Clinical Reference Systems: Pediatric Advisor 10.0
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Description

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

More than 25 percent of American children are overweight.

Causes

The tendency to be overweight is usually inherited. If one parent is overweight, probably 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, whereas 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 whether your child's obesity has a physical cause with 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 she becomes very 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

1. 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 often can 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 program focused on who can lose weight faster.

2. 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. Not letting a child eat eventually leads to overeating.
   • Don't nag your child about his weight or eating habits.

3. Setting weight-loss goals

   Pick a realistic target weight dependent on your child's bone structure and degree of obesity. The loss of 1 pound a week is an attainable goal. However, your child will have to work quite 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.

4. Diet: Decreasing calorie consumption

   Your child should eat three 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 (satiated). 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 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. 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, 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.
   • Desserts: Encourage smaller-than-average portions of desserts. Encourage more Jell-O and fresh fruits as desserts. Avoid rich desserts. 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 two snacks a day.
   • Vitamins: Give your child one multivitamin tablet daily during the weight-loss program.

5. 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 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. Discourage your child from continual snacking ("grazing") throughout the day.
   • Allow eating in your home only at the kitchen or dining-room table. Discourage eating while watching TV, 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.
   • 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."

6. 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:

   • Walking or riding a bicycle instead of riding in a car.
   • Using stairs instead of elevators.
   • Learning new sports. Swimming and jogging are the sports that burn the most calories. Your child's school may have an aerobics class.
   • Taking the dog for a long walk.
   • Spending 30 minutes a day exercising or dancing to records or music on TV.
   • Using an exercise bike or Hula Hoop while watching TV. (Limit TV sitting time to 2 hours or less each day.)

7. 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.

Call Your Child's Physician 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.