Issues

"The incidence of childhood obesity is rapidly rising throughout the world. The obesity epidemic is especially evident in industrialized nations where many people live sedentary lives and eat more convenience foods, which are typically high in calories and low in nutritional value. In just two decades, the prevalence of overweight doubled for U.S. children ages 6 to 11 — and tripled for American teenagers. The annual National Health and Nutrition Examination Survey by the Centers for Disease Control and Prevention found that about one-third of U.S. children are overweight or at risk of becoming overweight. In total, about 25 million U.S. children and adolescents are overweight or nearly overweight.

"How do you know if your child's weight gain is normal and when it's leading to childhood obesity? Children, unlike adults, need extra nutrients and calories to fuel their growth and development. So if they consume about the number of calories they need for daily activities, growth and metabolism, they add pounds in proportion to their added inches. But children who eat more calories than they need gain weight beyond what's needed to support their growing frames. In these cases, the added weight increases their risk of obesity and weight-related health problems.

"Childhood obesity is particularly troubling because the extra pounds often start kids on the path to health problems that were once confined to adults, such as diabetes, high blood pressure and high cholesterol.

"One of the best strategies to combat excess weight in your children is to improve the diet and exercise levels of your entire family. This helps protect the health of your children now and in the future."

Causes

"Although there are some genetic and hormonal causes of childhood obesity, most excess weight is caused by kids eating too much and exercising too little. If children consume more calories than they expend through exercise and normal physical development, they gain weight.

"Far less common than lifestyle issues are genetic diseases that can predispose a child to obesity. These diseases, such as Prader-Willi syndrome and Bardet-Biedl syndrome, affect a very small proportion of children. In the general population, eating and exercise habits play a much larger role."

Complications

"Obese children can develop serious health problems, such as diabetes and heart disease, often carrying these conditions into an obese adulthood. Overweight children are at higher risk of developing:

Type 2 diabetes
Metabolic syndrome
High blood pressure
Asthma and other respiratory problems
Sleep disorders
Liver disease
Early puberty or menarche
Eating disorders
Skin infections

"The social and emotional fallout also can hurt your child. Being overweight can cause:

Low self-esteem and bullying. Children often tease or bully their overweight peers, who suffer a loss of self-esteem and an increased risk of depression as a result.
Behavior and learning problems. Overweight children tend to have more anxiety and poorer social skills than normal-weight children have. At one extreme, these problems may lead to acting out and disrupting the classroom. At the other, they may cause social withdrawal. Stress and anxiety also interfere with learning. School-related anxiety can create a vicious cycle in which ever-growing worry fuels ever-declining academic performance.
Depression. Social isolation and low self-esteem create overwhelming feelings of hopelessness in some overweight children. When children lose hope that their lives will improve, they're well on the way to depression. A depressed child may lose interest in normal activities, sleep more than usual or cry a lot. Some depressed children hide their sadness and appear emotionally flat instead. Either way, depression is as serious in children as in adults. If you think your child is depressed, talk with him or her and share your concerns with his or her doctor and teacher."

Treatment

"Children, unlike adults, need extra nutrients and calories to fuel their growth and development. Even so, weight is the balance of calories in versus calories burned. Children who eat about the number of calories they need for daily activities and normal development gain weight in proportion to their added height. But children who eat more calories than they need gain weight beyond what's needed to support their growing frames. In these cases, the BMI-for-age increases as does their risk of obesity and weight-related health problems.

"For children under age 7 who have no other health concerns, the goal of treatment may be weight maintenance rather than weight loss. This strategy allows the child to add inches but not pounds, causing BMI-for-age to drop over time into a healthier range. However, for an obese child, maintaining weight while waiting to grow taller may be as difficult as losing weight for older persons.

"Weight loss is typically recommended for children over age 7 or for younger children who have related health concerns. Weight loss should be slow and steady — anywhere from 1 pound a week to 1 pound a month, depending on your child's situation.

"The methods for maintaining weight or losing weight are the same: Your child needs to eat a healthy diet and increase his or her physical activity. Success depends largely on your commitment to helping your child make these changes. Think of eating habits and exercise habits as two sides of the same coin: When you consider one, you also need to consider the other.

Eat a healthy diet
"Parents are the ones who buy the food, cook the food and decide where the food is eaten. Even small changes can make a big difference in your child's health.

When buying groceries, choose fruits and vegetables over convenience foods high in sugar and fat. Always have healthy snacks available. And never use food as a reward or punishment.
Limit sweetened beverages, including those containing fruit juice. These drinks provide little nutritional value in exchange for their high calories. They also can make your child feel too full to eat healthier foods.
Select recipes and methods of cooking that are lower in fat. For example, bake chicken instead of frying it.
Put colorful food on the table: green and yellow vegetables, fruits of various colors, and brown (whole-grain) breads. Limit white carbohydrates: rice, pasta, bleached bread and sugar (desserts).
Sit down together for family meals. Make it an event — a time to share news and tell stories. Don't eat in front of the television or computer, which fosters mindless munching.
Limit the number of times you eat out, especially at fast-food restaurants. Many of the menu options are high in fat and calories.
Discourage eating in front of a screen, such as a television, computer or video game. This leads to fast eating and lowered awareness of how much you're eating.

Increase physical activity
"A critical component of weight loss, especially for children, is physical activity. It not only burns calories, but also builds strong bones and muscles and helps children sleep well at night and stay alert during the day. Such habits established in childhood help adolescents maintain healthy weight despite the hormonal changes, rapid growth and social influences that often lead to overeating. And active children are more likely to become fit adults.

"To increase your child's activity level:

Limit recreational screen time to fewer than two hours a day. A surefire way to increase your child's activity levels is to limit the number of hours he or she is allowed to watch television each day. Other sedentary activities — playing video and computer games or talking on the phone — also should be limited.
Emphasize activity not exercise. Your child's activity doesn't have to be a structured exercise program — the object is just to get him or her moving. Free-play activities such as playing hide-and-seek, tag or jump-rope can be great for burning calories and improving fitness.
Find activities your child likes to do. For instance, if your child is artistically inclined, go on a nature hike to collect leaves and rocks that your child can use to make a collage. If your child likes to climb, head for the nearest neighborhood jungle gym or climbing wall. If your child likes to read, then walk or bike to the neighborhood library for a book.
If you want an active child, be active yourself. Take the stairs instead of the elevator and park the car farther away from stores. Never make exercise seem a punishment or a chore. Find fun activities that the whole family can do together.
Make chores a family affair. Who can pull the most weeds out of the vegetable garden? Who can collect the most litter? Have your kids help shovel the snow off the driveway and use that excess snow to build a snow fort.
Vary the activities. Let each child take a turn choosing the activity of the day or week. Batting practice, bowling and swimming all count. What matters is that you're doing something active.

Make a family commitment
"Children can't change their exercise and eating habits by themselves. They need the support and encouragement of their family and other caregivers. To increase the odds that your child finds success:

Commit to new healthy habits and behaviors as a family, with all members sticking to the plan. If not, your child may feel singled-out, deprived or resentful.
Be ready to make changes. Small, gradual changes are easiest to follow and incorporate into your daily lives.
Focus on long-term diet and exercise changes, not quick fixes or fad diets aimed at rapid weight loss. The goal is healthier eating and lifestyle changes not pounds lost.
Set achievable goals for your child and family. For example, your child's goal might be to reduce the number of sugar-sweetened beverages he or she drinks. The family's goal might be to eat meals at the table every night instead of in front of the television.

Surgery and medications
"If your child has been struggling with his or her weight for a long time, you might think that surgery or medications can help. But these treatments aren't often used for children.

Weight-loss surgery
"Because of the risks involved and possible long-term complications, weight-loss (bariatric) surgery is rarely considered for obese adolescents. The effects of surgery on adolescents' growing minds and bodies are largely unknown. However, if your child's severe weight poses greater health threats than the potential risks of surgery, your doctor may consider weight-loss surgery as an option.

"Even so, surgery isn't the easy answer for weight loss. It doesn't guarantee that your child loses all of his or her excess weight or that your child keeps it off long term. It also doesn't replace the need for following a healthy diet and regular physical activity program.

Medications
"Two prescription weight-loss drugs are available for adolescents: sibutramine (Meridia) and orlistat (Xenical). Sibutramine, which is approved for adolescents older than 16, alters the brain's chemistry to make the body feel fuller more quickly. Orlistat, which is approved for adolescents older than 12, prevents the absorption of fat in the intestines.

"Though available, these drugs are rarely prescribed to adolescents. The risks of taking the medications long term are still unknown, and their effect on weight loss and weight maintenance for adolescents is still questioned. And, once again, weight-loss drugs don't replace the need to adopt a healthy diet and exercise regimen."

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