritionists have preached that a low-fat diet is the key to managing weight and preventing health problems in kids and adults alike. But not all fats contribute to weight gain. So instead of trying to cut out fat from your child’s diet, focus on replacing unhealthy fats with healthy fats.

Avoid trans fats

French fries and other fried foods may contain artificial trans fats that are dangerous to your child’s health. Fast food, packaged food, baked goods, sweets, and anything fried in vegetable oil often contain trans fat, even if the packaging claims it’s “trans fat-free.” Try to eliminate or cut back on:

• Commercially-baked goods (cookies, crackers, cakes, muffins, pie crusts, pizza dough, breads like hamburger buns)
• Packaged snack foods (crackers, microwave popcorn, chips, candy)
• Solid fats (stick margarine, vegetable shortening)
• Fried foods (French fries, fried chicken, chicken nuggets, breaded fish, hard taco shells)
• Pre-mixed products (cake mix, pancake, chocolate milk)
• Anything with “partially hydrogenated” oil listed in the ingredients

Add more healthy fats

Eating foods rich in monounsaturated and polyunsaturated fat is an important part of a healthy diet and can help a child control blood sugar and avoid diabetes. These “good” fats include:

• Avocados
• Olives
• Olive oil
• Nuts such as almonds, peanuts, macadamia nuts, hazelnuts, pecans, cashews, and walnuts
• Fatty fish such as salmon, tuna, mackerel, herring, trout, sardines, or sablefish
• Non-GMO sources of soy and tofu
• Brussels sprouts, kale, spinach
• Sunflower, sesame, and pumpkin seeds
• Flaxseed

Unsaturated oils

When cooking for you and your child, choose your oils carefully. Cold-pressed oils such as extra virgin olive oil, sesame oil and peanut oil are rich in healthy fats. The same may not be true of modern processed oils such as soybean oil, sunflower oil, corn oil, canola oil, cottonseed oil, safflower oil and vegetable oil. These oils are industrially manufactured—usually from genetically modified crops in the U.S.—using high heat and toxic solvents to extract the oil from the seeds. Many experts recommend sticking to cold-pressed oils or using butter or ghee (clarified butter) for cooking and baking.

Choose saturated fats wisely

Not all saturated fat is the same. The saturated fat in whole milk, coconut oil, or salmon is different to the saturated fat found in pizza, French fries, and processed meat products (such as ham, sausage, hot dogs, salami, and other cold cuts) which have been linked to heart disease and cancer.
Despite the saturated fat content, kids who eat whole-milk dairy products tend to have less body fat and lower levels of obesity than those who eat skim or non-fat dairy. This may be because the saturated fat in whole milk dairy makes kids feel fuller, faster, and keeps them feeling satisfied for longer, thus helping them to eat less overall. Adding a small amount of butter or olive oil to vegetables will not only improve the taste but can be far more satiating to kids.
To help your child make healthier choices, focus on the source of saturated fats consumed: A glass of whole milk or natural cheese rather than a hot dog, donut, or pastry, for example, grilled chicken or fish instead of fried chicken, or a 4 oz. portion of grass-fed beef rather than a burger and fries. Other tips to choosing saturated fat:

• Avoid saturated fat from processed meats, packaged meals, and takeout food.
• Don’t replace healthy sources of saturated fat with refined carbs or sugary snacks.
• Don’t eat just red meat (beef, pork, or lamb) but vary your child’s diet with chicken, eggs, fish, and vegetarian sources of protein.
• When you choose to serve red meat, look for "organic" and “grass-fed” to avoid antibiotics, growth hormones, and GMOs often found in industrially raised meat.
• Roast, grill, or slow cook meat and poultry instead of frying.
• Allow your child to enjoy full-fat dairy and choose organic milk, cheese, butter, and yoghurt whenever possible.
• Avoid breaded meats and vegetables and deep-fried foods.
• Avoid snack foods such as corn or potato chips.

 For more on good fats, bad fats, and the debate over saturated fat, see Choosing Healthy Fats.

Weight problems and obesity in children tip 4: Be smart about snacks and sweet food

Your home is where your child most likely eats the majority of his or her meals and snacks, so it is vital that your kitchen is stocked with healthy choices and treats.

• Don’t ban sweets entirely. While many kids' sugar consumption exceeds healthy limits, having a no sweets rule is an invitation for cravings and overindulging when given the chance. Instead, limit the amount of cookies, candies, and baked goods your child eats and introduce fruit-based snacks and desserts instead.
• Limit juice, soda, and coffee drinks. Soft drinks are loaded with sugar—“empty” calories that don’t do anything healthy for your child’s growing body. Shakes and coffee drinks can be just as bad. Many juices aren’t any better nutritionally, so encourage your child to eat a piece of fruit instead—kids love satsuma or tangerine oranges. Instead of soda, offer your child sparkling water with a twist of lime, fresh mint, or a splash of fruit juice.
• Keep snacks small. Don’t turn snacks into a meal. Limit them to 100 to 150 calories.
• Go for reduced-sugar options. When buying foods such as syrups, jellies, and sauces, opt for products labeled “reduced sugar” or “no added sugar.”
• Focus on fruit. Keep a bowl of fruit out for your children to snack on. Offer fruit as a sweet treat. Kid-friendly favorites include frozen juice bars, fruit smoothies, frozen bananas dipped in chocolate and nuts, strawberries and a dollop of whipped cream, fresh fruit added to plain yogurt, and sliced apples with peanut butter.
• Experiment with herbs and spices. Use sweet-tasting herbs and spices such as mint, cinnamon, allspice, or nutmeg to add sweetness to food without the empty calories.
• Check the sugar content of your kid’s cereal. There’s a huge disparity in the amount of added sugar between different brands of cereal, even those proclaiming to be whole grain or high in fiber. Some cereals are more than 50% sugar by weight. Try mixing a low sugar, high-fiber cereal with your child’s favorite sweetened cereal, or add fresh or dried fruit to oatmeal for a natural sweet taste.

Snacks at home
Snacks to stock up:	Snacks to cut back:
Fresh fruit and vegetables that can be taken on the go or packed in a lunch.	Soda, sweetened lemonade, fruit punch, and fruit juice with added sugar.
Whole milk and dairy products, including string cheese.	Hot dogs, fatty lunch meats, sausage, chicken nuggets.
Whole grain breads and cereals, pretzels, nuts, olives.	White bread, sugary breakfast cereals, chips.
Greek yogurt, frozen fruit juice bars, fig bars, ginger snaps.	Cookies, cakes, candy, ice cream, donuts.

Weight problems and obesity in children tip 5: Watch portion sizes

There are strategies you can employ to retrain you and your family’s appetites and avoid oversized servings when eating out.

• Learn what a regular portion size looks like. The portion sizes that you and your family are used to eating may be equal to two or three true servings. Limit portions to the size of your fist.
• Read food labels. Information about serving size and calories can be found on the backs of packaging. You may be surprised at how small the recommended portions are or how many calories are in the dish.
• Use smaller dishes. Portions will look bigger and you’ll eat less when you use small bowls or plates.
• Dish up in the kitchen. To minimize the temptation of second and third helpings, serve food on individual plates, instead of putting the serving dishes on the table.
• Divide food from large packages into smaller containers. The larger the package, the more people tend to eat without realizing it.
• Downsize orders. When eating out, share an entrée with your child or order an appetizer instead. Order half-orders or a medium size instead of a large.

Weight problems and obesity in children tip 6: Get your kid moving

Children who sit too much and move too little are at the highest risk for becoming overweight. Kids need an hour of exercise daily for optimum health. This may seem like a lot, but exercise doesn’t have to happen in a gym or all at once. Instead, try to incorporate movement into your family’s regular routine.

Exercise ideas for kids

It used to be commonplace to find children running around and playing in the streets of their neighborhoods, naturally expending energy and getting exercise. In today’s world, that’s not always an option. If you’re not comfortable letting your children roam free, you still have options for boosting their activity level.

• Play active indoor games. Put the remote away and organize some active indoor games. You can play tag (perhaps crawling tag, so that you keep messes to a minimum), hide-and-seek, or Simon Says (think jumping jacks and stretches).
• Try activity-based video games, such as those from Wii and Kinect which are played standing up and moving around—simulating dancing, skateboarding, soccer, bowling, or tennis. Once you child gains in confidence, get away from the screen and play the real thing outside. 
• Get active outside with your child. Take a walk together, bike around the neighborhood, explore a local park, visit a playground, or play in the yard. If it makes sense for your neighborhood and schedule, walk to and from activities and school.
• Do chores together. Perhaps it’s not your child’s first choice, but doing household chores is a very effective way to get exercise. Mopping, sweeping, taking out trash, dusting or vacuuming burns a surprising number of calories.
• Enroll children in after school sports or other activities. If your budget allows, sign children up to play a sport or get involved in an activity where they are physically active. The local YMCA, YWCA, or Boys’ and Girls’ Club are safe places for children to exercise and play.
• Sign up for a 5 or 10K walk/run with your child. Sometimes having a goal in mind can motivate even the most reluctant exercisers. Find a kid-friendly walk/run “race” in your area and tell your child you’ll be “training” for it together. Be sure to celebrate when you accomplish this feat.

Weight problems and obesity in children tip 7: Reduce screen time

The more time your children spend watching TV, playing video games, or using computers or mobile devices, the less time they’ll spend on active pastimes. Limits on television and computer time lead directly to your child spending more time being physically active. Remember how important it is for you to be a positive role model—yes, you may have to cut down on your own viewing habits—and have a good attitude about the change.

• Limit daily screen time. Studies show a link between screen time and obesity, so set limits on your child’s TV-watching, gaming, and web surfing. Experts recommend no more than two hours per day.
• Stop eating in front of the TV. Limit your child’s calorie intake by limiting time spent eating in front of the tube. Tell your child that, starting now, your family does all their eating at the table.
• Pick a different reward or punishment. Instead of rewarding your child with more time in front of the television or computer, promise something different, such as an outing or an activity of their choice. 

Encourage your child to develop new hobbies

Making major lifestyle changes has the potential to add more stress to a child’s life. At times, your overweight or obese child might feel singled out, sad, angry, embarrassed, or discouraged. In the past, they might have dealt with stress by eating or zoning out in front of the TV. Since this is no longer an option, help them find a healthy alternative. Ask your child what he or she might like to take up as a hobby. Hobbies can help kids boost their self-esteem, relieve stress, and provide a positive outlet.

Weight problems and obesity in children tip 8: Get involved

You can make a huge impact on your children’s health by being involved with the details of their lives.

• Talk to your children. Ask them about the school day, every day. Listen to their concerns and take action if there is something they need.
• Be in touch with teachers. Speak to your child’s teachers, especially P.E. instructors, either in person or on the phone.
• Defy busy schedules. You may feel like neither you nor your child has time for long chats about the day. This may be the toughest lifestyle change to make, due to busy schedules, but it can be done. If you need to, treat getting involved like another appointment or meeting in your day.
• Spend time with your children. You don’t have to spend all your time having heart-to-hearts. Playing, reading, cooking, or any other activity, when done together, can supply your child with the self-esteem boost he or she may need to make positive changes.

When to seek professional help for weight problems and obesity in children

There are no easy options when it comes to tackling childhood weight problems and obesity. Weight-loss surgery and medications are rarely recommended for children and adolescents. If you have changed your family’s eating and physical activity habits and your child has not reached a healthy weight, or if your doctor determines that your child’s health or emotional well-being is at risk because of his or her weight, you may want to consider a weight-control program.
Depending on your child's BMI, age, and health, your doctor may refer you to a registered dietitian, psychologist, and/or exercise physiologist for additional guidance on healthy eating, physical activity, and weight control. Again, any treatment program should address healthy eating and physical activity habits for your entire family.

More help for weight problems and obesity in children

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• Nutrition for Children and Teens: Easy Ways to Help Your Kids Eat Healthier
• Emotional Eating: How to Recognize and Stop Emotional Eating
• How to Start Exercising and Stick to It: Making Exercise an Enjoyable Part of Your Everyday Life
• Healthy Weight Loss and Dieting Tips: How to Lose Weight and Keep It Off

Cooking at home and eating out

• Eating Well on the Cheap: Saving Money on Healthy Food
• Healthy Fast Food: Tips for Making Healthier Fast Food Choices
• Choosing Healthy Fats: Good Fats, Bad Fats, and the Power of Omega-3s

Resources and references

General information about weight problems and obesity in children

Overweight and Obesity – Learn how to tell if your child is overweight, explore the causes and effects of childhood obesity, and find helpful tips for preventing weight problems. (KidsHealth)
We Can! Families Finding the Balance: A Parent Handbook (PDF) – Guide to tackling the problem of childhood obesity and making healthy changes for the whole family. (U.S. Dept. of Health & Human Services)
Helping Your Overweight Child – Parent’s guide to helping an obese or overweight child begin to eat better and be more active. (Weight-control Information Network, National Institute of Diabetes and Digestive and Kidney Diseases)
Is Dieting Okay for Kids? – Discover why the majority of overweight kids should not diet, and find out healthier strategies for combating childhood obesity. (KidsHealth)

Weight problems and obesity in children: resources for parents

Be a Healthy Role Model for Children (PDF) – Ten tips for setting a good example for your child and preventing childhood overweight and obesity. (MyPyramid.gov)
Cut Back on Sweet Treats (PDF) – Ten tips for fighting childhood obesity and overweight by cutting back on added sugar. (MyPyramid.gov)
Talking to Kids About Weight – Advice for addressing the sensitive subject of weight and offering support to an overweight or obese child. (American Dietetic Association)
Healthy at Home – List of practical tips for creating a healthy environment at home and encouraging better habits in overweight or obese children. (Get Kids In Action)

Sugar and obesity in children

Sugary Drinks and Obesity Fact Sheet – How sugary drinks are a major contributor to the current obesity epidemic. (Harvard School of Public Health)
Sugar intake, diabetes and kids – Q&A with a pediatric obesity expert about the link between added sugar and childhood weight gain and diabetes problems. (Stanford Medicine)

BMI Calculators

BMI Calculator – Use this calculator for children and teens, aged 2 through 19 years old. (CDC)
Childhood Obesity Assessment Calculator – Tool that lets you calculate your child’s Body Mass Index (BMI). (Shape Up America)

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