Clinical Reference Systems: Pediatric Advisor 10.0

DESCRIPTION

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

More than 25 percent of American teenagers 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 percent 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.

Less than 1 percent of obesity has an underlying medical cause. Your physician can easily determine whether your 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 teenager becomes very concerned with personal appearance. A self-motivated teenager can follow a diet and lose weight regardless of what his or her family eats.

HOW TO LOSE WEIGHT

1. Motivation

   You can increase your motivation by joining a weight-loss club such as TOPS or Weight Watchers. Sometimes schools have classes for helping teenagers lose weight.

2. Setting weight-loss goals

   Pick a realistic target weight dependent on your bone structure and degree of obesity. The loss of 1 pound a week is an attainable goal. However, you will have to work quite hard to lose this much weight every week for several weeks. You should weigh yourself no more than once each week; daily weighings generate too much false hope or disappointment. When losing weight becomes a strain, take a few weeks off from the weight-loss program. During this time, try to stay at a constant weight.

   Once you have 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. You will probably always have the tendency to gain weight easily and it's important that you understand this.

3. Diet: Decreasing calorie consumption

   You should eat three well-balanced meals a day of average-sized portions. There are no forbidden foods; you can have a serving of anything family or friends are eating. However, there are forbidden portions. While you are reducing, you must leave the table a bit hungry. You cannot lose weight if you eat until full (satiated). Eat average portions instead of large portions and avoid 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 drink 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, drink no more than 16 ounces of skim, 1-percent, or 2-percent milk each day. Drink no more than 8 ounces of fruit juice a day. All other drinks should be either water or diet drinks. Try to drink six glasses of water each day.
   • Meals: Eat 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. Eat more baked, broiled, boiled, or steamed foods and fewer fried foods. Eat more fruits, vegetables, salads, and grains.
   • Desserts: Try to eat smaller-than-average portions of desserts. Try more Jell-O and fresh fruits as desserts. Avoid rich desserts. Do not eat second helpings.
   • Snacks: Eat mainly 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. You should have no more than two snacks a day.
   • Vitamins: Take one multivitamin tablet daily during your weight-loss program.

4. Eating habits

   To counteract the tendency to gain weight, you must learn eating habits that will last you for a lifetime.

   • Don't skip any of the three basic meals.
   • Drink a glass of water before meals.
   • Eat smaller portions.
   • Chew your food slowly.
   • Avoid high-calorie snack foods such as potato chips, candy, or regular soft drinks.
   • Do 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.
   • Eat no more than two snacks each day. Avoid continual snacking ("grazing") throughout the day.
   • Eat only at the kitchen or dining-room table. Don't eat 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.
   • Don't eat alone.
   • Reward yourself for hard work or studying with a movie, TV, music, or a book instead of food.
   • Post some reminder cards on the refrigerator and bathroom mirror that state "EAT LESS" or "STICK TO THE PROGRAM".

5. 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 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 your TV sitting time to 2 hours or less each day.)

6. Social activities: Keeping the mind off food

   The more outside activities you participate in, the easier it will be for you to lose weight. Spare time fosters nibbling. Most snacking occurs between 3 and 6 PM. Fill after-school time with activities such as music, drama, sports, or scouts. A part-time job after school may help. If nothing else, call or visit friends. An active social life almost always leads to weight reduction.

CALL YOUR PHYSICIAN DURING OFFICE HOURS IF:

• You have not improved your eating and exercise habits after trying this program for 2 months.
• You are a compulsive overeater.
• You are depressed.
• You feel you have no close friends.
• You have other questions or concerns.