Understanding and Preventing Childhood Obesity

t's hard not to smile when you see an overweight child with a round face or chubby little thighs. But the cherubic image of an overweight child raises several important questions. Is he dangerously overweight? Will the baby fat melt away with age? Does she eat too much? Exercise too little? Is an overweight child an unhealthy child? Should we just accept this child's weight as his or her predestined body type and focus on developing the child's self-esteem?

 

Obese Child, Obese Adult?

Such concerns are valid. According to a national health survey, nearly one-third of children aged 6 to 11 are obese and that number is growing. Why worry? For one thing, chances are that the obese child will become an obese adult. About one-third of obese preschool children and about half of obese school-age children become obese adults, with the risk of adult obesity at least twice as high for obese children as non-obese children. With overweight adults facing such life-threatening health risks as high blood pressure, diabetes, heart disease, gall bladder disease and cancer, chances are that whatever we can do to prevent obesity in childhood will lengthen lives.

Childhood obesity is not only a health issue. Anyone who has played in a schoolyard is familiar with the shouts of "Fatso!" "Baby Huey!" and "Chubby Checker!" that overweight kids hear from their peers. They're even treated as stupid or inferior by some teachers and other adults. As a result, adults who've been overweight as children often suffer from low self-esteem and face serious social, psychological and economic problems.

 

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What's a Child Care Provider to Do? - How can you help an overweight child?

Help parents recognize that their child's weight is an issue and make recommendations for handling the child's weight problem. Because you provide two or even three of the child's meals each day and supervise daytime activities, you're in an excellent position to help the child directly. You can help prevent obesity by teaching healthy eating and exercise habits that children take home.

One hotly debated issue is when a child's weight should be considered to be a problem. After all, we often assume that the fat on a child is baby fat the child will lose as he or she gets older. For some children, that's undoubtedly true. Yet, obesity experts disagree on when a child should have outgrown this baby fat and start slimming down. For some researchers, the age is six. Others suggest waiting until the age of eight before putting a child on a weight control program.

Two strong clues to whether a child's weight needs to be addressed:

• The child has been in the 95th percentile in weight for height for several years.

• One or both parents are overweight or obese.

Encourage parental involvement so the child knows that he/she has the whole family's support.

Be sensitive to the parents' cultural bias. Some members of ethnic groups, including African-Americans, Native Americans and Hispanics, consider overweight to be a sign of health and prosperity. Be sure these parents are aware of the risks of obesity and the importance of addressing the problem early on.

Recommend programs that emphasize nutrition, exercise and social issues. The most successful weight control programs for children are those that involve parents and treat the whole child by offering nutrition counseling, psychosocial counseling and exercise instruction. Weight loss programs that emphasize low-calorie diets should be avoided. Remember, an adequate diet is necessary to ensure a child's growth. Programs should be designed to control the child's weight as he or she continues to grow.

Teach healthy eating and exercise habits to all children. The best way to control obesity is to prevent it by serving nutritious snacks and leading exercise sessions. Encourage these practices at home by inviting parents to day care programs, send home news of your activities and provide handouts on activities that can be done at home.

Discourage children from teasing others.

Don't create an eating disorder or poor self-esteem. The emphasis should be on teaching children to eat right and exercise regularly. Avoid promoting an ideal body image of thinness. Overweight children may continue to be larger than the ideal even after developing healthy habits. These children need to know that their self-worth is not tied to how much they weigh or how they look. Instead, emphasize their talents and accomplishments. Help all children to accept and appreciate their individual body shapes.

Ilene V. Smith, M.S., R.D., C.N. is a nutritionist in private practice in New York City. She is currently developing a pediatric obesity program for New York Medical College and serves on the American Heart Association-New York affiliate Task Force on Obesity and Inactivity in Youth.

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Will A Chubby Child Be A Fat Adult?

In the past, chubby babies considered healthy babies. Then came the dawning of our society's “slim-mania�. Chubby babies were no longer cute, and the fear of a lifetime of weight problems appeared. But you rest assured – a fat baby is not predictive of a fat adult. However, there are many good eating habits you can instill in babies and children to ensure a healthier lifestyle for many years to come.

Obesity in Children

During the past 20 years, obesity among 6 to 11 year-old children has increased 54%. Fortunately, over weight infants and children are not doomed to have weight problems as adults. A good feeding relationship between the provider and the child can minimize future problems. In this relationship the provider provides the food, and the child selects the appropriate amount. Conversely, deprivation of food n overweight infants or children makes them crabby and obsessed with food. They need the nourishment – that's why you should never put a growing child on a weight-reduction diet without a doctor's supervision. Allowing children to choose from a wide selection of nutritious foods helps them establish good eating habits.

Eating Philosophies

Planning snacks and mealtimes is the most important factor in avoiding obesity. Children who are allowed to graze between meals consume poor, high-calorie diets. They need to know that their provider and parents value a family mealtime. Children should not be forced to clean their plates or to eat foods they hate.

To avoid hopeless power struggles let them be the guide on the quantity they want to eat. Their appetites fluctuate daily. Small tablespoon servings are adequate for little ones, but children can take more with increasing age.

Desserts and sweets should not be used for rewards. Instead, place dessert on the table with the rest of the meal, and your child can decide when to eat it.

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Does Dieting Work?

Dieting is a temporary change in eating designed to dramatically lower calories for the purposes of weight loss. Any weight control diet should represent an overall nutritional plan that takes into account the quality and quantity of food necessary to provide for optimum health. Dieting is a temporary solution to the long-term problem of weight management. Sometimes the adjustments made to "go on a diet" are extreme, cannot be sustained, and are not nutritionally sound.

Parents of overweight children are encouraged to consult with a doctor or registered dietitian to modify the child's eating behaviors, rather than just restrict calories. Children are developing both physically and mentally, and they need adequate nutrition as they grow. Just as too many calories can cause obesity and the health problems that accompany it, a diet with too few calories can have unhealthy consequences as well. Combining a healthy diet with exercise is the best way to achieve healthy levels of body fat.

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Making Healthy Habits a Family Affair

To promote healthy attitudes about eating and fitness in your child:

• Take a look at your own eating habits to see if you're setting a good example.
• Eliminate unhealthy foods from your household rather than singling out your child and prohibiting her from eating them.
• Keep healthy snacks in a place where your child can easily get to them.
• Make time to exercise with your child.
• Limit TV and computer time for the whole family, and don't eat in front of the TV.
• Discourage talk about weight unless your child brings it up.
• Avoid cute names like "pleasingly plump" or "skinny Minnie."
• Avoid preparing fried and high-fat convenience foods.
• Support your child by creating healthy habits for the entire family.

The best thing you can do is make good nutrition and exercise a family affair by planning lower fat meals, nutritious snacks, and family activities. This will make your child feel included in a total family effort focused on health and not feel isolated as the one with the problem

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Factors to identify kids at risk for weight problems studied

Being able to identify children "at risk" for weight problems may enable health professionals to help them long before those excess pounds start adding up.

"There has been a dramatic increase in the number of overweight children in America over the past decade," said Dr. Margarita Treuth, a USDA/ARS Children's Nutrition Research Center scientist and Baylor College of Medicine assistant professor of pediatrics.

According to the latest national statistics, almost one in four children are at or above the 85th percentile of weight for height on pediatric growth charts and are considered overweight. "And while much has been written about children who are already overweight," she said, "less is known about why some children begin to gain excess weight as fat in the first place."

Treuth hopes to change that with a study designed to pinpoint factors involved in weight gain. She is following 100 normal weight 8-year-old girls over a period of two years, noting changes in weight and height as well as specific factors thought to be involved in weight gain.

While fat gain can be described as the storage of excess calories, the reasons behind this energy imbalance are complex. Heredity, family and social influences, the child's tendency to be active or sedentary, and food choices all may play a role.

Children of overweight parents appear to have a 25 to 40 percent chance of becoming overweight adults according to some geneticists. "Heredity is important to a point, yet recent increases in childhood obesity cannot be totally attributed to genetic makeup," Treuth said.

Overweight children are often less physically active. Data from the Third National Health and Nutrition Examination Survey showed children who watched four or more hours of television per day were more overweight and had a significantly greater amount of body fat.

Food choices may also play a role in excessive weight gain among individual children. Obese children have been found to consume a significantly greater proportion of their calories from fat.

"Overweight children face many social, psychological, and health problems," said Treuth, "and if they remain overweight they are much more likely to experience weight-related illnesses such as hypertension, diabetes, cardiovascular disease, and some cancers as they get older."

According to Treuth, some of the girls in her study thus far have gained more weight than expected for normal growth. She believes that by analyzing the extensive profiles developed on each girl at the beginning of the study, she will find predictive factors that can identify normal weight children who are at risk for excessive weight gain. This information could then be incorporated into customized preventive programs.

New publications available to help parents of overweight children:

• If My Child is Overweight, What Should I Do About It? by Joanne Ikeda, M.A.,R.D., Department of Nutritional
• Sciences and the Graduate School of Education, University of California, Berkeley. Call: 1(800)-994-8849 or e-mail: danrcs@ucdavis.edu
• Childhood and Adolescent Obesity in America: What's a Parent to Do? by Betty Holmes, MS, RD, University of Wyoming Cooperative Extension. This publication is accessible on line via http://west.uwyo.edu/food/ or may be ordered from: University of Wyoming, Bulletin Room, PO Box 3313, Laramie. WY. 82071. The cost is $2.00.

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Factors to identify kids at risk for weight problems studied

Being able to identify children "at risk" for weight problems may enable health professionals to help them long before those excess pounds start adding up.

"There has been a dramatic increase in the number of overweight children in America over the past decade," said Dr. Margarita Treuth, a USDA/ARS Children's Nutrition Research Center scientist and Baylor College of Medicine assistant professor of pediatrics.

According to the latest national statistics, almost one in four children are at or above the 85th percentile of weight for height on pediatric growth charts and are considered overweight. "And while much has been written about children who are already overweight," she said, "less is known about why some children begin to gain excess weight as fat in the first place."

Treuth hopes to change that with a study designed to pinpoint factors involved in weight gain. She is following 100 normal weight 8-year-old girls over a period of two years, noting changes in weight and height as well as specific factors thought to be involved in weight gain.

While fat gain can be described as the storage of excess calories, the reasons behind this energy imbalance are complex. Heredity, family and social influences, the child's tendency to be active or sedentary, and food choices all may play a role.

Children of overweight parents appear to have a 25 to 40 percent chance of becoming overweight adults according to some geneticists. "Heredity is important to a point, yet recent increases in childhood obesity cannot be totally attributed to genetic makeup," Treuth said.

Overweight children are often less physically active. Data from the Third National Health and Nutrition Examination Survey showed children who watched four or more hours of television per day were more overweight and had a significantly greater amount of body fat.

Food choices may also play a role in excessive weight gain among individual children. Obese children have been found to consume a significantly greater proportion of their calories from fat.

"Overweight children face many social, psychological, and health problems," said Treuth, "and if they remain overweight they are much more likely to experience weight-related illnesses such as hypertension, diabetes, cardiovascular disease, and some cancers as they get older."

According to Treuth, some of the girls in her study thus far have gained more weight than expected for normal growth. She believes that by analyzing the extensive profiles developed on each girl at the beginning of the study, she will find predictive factors that can identify normal weight children who are at risk for excessive weight gain. This information could then be incorporated into customized preventive programs.

New publications available to help parents of overweight children:

• If My Child is Overweight, What Should I Do About It? by Joanne Ikeda, M.A.,R.D., Department of Nutritional
• Sciences and the Graduate School of Education, University of California, Berkeley. Call: 1(800)-994-8849 or e-mail: danrcs@ucdavis.edu
• Childhood and Adolescent Obesity in America: What's a Parent to Do? by Betty Holmes, MS, RD, University of Wyoming Cooperative Extension. This publication is accessible on line via http://west.uwyo.edu/food/ or may be ordered from: University of Wyoming, Bulletin Room, PO Box 3313, Laramie. WY. 82071. The cost is $2.00.