Curbing Weight Problems and Obesity in Children

Helping Your Child Reach and Maintain a Healthy Weight

As a parent, few things are cuter than your full-cheeked baby or the chubby knees of your toddler. For some children, however, that adorable baby fat may turn into a health concern. If you’re watching your child struggle with his or her weight, you may feel alone or helpless; in reality, you are neither. Childhood obesity affects an enormous and growing number of families around the world, but the vast majority of these cases are preventable—and can still be reversed. With support, encouragement, and positive role modeling, you can help your child reach and maintain a healthy weight.

Childhood obesity: a growing problem

Over the past 30 years, the number of kids with weight problems has increased at an alarming rate. Today, 1 out of 3 children and teens in the U.S. are overweight or obese. Those extra pounds put kids at risk for developing serious health problems, including diabetes, heart disease, and asthma. Childhood obesity also takes an emotional toll. Overweight and obese children often have trouble keeping up with other kids and joining in sports and activities. Other kids may tease and exclude them, leading to low self-esteem, negative body image, and even depression.

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 Facts about Weight Problems and Obesity in Children
Myth 1: Childhood obesity is genetic, so there’s nothing you can do about it.

Fact: 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 2: Children who are obese or overweight should be put on a diet.

Fact: 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 3: It’s just baby fat. Children will outgrow the weight.

Fact: 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.

To combat weight problems, 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 canchoose to get off the bus one stop earlier than usual and walk the rest of the way, especially when you are with your kids. Youcan 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.

 

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.

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:

  1. Avocados
  2. Olives
  3. Olive oil
  4. Nuts such as almonds, peanuts, macadamia nuts, hazelnuts, pecans, cashews, and walnuts
  5. Fatty fish such as salmon, tuna, mackerel, herring, trout, sardines, or sablefish
  6. Non-GMO sources of soy and tofu
  7. Brussels sprouts, kale, spinach
  8. Sunflower, sesame, and pumpkin seeds
  9. 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:

  1. Avoid saturated fat from processed meats, packaged meals, and takeout food.
  2. Don’t replace healthy sources of saturated fat with refined carbs or sugary snacks.
  3. 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.
  4. 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.
  5. Roast, grill, or slow cook meat and poultry instead of frying.
  6. Allow your child to enjoy full-fat dairy and choose organic milk, cheese, butter, and yoghurt whenever possible.
  7. Avoid breaded meats and vegetables and deep-fried foods.
  8. Avoid snack foods such as corn or potato chips.

For more on good fats and bad fats, see Choosing Healthy Fats.

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.

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.

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.

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.

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.

Safe Weight Loss for Seniors through Diet and Exercise

In the United States, the number of obese older adults has reached disturbing heights—now affecting approximately 20 percent of those ages 65 and older—and is only expected to rise as more “baby boomers” become senior citizens.

Weight loss through calorie reduction or exercise is generally good for most people as an intervention in obesity, although the appropriateness of these methods has historically been a matter of controversy in older adults who are overweight.

A major concern with weight loss for seniors is the accompanying loss of lean tissue, which can accelerate existing sarcopenia (age-related loss of muscle and strength). The result could also include reduction of bone mineral density that could worsen frailty and lead to greater risk of bone fractures and broken hips. Studies have yet to provide sufficient evidence, one way or another, as to whether or not weight loss provides a true enhancement to quality of life.

In a one-year, randomized, controlled trial, researchers from Washington University School of Medicine in St. Louis evaluated independent and combined effects of weight loss through calorie reduction and exercise in nearly 100 obese older adults with an average age of 70. The study, published in the March issue of New England Journal of Medicine, randomized subjects into one of four groups:

  1. Control group – participants of which did not receive any advice to change diet or activity.
  2. Diet group – followed a reduced-calorie diet (deficit of 500 to 750 calories per day) with high-quality protein (1 gram per kilogram of body weight per day).
  3. Exercise group – maintained weight and exercised three times weekly, which included 90 minutes of aerobic exercises, resistance training, and flexibility and balance exercises.
  4. Diet-exercise group – combined weight management instructions and exercise trainings as described in 1 and 2.

To “even the playing field” and reduce confounding variables,  the researchers gave participants 1,500 milligrams of calcium and 1,000 IU of vitamin D as supplements per day.

Villareal et al PPT graphResults from this carefully designed study show the “diet-exercise group” preserved more lean muscle and bone density when compared to the other groups. They also gained significantly better physical function and were less frail than other groups, outperforming in all measured parameters. (See Figure A: Results of Physical Performance Test (PPT).)

“Weight loss combined with regular exercise may be beneficial in helping obese older adults maintain their functional independence,” the authors wrote.

Engaging in a variety of exercises, such as aerobic exercises, resistance training, and flexibility exercises is essential for healthy aging. Most older, obese adults are able to safely engage in regular physical activity; however, because fitness levels vary, a medical professional is important to determine which exercises are appropriate for an individual’s specific needs. Certain medical conditions, as well as medications, can also affect a person’s tolerance for exercise.

Aerobic Exercise

Moderate intensity aerobic exercise, 30 minutes a day, five times per week is currently recommended for adults ages 65 and older, according to the guidelines presented by the American College Sports of Medicine (ACSM). Those who are not used to exercising can start out with a shorter duration at a lower intensity and work up to the recommendations.

Aerobic exercise can lead to improved cardiovascular function, better quality of sleep, improved mental health, weight loss, and enhanced immune function. Suggested aerobic activities for older adults include low-impact exercises such as walking, biking, low-impact aerobics, and water activities such as swimming or water aerobics.

Resistance Training

Resistance training is essential to preserve lean muscle and bone density or even regain lost muscle. Seniors should perform resistance-training exercises two to three times weekly. The trainings should consist of 8 to 10 different strength exercises with 8 to 12 repetitions each. Again, it’s best to start out slow, with lighter weights and fewer repetitions.

There are many different types of strength training exercises and a variety of equipment that can be used, including weight-training machines, dumbbells, resistance bands, medicine balls, or weighted bars.

It’s best to work muscles to the point of fatigue, without overstraining, while taking enough time between workouts to allow the muscles to rest and recover. (Some examples of strength training exercises can be seen in Kathy Coover’s at-home workout. See KC Workout.pdf.)

Flexibility Exercises

Flexibility and balance are also factors important to health that decrease with age. Leading a sedentary lifestyle can cause connective tissues to weaken and joints to stiffen. Ultimately, the lack of activity affects a person’s range of motion, balance and posture.

Performing stretching exercises regularly can help improve flexibility and increase freedom of movement. Every workout should begin and end with proper stretching exercises to help warm up and soothe the muscles. Stretching, along with strength exercises, can also improve balance, which can help reduce the risk of falling, particularly important for elderly individuals.

Seniors (or anyone, really) should be sure to warm up to get blood flowing before stretching and then hold each stretch for 20 seconds to help avoid injury.

Final Word

It’s never too late to begin a weight-control and exercise program. Along with a healthy diet, engaging in individually-appropriate physical activity—aerobics, resistance training, and flexibility exercises—can provide seniors a way toward feeling younger.