Obesity and Overweight

By far the best approach is helping your whole family—-including your child— change their behavior.

How can I help my child lose weight, or stay a healthy weight?

• Obesity develops over time and cannot be solved overnight.  Remember that this is not an emergency.  Do not expect dramatic change.  That is unrealistic. 
• The best way to have a healthy weight is prevention. Be sure your family has healthy habits from the beginning, and prevent yourself and your children from becoming overweight. It is much easier to maintain a healthy weight than it is to lose weight.

Make it a whole family effort:

• Obesity is not just your child’s problem.  It is a problem that the whole family must be involved in solving.  Your child lives within your family environment.
• Chances are, someone else in your family has also struggled with weight or experienced obesity.  They may be able to offer valuable help and support in developing realistic goals for your child.
• As a family try to think of problems that you have solved successfully.  This will help you stay positive, and look for other areas that are opportunities for change.
• Mealtimes should be family times! Create a relaxed atmosphere around mealtime.  Eat slowly and enjoy your food. Eat together as a family, and don’t watch TV during meals. Families that do not eat together tend to consume more fried foods and soda and less fruits and veggies than families that share meals.
• Here are some tips for making family meals work, and a family mealtime goal planner. 
• Reduce power struggles at mealtime by deciding who does what.

Be a positive role model:

• Remember the old adage:  “Kids will do as you do, not as you say”?  Your kids look to you, the parents, to see how to behave.  If your whole family eats healthy foods and gets active, and then your child will, too!

Help your child set goals:

• Set short-term goals for changes in your child’s diet and exercise on a weekly basis.  Update your goals each week.  Write them down.  Examples of goals include setting a time limit on TV watching, and taking a walk every day.
• Make sure the goals you set are realistic.  For example, exercising an hour every day is unrealistic for a child who is de-conditioned, and not used to even minimal physical activity. 
• Use rewards when your child meets their weekly goals.  Rewards could be special time with you doing an activity your child enjoys or a special toy.
• Have your child keep a record of their food intake and exercise.  This will allow them to be more self-aware of their behavior.  Then look at the record together, one-on-one, and go over it.  Give them positive feedback.
• Praise your child for healthy food choices and physical activity.  Remember:  criticism and punishment just don’t work.
• Make sure your child understands that they can make a difference in their weight and that you will support them all the way.
• Help your child recognize hunger and fullness signals.  Stop eating when you’re full and turn down helpings when you are no longer hungry.  Help your child do the same.
• Help your child figure out what kinds of emotions and situations trigger overeating for them.
• Make your child’s behavior changes a positive, fun experience by planning healthy foods, fun activities, and rewards for positive behavior.

Watch their “media diet”, too:

• Think about all the media your child uses: television, computer, video games, hand-held computer games. These are all activities that replace physical activity in your child's daily routine. Placing time limits on them will free up time for a more active lifestyle. Watching TV can use less energy than simply sitting and resting! Also, we tend to snack on high calorie foods during these inactive times.
• Teach your child to be media savvy. The media bombards us with images of thin people having fun while eating and drinking high calorie foods. Kids don't necessarily have the cognitive abilities to process this paradox.
• Limit inactive things like TV, video games and computer time.  Watching TV can use less energy than simply sitting and resting!  Also, we tend to snack on high calorie foods during these inactive times.

Eat healthy meals and snacks:

• Have structured mealtimes and snacks on a schedule. Model and insist on good meal habits— eating less breakfast and more dinner or skipping breakfast increase the risk for obesity.
• Don't mistake healthy eating for dieting. Eating large amounts of high calorie foods ("Want to super-size that?") and frequent snacking have become commonplace. Bad eating habits become accepted as normal eating habits. Eating healthful foods in a healthy manner is not the same as dieting.
• Use the food pyramid (also in Spanish) and the food pyramid for young children (aged 2-6) to help guide your food choices for your family.  The emphasis should be on grains, vegetables and fruits.  Food pyramids representing ethnic foods are also available.
• Keep only healthy foods in your home. Keeping junk food around for other family members, and trying to “police” what your child eats, only promotes sneak eating.  The American Dietetic Association has information on eating healthy—check out their daily tips and nutrition fact sheets.
• Children under 2 may need a little more fat in their diet for proper brain development. Between ages 2-3 you can gradually transition your child to the lower-fat diet that is healthiest for the rest of the family.
• Pay attention to snacks. They count! Lots of snacking leads to a higher calorie intake, and many typical snack foods are not very nutritious. Keep healthy snacks on hand, like fruit and cut up veggies.  Allow your child easy access to them.

Get moving:

• Encourage physical activity.  As kids move into adolescence, their levels of activity tend to drop too low. Do active things together as a family, like bike riding, hiking, walking and swimming. Here are some great ideas for helping to get your child and your family more active.
• Build activity into your family's daily life with household chores, walking to school, parking farther from buildings and taking the stairs. Decreasing inactivity works better for long-term weight loss than focusing on vigorous aerobic exercise. It's also an easier lifestyle change for your family to make!
• Make sure your kid gets outside during daylight hours.  You could make it a policy in your family that unless the weather is bad, your children play outdoors after school.  This encourages physical activity, and rules out the inactive pursuits of TV and other media.

For more information and tips:

• The National Institutes of Health has a great online pamphlet on Helping Your Overweight Child.  It includes many useful tips and resources.
• For more, see what our own Dr. Gahagan has to say about how parents can fight obesity in their kids.

What if everything you suggest does not seem to be working?

If making these changes at home does not seem to be helping, you can talk to your child’s doctor about a formal weight-control program.  A weight-control program should:

• Have the overriding goal of helping the whole family make and maintain healthy changes in their eating and activity habits.
• Have dieticians, exercise physiologists, doctors, and either psychiatrists or psychologists on staff.
• Perform a medical evaluation of your child—including weight, growth, and health—before starting the program, and at regular intervals throughout the program.
• Be developmentally appropriate for the age and capabilities of your child.
• Focus on behavior changes.
• Teach your child how to choose a healthy variety of foods and the right size portion.
• Encourage daily physical activity.
• Include a maintenance program and other support and referrals.
• Focus on your whole family—not just your overweight child.

What books do you recommend?

• How to Get Your Kid to Eat…But Not Too Much, by Ellyn Satter.  This is a book all parents should read, whether their children are overweight or not.  It applies to kids from birth through the teen years. The advice in this book can help your child develop a healthy relationship with food that will last a lifetime.
• The Stoplight Diet for Children:  An Eight-Week Program for Parents and Children, by Leonard Epstein and Sally Squires.  This book is out of print, but should be available in your public library.
• Shapedown books and workbooks for parents and kids ages 6-20

What are some other sources of information and support?

Information:

• The National Institutes of Health (NIH) has a toll-free consumer health information line on weight control.  Call 1-877-946-4627.  They can help you and your child with pamphlets, fact sheets and referrals.
• YourChild: Feeding Your Child and Teen
• YourChild: Feeding Your Baby and Toddler
• YourChild: Eating Disorders
• YourChild: Food Safety
• YourChild: Pediatrician Commentary: How Parents can Fight the Obesity Epidemic
• YourChild: Precocious Puberty
• YourChild: Sleep Problems
• For Kids:  What being overweight means
• For Teens:  Obesity
• For Teens: The Deal with Diets
• Prevention of Pediatric Overweight and Obesity—a policy statement from the American Academy of Pediatrics.
• Weight and Diabetes—weight can influence diabetes, and diabetes can influence a person’s weight.
• Overweight in Children, from the American Heart Association (AHA) has basic information, research, and more pamphlets and resources. 
• The Weight-control Information Network provides information about weight control, obesity, and related topics to health professionals and the public. Develops, identifies, and distributes educational materials. Phone: (202) 828-1025 or 1-877-946-4627.

Organizations and Support:

• Find a Registered Dietician in your area through the American Dietetic Association’s website.
• Check out Just Move!, also from the AHA, where you can get the latest fitness news, start an online exercise diary, and receive email feedback from a virtual personal trainer. 
• The Nutrition Information Service is part of the University of Alabama-Birmingham, and provides up-to-date, accurate, and useful nutrition, health, and food information to the community and health care professionals. They will answer nutrition questions from health professionals and the public. Phone: 1-800-231-DIET (3438).
• The Vegetarian Resource Group (VRG) educates the public on vegetarianism, health, nutrition, and more. 
• The Council on Size and Weight Discrimination, Inc. provides information on eating disorders, "sizism," the non-dieting movement, and size discrimination. Phone: (914) 679-1209.
• The National Association to Advance Fat Acceptance provides support and attempts to eliminate discrimination against fat people. Provides information to health professionals on how to treat very large patients (e.g., weighing). Phone: (916) 558-6880.
• The President's Challenge works to promote the development of physical fitness facilities and programs. Offers a variety of testing, recognition, and incentive programs. Phone: 1-800-258-8146.
• The American Dietetic Association works to serve the public through the promotion of optimal nutrition, health, and well-being. Phone: 1-800-877-1600, ext. 5000 (for publications).
• The American Obesity Association is dedicated to public education about the dangers of obesity, preventing obesity in children, advocating for good health care and adequate insurance coverage for obesity treatment, supporting research on obesity, and ending discrimination against people with obesity.  Phone 1-800-98-OBESE (1-800-986-2373) or 202-776-7711.
• Shapedown is a weight management program for children and adolescents. It was developed at the University of California, San Francisco, School of Medicine and includes contributions from nutrition, exercise physiology, endocrinology, psychology, family therapy, adolescent medicine, family medicine and behavioral and developmental pediatrics. Shapedown is continually reviewed and revised to ensure that it reflects current scientific and clinical understandings. The program helps kids and teens enhance their self-esteem, improve peer relationships, adopt healthier habits and begin to normalize their weight within their genetic potential. Parents feel better about their parenting and about their child. The family becomes healthier and closer. The results of Shapedown go far beyond weight.