The press has frequently focused on infectious disease epidemics such as H1N1 influenza and HIV, but rarely discusses the growing problem of pediatric obesity. If HIV affected 30% of the population you would bet there would be an outcry for the government to do something about this problem. Right now almost 32% of children 6-17 are considered overweight or obese. There are some general guidelines on what to eat and how much to exercise but really there are no easy straightforward plans for families to address obesity in their children. Obesity is not as simple as eating less and exercising more or following the food pyramid, if it were that simple all my patients would be thin and fit and I wouldn’t be writing this article. Weight management should be approached in a holistic manner in that diet, exercise, emotional and family dynamics should be addressed.

The diagnosis of obesity is dependent on two main factors, height and weight. These two factors are used to calculate the Body Mass Index or BMI. The CDC has an excellent BMI calculator on their website. The BMI is then adjusted for age and graphed to determine the BMI percentile. If the BMI percentile is between 5-84%, that is considered normal; 85-94% is overweight; and greater than or equal to 95% is obese. Your healthcare provider can order additional laboratory tests to rule out metabolic causes for obesity. 

We try not to use the word “Diet” in our practice because it implies a temporary change that will fix a lifelong challenge. We try to emphasize “Healthy Eating” and help the families to make better decisions on what to eat and healthier choices when they have the occasional fast-food. In general, “Fad Diets” usually drastically reduce calories and nutrients in order to quickly produce weight loss. Children and teens need to eat healthy foods for normal growth and fad diets do not address the nutritional needs of growing children. The reality is that it’s almost impossible to avoid fast food nowadays but thankfully many of the major fast food restaurants now offer healthier alternatives to French fries or hamburgers such as salads, fruit or grilled chicken. In addition, we emphasize portion size and second helpings. Most families are already familiar with the food pyramid and it’s a great place to start to get healthy food ideas but this should be a family effort and the entire family’s eating habits should be adjusted. Children tend to eat what their parents buy and if the cabinet is full of cookies and chips that are what they’ll snack on. So we emphasize that parents should be role models for a healthy eating lifestyle. 

Meal & Food Tips

• Make small changes such as switching from soft drinks to water
• Switch from Regular Whole Milk to 1% Milk
• Buy Low Fat Choices such as beans, lean meats, fish
• Don’t buy junk foods for the house
• Keep healthy foods around like fruits and whole grain foods
• Eat regular meals, avoid skipping meals especially breakfast
• Smaller portions (no second helpings)
• Limit snacks (amount and type)
• Avoid food as rewards (If you behave, you’ll get an ice cream)
• Eat together as a family
• Turn off TV during meals

Most of our overweight patients simply don’t get enough exercise. Some of the causes are television-viewing habits, videogames and that physical education programs at schools have been pared down. Before videogames, children were out riding bicycles, skateboarding, and playing basketball. I now recommend to the parents to take their children out to do regular exercise and to participate with their children. The reality is that many of the overweight children have overweight parents. Here parents need to be the role model again and show their children an active lifestyle. Simple changes could be taking a 60-minute walk or bicycle ride together everyday after dinner. The activity doesn’t have to be 60 minutes all at once; it can be two 30-minute walks a day. Offer to have the child pick a fun activity that everyone can enjoy. For those that feel that videogames are tough to give up, I would recommend activity-oriented videogames like Wii Fit Plus or Wii Sports.

Activity Tips

• Start simple like walking
• Short sets of exercises throughout the day instead on one 60 minute period
• Exercise together as a family
• Incorporate activity chores such as mowing the lawn
• Enroll child in an organized sport like Soccer, Baseball, etc.
• Limit TV, computer and video games

Healthcare professionals have largely ignored the emotional aspects of obesity. Children may become overweight because of depression or anxiety that leads to overeating. Oftentimes obese children are singled out and bullied at school because of their appearance. This leads to additional emotional and behavioral problems that parents and healthcare professionals fail to address. Parents should look for signs and symptoms of depression such as social isolation, poor school performance, secretive eating, or changes in mood. These issues should be brought up to your healthcare professional for referral to a psychologist. Eating problems may be a small aspect of a larger emotional issue. Two excellent behavioral health resources are Your Child or YourTeen.

Signs of Depression

• Low self esteem
• Poor school performance or school avoidance
• Irritability
• Socially isolated
• Crying a lot
• Change in sleeping habits
• Vague complaints of illnesses (headaches, stomach aches)
• Thoughts of suicide

Obesity is a complex problem and there is no simple fix for this condition. Parents can make a great impact by being a role model for a healthy living lifestyle. Making healthy food choices now will have lifelong implications for your child. Creating an active lifestyle will keep your child from falling back into a sedentary life of videogames, web-surfing, and television. Parents should be aware that emotional issues can cause obesity or be exacerbated by obesity. Contact your healthcare professional for additional advice on healthy living tips.