It's these consequences — paired with the alarming statistic that nearly 30 percent of U.S. children and teens are overweight or at risk for overweight — that have forced pediatricians and parents to drop their watch-and-wait attitude toward childhood pudginess.
"I've always mentioned healthy food choices and limiting TV time with parents of overweight kids, but now I'm sounding a lot more worried about it, and I'm being much more directive," says Dr. Mark Greenfield, a Seattle pediatrician. And parents, he says, are desperate for direction.
The prescription is as generic and obvious for kids as it is for adults: Get children to eat less and move more. But there's a catch. The only way to achieve this while sparing a child's self-esteem is to make it a family affair, experts say.
Is your child overweight?
The first step is to determine whether your child actually has a weight problem. That's not as simple as it sounds. While a bully can spot a tubby kid across a playground, parents have a little more difficulty.
A study last year by the U.S. Centers for Disease Control and Prevention found that nearly a third of mothers whose children were overweight said they were about the right weight. Other parents may fuss over the normal packing on of pounds that often precedes a vertical growth spurt.
That's where those growth charts on the pediatrician's wall come in. Make sure the doctor tracks your child's body-mass index (BMI) — a ratio of height to weight — at annual checkups, Greenfield says. Tracking a child's BMI over time can help distinguish between a pudgy phase and a growing weight problem.
Unlike the adult system in which anyone with a BMI over 25 is considered overweight and those over 30 are deemed obese, the childhood charts take into account age and gender and avoid the term obese. The charts use the sizes of U.S. children from the 1960s through the 1980s as reference points to determine healthy BMIs for today's kids.
According to the charts, a 10-year-old boy standing 5 feet tall and weighing 115 pounds, for a BMI of just over 22, would be in the 95th percentile. That means that he's bigger than 95 percent of boys his age in his parents' generation. Children in the 95th percentile are considered "overweight"; those in the 85th percentile are "at risk for overweight."
The good news is that if a child is still gaining in height, he may not need to lose weight or even have to stall it to get his BMI back on track, says L. Kathleen Mahan, a registered dietitian in Seattle. "If he's been gaining a couple of pounds a month, and we can slow that down to a pound or half a pound, he's going to be taller and thinner in a year."
A family affair
Once a pediatrician determines a child is growing out faster than up, parents should take stock of the entire family's eating and activity patterns.
Eat less, move more — but how much?
Children are supposed to get 60 minutes of physical activity — moderate or vigorous — each day. This is more than double what most kids get. To up their exercise quotient:
• Make it fun. Plan an evening playing miniature golf, turn off the TV and start a game of freeze tag or buy a kite and head to the park.
• Assign kids household chores. Walking the dog, dusting, vacuuming, raking (and jumping in) leaves all burn calories and ease your load.
• Work movement into daily activities. Park farther from the store, race up the stairs and walk your kid to school rather than drive if you're able.
The calorie requirements of most active kids is about 2,200 calories per day, less for kids younger than 6 and more for teenage boys. What does that look like?
• The current recommendations are 6-9 servings of grain, 3-4 vegetables, 2-3 fruits, 2-3 servings of milk and about 4-6 ounces of meat a day.
• Give your portion sizes a reality check. A heaping plate of spaghetti may be four servings, not one. A serving of grain is one slice of bread or half-cup of cereal. A serving of cheese should be about the size of four dice. A handful of grapes counts as a serving of fruit.
Source: American Dietetic Association; Centers for Disease Control and Prevention; USDA
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What's in the refrigerator? How many hours a day do you watch television? Do you walk anywhere? How many times a week is fast-food on the menu?
Once you have a baseline, you can start to make slow changes. "I tell parents it's a cruise ship — you can't turn on a dime, it takes 30 or 40 miles to turn around," says Bellevue pediatrician Dr. Don Shifrin.
Most important, he says, these changes must be family-wide. You can't give one kid dessert and the other carrot sticks. Children rarely grow overweight alone. Most overweight kids have a parent who could stand to lose some weight — or at least adopt a healthier lifestyle.
"It can't be 'this is your problem,' " says Dr. Laura Richardson, a professor of pediatrics at the University of Washington. "It has to be 'this is our problem, and we are all going to make choices to be healthier.' "
The operative word here is health, she says. Parents should avoid focusing on weight loss.
That doesn't mean parents must avoid the weight issue altogether. "Kids who are overweight are already conscious of it, so if you pretend otherwise, it may make them feel even worse — like it's too shameful to mention," says Richardson, who specializes in obesity and eating disorders at the adolescent-medicine clinic at Children's Hospital and Regional Medical Center. "The best thing a parent can do is talk about it in a nonjudgmental way and ask the child what her concerns are."
Parents also need to look for signs that children are using food as an emotional escape. Do they dive into ice cream when criticized? Cure boredom with Little Debbies?
Get kids moving
Almost across the board, doctors and nutritionists offer the same first recommendation: Reduce TV and video-game time. Studies show time in front of a screen is a major predictor of obesity. Some say no more than one hour a day, others, including the American Academy of Pediatrics, say two hours is the maximum.
And that goes for mom and dad, too. "If dad collapses on the couch in front of the TV all night how can he expect the kid to do any different?" Mahan wonders.
Now you've reclaimed the couple more hours a day needed to make the next change. Children are supposed to be physically active at least 60 minutes a day, yet only 21 percent of Washington's eighth-graders reported getting more than 30 minutes of moderate daily exercise. The state's Healthy Youth Survey, taken in 2002, also found that under a third of eighth graders got 20 minutes of vigorous exercise each day.
This can but doesn't have to mean putting your child in an organized sport or activity such as ice-skating lessons, dance class or taekwondo. Heavy kids are often self-conscious about competing or performing, so parents may want to start with something as simple as going for a walk after dinner. Play catch, go for a family bike ride, Rollerblade, walk the dog — it all counts. On weekends, take a nature walk, take up bowling, go fishing in the summer or snow tubing in the winter. But by all means, resist the urge to call it "exercise." Remember, this is fun stuff.
For some kids, these first two steps alone could potentially slow down weight gain until their height catches up. But for most, the next step — making diet changes — is the hardest.
The food component
Most experts eschew the D word when talking about overweight kids. Cutting calories is controversial in growing children. Plus, dieting appears to backfire in kids. A study of nearly 15,000 children published in the journal Pediatrics last October found that kids who dieted wound up weighing more years down the road.
"Drastic changes are rarely sustainable for anyone, so it's not surprising these children gained more weight," says study author Alison Field, a researcher at Brigham and Women's Hospital in Boston. "The vicious cycle of restrictive diets followed by overeating could end up making the child-obesity epidemic worse."
Parents especially need to be role models in this area, she says. A mother who hops from Atkins to South Beach to the next fad diet is not teaching her child lifelong healthy eating.
The most obvious areas to cut back, says Dr. Brent Wisse, co-director of Harborview's Weight Disorders Clinic, are soda pop and fast food. If a child who drinks two sodas a day switches to water, he should lose a pound in a week and a half. A study out last month showed that one-third of U.S. children eat fast food on a given day, and they consume 187 more calories on those days. That adds up to about six extra pounds a year.
The next step is for families to get reacquainted with proper portion sizes. Platter-sized plates at Italian restaurants and jumbo burritos have thoroughly distorted most people's idea of what a normal meal should look like. Serving sizes are on the order of ½ cup of pasta, 2 tablespoons of peanut butter, a piece of meat about the size of a deck of cards, and an apple the size of a child's fist, not a softball.
But be careful not to play the role of food police, Mahan says. Telling a kid to put down on those potato chips isn't going to help anyone. In fact, kids whose parents dictate every bite tend to get fatter, she says. Adults can well relate to the fact that children tend to crave treats they can't have, so no food should be forbidden, it just shouldn't be available all the time. At least when children are young, the easiest solution is not to have potato chips in the house very often. When they're older and they can pick up all the soda, fast food and potato chips they desire, the only thing a parent can do is provide a variety of healthy foods at home.
Mahan also calls for a return to the family dinner table. "You know, the evening meal where everyone sits down at the table, not in front of the TV, with four things on their plate at one time."
Studies show children who eat meals with their families tend to eat healthier, she says. Plus, setting a meal schedule helps cut down on after-school grazing.
What nutritionists and pediatricians are proposing makes sticking to a 1,000-calorie diet sound like a piece of cake by comparison. It's a veritable turning back of the clock to an era when dinner was on the table at 6 p.m. sharp, and fathers tossed off their sports coats after work to play catch with kids in the cul-de-sac. The sitcom family dynamics may be a stretch, but it's not impossible for parents to make very difficult lifestyle changes for the health of their kids, Wisse points out. After all, parents quit smoking for their kids every day. |
