Obesity

Definition

• Your child appears overweight to an objective person.
• Your child’s body mass index is greater than 85% for age.
• The skinfold thickness (fat layer) of your child’s upper arm is more than 1 inch (25mm), as measured with a special instrument.
• More than 25% of American children are overweight.

Causes

• The tendency to be overweight is usually inherited.  If one parent is overweight, half of the children will be overweight.  If both parents are overweight, most of their children will be overweight.  If neither parent is overweight, the children have a 10% chance of being overweight.
• Heredity alone (without overeating) accounts for most mild obesity (defined as less than 30 pounds overweight in an adult).  Moderate obesity is 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.  It is therefore not reasonable to blame your child for being overweight.
• Less than 1% of obesity has an underlying medical cause.  Your physician can easily determine this by a simple physical examination.

Expected Course

Losing weight is very difficult.  Keeping the weight off is also a chore.  The best time for losing weight is when a child is over 15 years old, that is, when he/she becomes concerned with appearance.  The self- motivated teenager can follow a diet and lose weight regardless of what the family eats.  Helping children lose weight between 5 and 15 years of age is very difficult because they have access to so many foods outside the home and are not easily motivated to lose weight.  It is not quite as difficult to help a child less than 5 years old to lose weight because the parents have better control of the foods offered to the child.

How to Help Older Children and Teenagers Lose Weight

Readiness and Motivation 

• Teenagers can increase their motivation by joining a weight-loss club such as TOPS or Weight Watchers.  Sometimes schools have classes for helping children lose weight.  A child’s motivation can often be improved if diet and exercise programs are undertaken by the entire family.  A cooperative parent-child weight-loss program with individual goals is usually more helpful than a competitive 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/she is probably already disappointed in himself.  He needs his family to support him and accept him as he is.  Self-esteem can be reduced or destroyed by parents who become over-concerned 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 and should be self-imposed.
  • Never deprive your child of food if he says he is hungry.  Withholding food eventually leads to overeating.
  • Don’t nag him about his weight or eating habits.

Setting Weight-Loss Goals

• Pick a realistic target weight, depending on your child’s bone structure and degree of obesity.  The loss of 1 pound per week is an attainable goal, but your child will have to work quite hard to maintain this rate of weight loss for several weeks.  Have your child weigh himself no more than once a week; daily weighings generate too much false hope or disappointment.  Keeping a record of weekly weights may provide added motivation.  When losing weight becomes a strain, have your child take a few weeks off from the weight-loss program.  During this time, try to 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 permanent moderation in eating and maintaining a reasonable exercise program.  Your child will probably always have the tendency to gain weight easily and it’s important that he understand this.

Diet:  Decreasing Calorie Consumption 

• Your child should eat three well-balanced meals of average-size portions every day.  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 (satiated).
• Encourage average portions and discourage seconds.  Shortcuts such as fasting, crash dieting, and diet pills rarely work and may be dangerous.  Liquids diets are safe only if used according to directions.  If you have any questions, consult a dietician.
• 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 drinks, or flavored mineral water.  Because milk has lots of calories, your child should drink no more than 16 ounces of skim or low-fat milk each day.  Since fruit juices and 2% milk have similar calories per ounce, keep juice consumption to 8 ounces or less per day.  All other drinks should be either water or diet drinks.  Encourage your child to drink six glasses of water each day.
  • Meals:  Serve fewer fatty foods (for example, eggs, bacon, sausage, 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, boiled, or steamed foods and fewer fried foods.  Serve more fruits, vegetables, salads, and grains.
  • Desserts:  Encourage smaller-than-average portions.  Encourage more gelatin and fresh fruits as desserts.  Avoid rich desserts.  Do not serve seconds.
  • Snacks:  Serve only low-calorie foods such as raw vegetables (carrot sticks, celery sticks, raw potato sticks, pickles), raw fruits (apples, oranges, cantaloupe), popcorn, or diet soft drinks.  Limit snacks to two each day.
  • Vitamins:  Give your child one multivitamin tablet daily during the weight-loss program.

Eating 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 weight 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 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 and fresh fruits and vegetables.
  • Leave only low-calorie snacks out on the counter – fruit, or 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.  Discourage your child from continual snacking throughout the day.
  • Allow eating in your home only at the kitchen or dining-room table.  Discourage eating while watching television, studying, riding in the car, or shopping.  Once eating becomes associated with these activities, the body learns to expect it.
  • Discourage eating alone.
  • Help your child reward herself for hard work or studying with a movie, television, music, or a book rather than food.
  • Put up reminder cards on the refrigerator and bathroom mirror that state: Eat Less.

Exercise:  Increasing Calorie Expenditure 

• Daily exercise can increase the rate of weight loss as well as the sense of physical well-being.  The combination of diet and exercise is the most effective way to lose weight.  Try the following forms of exercise:
  • Walk or bike 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 aerobic class.
  • Take the dog for a long walk.
  • Spend 30 minutes daily exercising or dancing to records or music on television.
  • Use an exercise bike or hula-hoop while watching television.  (Limit television sitting time to 2 hours or less each day.)

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 6pm.  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.

Call our office during regular hours if . . . 

• Your child has not improved his eating habits and exercise 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 do so.
• You think your child is depressed.
• Your child has no close friends.
• You have other questions or concerns.