Overweight and Obesity

The number of overweight and obese children in the United States is growing at a phenomenal rate. On the whole, kids are spending less time exercising and more time in front of the TV, computer, or video game console. And today's busy families have fewer free moments to prepare wholesome, home-cooked meals, day in and day out. From fast food to electronics, quick and easy seems to be the mindset of many people, young and old, in the new millennium.

Since the 1960s, the number of overweight kids and adolescents in the United States has nearly doubled. Today, 10% of 2- to 5-year-olds and more than 15% of children between the ages of 6 and 19 are overweight. And a whopping 31% of adults are also obese. Studies indicate that overweight and obese adolescents have up to an 80% chance of becoming overweight and obese adults, especially if one or more parent has the same condition.

Overcoming overweight and obesity in your own children means adapting the way you and your family eat and exercise and the way you spend time together. Ensuring that your children lead a healthy lifestyle begins with you, the parent, and leading by example.

Is Your Child Overweight or Obese?

Although you may think that your child is overweight or even obese, only a doctor should make that determination (calculating your child's body mass index, or BMI, can be a good indicator).

To determine BMI, the doctor divides the child's weight by his or her height squared, or wt/ht2. (Important: To use this formula for BMI, the child's weight and height measurements must be in kilograms and meters, respectively. If you use pounds and inches, multiply the result by the conversion factor 703.) This calculation helps the doctor determine whether the child's weight is appropriate for height.

Children ranking higher than the 97th percentile for age are considered obese. Kids with a BMI score between the 85th and 97th percentile are considered overweight or at risk for becoming obese (or extremely overweight). And children who fall between the 5th and 85th percentile are considered normal weight.

For example, a 13-year-old boy who's an average 5 feet, 3 inches tall would rank as follows:

* Above 141 pounds = obese
* 124 -141 pounds = overweight
* 88 - 123 pounds = normal weight
* Below 88 pounds = underweight

There are exceptions, of course, like for those who are very muscular (because extra muscle adds to a person's body weight - but not fatness). It's important to remember that BMI is usually a good indicator - but is not a direct measurement - of body fat.

If you're worried that your child or teen may be overweight, make an appointment with your family doctor to find out for sure. Your doctor will need to evaluate your child not only for obesity, but for the medical conditions that can be associated with obesity (see below).

Before adopting any kind of diet or weight-loss plan, talk to your child's doctor, who may refer you to a registered dietitian or a weight management program. Depending on the child's weight and age, the doctor or specialist may not emphasize immediate weight loss but may focus, instead, on decreasing the rate of weight gain as the child grows.

The Effects of Overweight and Obesity

Not only are overweight and obese children at risk for serious health conditions like type 2 diabetes, high blood pressure, and high cholesterol - all once considered exclusively adult issues - they're also prone to low self-esteem that stems from being teased, bullied, or rejected by peers. Overweight children are often the last to be chosen as playmates, even as early as preschool. They may also be more likely than average-weight children to develop unhealthy dieting habits and eating disorders, such as anorexia nervosa and bulimia, and they may be more prone to depression, as well as substance abuse.

Being overweight or obese can be associated with medical conditions that affect a child's present and future health and have direct impact on quality of life:

* trouble with bones and joints
* shortness of breath that makes exercise, sports, or any physical activity more difficult and may
* aggravate the symptoms or increase the chances of developing asthma
* restless or disordered sleep patterns
* tendency to mature earlier (overweight kids may be taller and more sexually mature than their peers; overweight girls may enter puberty earlier, have irregular menstrual cycles, excessive body hair growth, and may experience potential fertility problems in adulthood)
* the presence of risk factors such as hypertension, lipid problems, insulin resistance, and type 2
* diabetes, which can lead to the early development of cardiovascular disease
* liver problems
* depression

Serious adult medical conditions like heart disease, heart failure, stroke, and certain cancers can have their roots in childhood. Preventing or treating obesity in children may reduce the risk of developing these conditions as they get older.

What Causes Obesity?

There are a number of factors that can cause obesity, either alone or together. If someone becomes overweight or obese, genetic factors, lifestyle habits, or both may be involved.

Much of what we eat is quick and easy - from fat-laden fast food to microwave and prepackaged meals. Daily schedules are so jam-packed that there's little time to prepare healthier meals or to squeeze in some exercise. Portion sizes, in the home and out, have drastically increased.

Plus, now, more than ever, life is sedentary - children spend more time playing with electronic devices, from computers to home video game systems, than actively playing outside. Television is a major culprit.

"We should be turning off the TV for every age," says Dr. Dorothy Anne Richmond, director of the Eating, Assessment and Treatment Clinic at Georgetown University Hospital in Washington, D.C. "More TV viewing is associated with being overweight."

In fact, kids younger than 8 spend an average of 2.5 hours watching TV or playing video games, and kids 8 and up spend 4.5 hours plopped in front of the TV or wriggling a joystick. In other words, once many kids get home from school, virtually all of their free time before dinner, doing homework, and getting ready for bed is spent in front of one screen or another!

And although physical education (PE) in schools can help kids get up and moving, more and more schools are cutting PE programs altogether or cutting down on the amount of time spent actually doing fitness-building physical activities. One study showed that gym classes offered third graders just 25 minutes of vigorous activity each week.

A greater reliance on "food fixes" to deal with emotions can also contribute to weight gain. Some people tend to eat more when they're feeling sad, stressed, or bored. Children will often pick up negative eating patterns from their parents. Certain endocrine problems, genetic syndromes, and medications can also be associated with excessive weight gain.

Genetics also plays a role - genes help determine how your body stores and burns fat just like they help determine other body traits. Because both genes and habits can be passed down from one generation to the next, multiple members of a family may struggle with weight.

People in the same family tend to have similar eating patterns, maintain the same levels of physical activity, and adopt the same attitudes toward being overweight. Studies have shown that a child's risk of obesity greatly increases if one or more parent is overweight or obese.

Overcoming Overweight and Obesity in Your Child
The key to keeping kids of all ages at a healthy weight is taking a whole-family approach. It's the "practice what you preach" mentality. Make eating and exercise a family affair. Have your children help you plan healthy meals and go grocery shopping, so they can learn how to make good food choices.

Lead by example. Watch less television and go for a walk with your children. Help them feel good about themselves and build their confidence. "Some activities are more prone to building self-esteem, like tae kwon do or other martial arts," Dr. Richardson suggests.

Avoid falling into some common food/eating behavior traps:

* Don't reward children for good behavior or try to stop bad behavior with sweets or treats. Come up with other solutions to modify their behavior.
* Don't maintain a clean-plate policy. Be aware of kids' hunger cues. Even babies who turn away from the bottle or breast send signals that they're full. If kids are satisfied, don't force them to continue eating. Reinforce the idea that they should only eat when they're hungry.
* Don't talk about "bad foods" or completely eliminate all sweets and favorite snacks from overweight children's diets. Children may rebel and overeat these forbidden foods outside the home or sneak them in on their own.

Here are some additional recommendations for children of all ages:

* Birth to age 1: Some doctors feel that breastfeeding instead of using formula may help prevent excessive weight gain because breastfed babies are more able to control their own intake and follow their own internal hunger cues. Also, limit the amount of extra sugar infants get, particularly in what they drink; instead of lots of juice, offer water when they're thirsty.
* Ages 2 to 6: Start good habits early. Limit children's TV time (better yet, leave the tube off) and increase their physical activity. Encourage children to eat healthy foods and only to eat when they're hungry. "Don't use food as a reward system," Dr. Richmond says. Make good foods fun and try to eat meals together as often as possible.
* Ages 7 to 12: Encourage children to be physically active every day, whether it's a pick-up game of soccer or playing in a community sports league. Keep your kids active at home, too, through everyday activities like walking and or playing in the yard. Even basic household chores like vacuuming, washing the car, and raking leaves burn calories.
* Ages 13 to 17: Teens like fast-food joints, but try to steer them toward healthier choices like grilled chicken sandwiches, salads, and smaller sizes. Encourage them to join a school sports team. If they don't feel very athletic, suggest a less competitive community program or alternative sport like skateboarding, inline skating, or mountain biking. Don't force any one sport or activity - help your children find what they enjoy and then support them in their efforts.
* All ages: Cut down on TV, computer, and video game time, and discourage eating while watching the tube. Try to include 5 servings of fruits and vegetables a day in their diet, plan healthy snacks, and encourage kids to eat a nutritionally balanced breakfast every day.

Most of all, let your children know you love them - no matter what their weight - and that you want to help them be happy and healthy. If you, as a parent, eat well and exercise often and incorporate healthy habits into your family's daily life, you're modeling a healthy lifestyle for your children that could last into adulthood. Instead of constantly harping on kids to eat well and be active, make it a family affair that will become second nature for both you and your children.