Overweight children and their parents may be
referred to a registered dietician or nutritionist who
can help them develop a plan for eliminating empty
calories and increasing the amount of nutrient-rich,
low-calorie foods in their diets. Nutrition education
usually involves the entire family. Children may be
asked to keep a food diary to record everything that
they eat in order to determine what changes in behavior
and diet need to be made. Typically, children are
encouraged to increase their level of exercise rather
than to drastically reduce calories.
Drug therapy and weight-loss surgery are very
rarely used in children, except in the most extreme
cases of health-threatening obesity when other methods
of weight control have failed. Some teenagers
benefit from joining a structured weight-loss program
such as Weight Watchers or Jenny Craig. They should
check with their physician before joining.
Nutrition/Dietetic concerns
Teaching children how to eat a healthy diet sets a
framework for their lifetime eating habits.Anutritionist
or dietitian can help families to understand how
much and what kinds of food are appropriate for their
child’s age, weight, and activity level.
The American Heart Association has adapted the
following dietary suggestions from the federal Dietary
Guidelines for Americans 2005. These guidelines
apply to people over age 2. Separate guidelines exist
for infant nutrition.
-For children ages 2–3, no more than 35% of their
calories should come from fats.
-Children over age 3 should limit their fat intake to
about 30% of their total calories. These fats should
be monounsaturated or polyunsaturated. Saturated
fats and trans fats should be avoided.
-Fruit and vegetable intake should be increased, but
fruit juice should be limited.
-At least half of all grains eaten should be whole
grains.
-Sugary drinks, such as carbonated soft drinks,
should be extremely restricted.
-Dairy products should be fat-free or low fat after age
2. Before age 2 children need milk fats for proper
growth and development of the nervous system.
-A variety of foods should be offered children, including
fish and shellfish.
-Overfeeding children or making them ‘‘clean their
plates.’’ should be avoided.
It is often difficult for parents to understand how
much food their child should eat at a particular age.
Parents tend to overestimate the amount of food small
children need. The daily amounts of some common
foods that meet the American Heart Association
guidelines for different ages are listed below. These
amounts are based on children who are sedentary or
physically inactive. Active children will need more
calories and slightly larger amounts of food.
-children age 2– 3 years: Total daily calories 1,000;
milk 2 cups; lean meat or beans 2 ounces, fruits 1 cup;
vegetables 1 cup; grains 3 ounces.
-girls ages 4–8 years: Total daily calories 1,200; milk 2
cups; lean meat or beans 3 ounces; fruits 1.5 cups;
vegetables 1 cups; grains 4 ounces.
-boys ages 4–8 years: Total daily calories 1,400; milk 2
cups; lean meat or beans 4 ounces, fruits 1.5 cup;
vegetables 1.5 cups; grains 5 ounces.
-girls ages 9–13 years: Total daily calories 1,600; milk
3 cups; lean meat or beans 5 ounces, fruits 1.5 cups;
vegetables 2 cups; grains 5 ounces.
-boys ages 9–13 years: Total daily calories 1,800; milk
3 cups; lean meat or beans 5 ounces, fruits 1.5 cups;
vegetables 2.5 cups; grains 6 ounces.
-girls ages 14–18 years: Total daily calories 1,800;
milk 3 cups; lean meat or beans 5 ounces, fruits 1.5
cups; vegetables 2.5 cups; grains 6 ounces.
-boys ages 14–18 years Total daily calories 2,200; milk
3 cups; lean meat or beans 6 ounces, fruits 2 cups;
vegetables 3 cups; grains 7 ounces.
Therapy
Children who are overweight often have psychological
and social problems that can be helped with
psychotherapy in addition to nutritional counseling.
-Cognitive behavior therapy (CBT) is designed to confront
and then change the individual’s thoughts and
feelings about his or her body and behaviors toward
food, but it does not address why those thoughts or
feelings exist. Strategies to maintain self-control may
be explored. This therapy is relatively short-term.
-Family therapy may help children who eat for emotional
reasons related to conflict within the family.
Family therapy teaches strategies to reduce conflict,
disorder, and stress that may be factors in triggering
emotional eating.
-Although drugs are rarely prescribed for weight control
in children, many overweigh children have
depression and anxiety. Drug therapy to treat these
conditions may help the child to better deal with his or her weight and become more involved in physical
activities and weight loss strategies.
Prognosis
The younger the child is when weight control strategies
begin, the better the chance that the child will be
able to maintain a normal weight. When it comes to
weight control, one advantage children over adults is
that they grow. If a child can maintain his weight without
gaining, he may grow into a normal weight as he
becomes taller. Parents need to be careful about how
they approach weight loss in children. Critical comments
about weight from parents or excess zeal in
putting their child on a rigorous diet can trigger eating
disorders such as anorexia nervosa or bulimia nervosa
in some children, especially adolescent girls.
Children who remain overweight have a much
greater likelihood of being overweight adults with all
the health problems that obesity brings. Studies have
found that 26–41% of preschoolers who are obese
become obese adults. In school-aged children, 42–63%
of children with obesity become obese adults. The
greater the degree of overweight, the higher the likelihood
that overweight will continue into adulthood.
Prevention
Parents must take the lead in preventing obesity in
children. Some of the ways they can do this are:
-Serve a healthy variety of foods; keep healthy snacks
on hand.
-Choose low-fat cooking methods such as broiling or
baking
-Eliminate junk snack food and sugary beverages
from the house. This removes temptation and eliminates
the need to nag.
-Eat meals together as a family rather than grabbing
something quick on the run.
-Limit visits to fast-food restaurants.
-Limit television and computer time.
-Plan family activities that involve physical activity,
such as hiking, biking, or swimming.
-Encourage children to become more active in small
ways such as walking to school, biking to friends’
houses, or doing chores such as waking the dog or
mowing the lawn.
-Avoid using food as a reward.
Pack healthy homemade lunches on school days.
-Encourage school officials to eliminate soda machines
on campus, bake sales, and fundraising with candy
and cookies.
-Set realistic goals for weight control and reward
children’s efforts.
-Model the eating behaviors and active lifestyle you
would like your child adopt.
