Achieving a Healthy Weight for Your Child: An Action Plan for Families

By Sandra G. Hassink

Achieving a Healthy Weight for Your Child: An Action Plan for Families is an essential guide to help parents take action to support their child's healthy nutrition and physical activity at home, in school, and in the community. Whether your child struggles with weight issues or you are working on obesity prevention, this book will help you understand childhood obesity and take an informed approach to your child's eating, activity, screen time, and physical and emotional health.

Included in this highly readable guide are:

• Sensible, nutritional guidelines emphasizing balanced and nourishing meals
• Suggestions for encouraging your child to become more physically active
• Advice on how to partner with your pediatrician, extended family members, schools and child care to help ensure success
• Guidance for dealing with emotional turmoil, setbacks and detours along the way
• Interactive questions to help you individually tailor your approach to the needs of your child and family

With the information and tools provided in Achieving a Healthy Weight for Your Child: An Action Plan for Families along with hard work and perseverance your family will succeed in reaching your goals.

• Language: English
• Publisher: American Academy of Pediatrics
• Release date: Apr 1, 2018
• ISBN: 9781610021562

Book preview

life.

Chapter 1

The Problem of Obesity

If you spend a few minutes watching children getting off a school bus, you might be surprised by what you see. Amid the expected sights and sounds of kids talking, laughing, and toting backpacks to class, you’ll probably also notice a significant number of children who are overweight or have obesity.

In fact, in every corner of the United States—from California to New York and everywhere in-between—obesity among children is at epidemic levels. Just consider the following statistics:

Since 1980, the prevalence of obesity in children has tripled.

Seventeen percent (12.7 million) of children and adolescents in the United States have obesity.

The prevalence of obesity increases with age, with 8.9% of children aged 2 to 5 years, 17.5% of children aged 6 to 11 years, and 20.5% of adolescents aged 12 to 19 years having obesity.

These unsettling trends affect boys and girls. They involve children of all races, all ethnic groups, and all socioeconomic classes. If your child is one of the children affected by obesity, this book offers a way to begin helping him. Whether you have just realized your child has a problem with his weight or have been aware of it for a long time, this book, along with guidance from your pediatrician, can help you and your child find a path through the risks and problems associated with childhood obesity to a healthier lifestyle and a healthy weight. Throughout the rest of this chapter we will be discussing the medical and psychological issues associated with obesity and some common misconceptions that may be getting in the way of moving forward.

The Physical Toll: Medical Diseases and Conditions

Pediatricians are very concerned for many reasons about the growing number of children who have obesity. Not surprisingly, having obesity can limit a child’s physical activity on the playground and athletic field. But more worrisome, there are many health risks associated with being too heavy. For example, one study stated that among children who have obesity, 40% already had 2 risk factors for cardiovascular disease, such as high cholesterol levels, high triglyceride levels (another type of blood fat), and high blood pressure. Cardiovascular-related conditions aren’t the only health problems associated with childhood obesity (see Your Child With Obesity and the Risk of Disease box).

Diabetes, for example, is another increasing concern among pediatricians and parents of children with obesity. That’s because a fast-growing number of newly diagnosed cases of childhood diabetes are the so-called type 2 form of the disease. Type 2 diabetes used to be called adult onset because it almost always affected adults, but now this form of diabetes is increasingly evolving into a disease of children and teenagers, as well. In fact, research has shown that about 1 in 3 cases of newly diagnosed diabetes in children are now type 2. Particularly if your child has obesity and is inactive, he has an increased risk of developing type 2 diabetes, and this can mean a lifetime of chronic illness and medication use and result in serious complications, such as loss of vision and kidney function, as well as increased risk of heart disease.

To make matters worse, if your child has obesity, he is much more likely to have obesity as an adult. The statistics are worrisome—about one-third of preschoolers with obesity will grow up to become adults with obesity. That figure rises to about 50% of school-aged children and 80% among teenagers who have obesity. And once your child is an adult, he’ll be more likely to have obesity-related health problems, from high blood pressure to joint problems, as well as a greater risk of death, as his weight increases. The bottom line is that obesity can cause a lifetime of very serious health concerns.

YOUR CHILD WITH OBESITY AND THE RISK OF DISEASE

If you child or adolescent has obesity, he has a higher chance of having a number of serious medical problems, including

High blood pressure (hypertension)

Abnormal lipid levels

Type 2 diabetes (once called adult-onset diabetes)

Asthma

Sleep apnea (repeated disruption of normal breathing during sleep)

Skin infections (eg, fungi trapped in folds of skin)

Pain in the knee, thigh, and hip (often associated with a condition called slipped capital femoral epiphysis)

Back pain

Liver disease

Gallstones

Menstrual abnormalities (eg, irregular or missed periods, known as polycystic ovary syndrome)

Severe headaches with visual disturbances

Disordered Eating

One other point is important to make: Some children become so obsessed with their excess pounds and have such a distorted body image that they begin to try unusual diets, skip meals, or eliminate food groups, further adding to unhealthy eating and poor nutrition. Rarely, some children can become so focused on their weight and body image that they may develop eating disorders, such as bulimia and anorexia, all because they’re trying to get their weight under control in an unhealthy way.

Mental Health Concerns

It is important to know that mental health concerns can be increased in children with obesity. Children with obesity have been found to have higher rates of attention-deficit/hyperactivity disorder, conduct disorder, and depression than children without obesity. There are also higher rates of anxiety and mood disorders found in children with obesity who attend weight management clinics. Many children and adolescents with obesity experience bullying and teasing, and this is associated with lower self-esteem and, in adolescents, has also been linked to disordered eating and severe depression. Children with obesity and their parents report lower quality of life, scoring lower on physical and social functioning than children who do not have obesity. Children with obesity may have increased problems in schools, such as increased absences, repeating a grade, and behavior problems.

ENVIRONMENTAL FACTORS

Your child’s day-to-day environment—at home, at school, at friends’ homes, and virtually everywhere else he spends time—can affect his risk of becoming and remaining overweight. The fast-food restaurants where he eats, television (TV) he watches, and video games he plays can contribute to his likelihood of developing obesity.

For example, the risk of having obesity is more than 4½ times greater for children who watch more than 5 hours of TV a day, compared with children who watch no more than 2 hours a day. That’s because children are not only inactive while watching TV, but they also tend to snack at the same time, often eating high-fat foods like cookies or potato chips rather than an apple or a pear, all while watching endless advertisements for high-calorie fast food and sugary drinks. Even so, except for sleeping, most US children spend more time (outside of school hours) watching TV than participating in any other activity.

The Emotional Toll

For children with obesity, as well as their parents, living with excess pounds can be heartbreaking. In its own way, the social stigma attached to having obesity can be as damaging to a child as the physical diseases and conditions that accompany obesity. You can probably see it in the eyes and hear it in the words of your own child. In a society that puts a premium on thinness, studies show that children as young as 6 years may associate negative stereotypes with excess weight and believe that a heavy child is simply less likable.

True, some children are very popular with their classmates, feel good about themselves, and have plenty of self-confidence. But in general, if your child has obesity he is more likely to have low self-esteem than his thinner peers. His weak self-esteem can translate into feelings of shame about his body, and his lack of self-confidence can lead to poorer academic performance at school. The AAP policy statement, Stigma Experienced by Children and Adolescents With Obesity, provides more information for pediatricians, families, and policy makers on weight bias. For more information on self-esteem and bullying during the school-age and adolescent years, refer to chapters 11 and 12.

You probably don’t need a detailed description of how difficult the day-to-day life of children with obesity can sometimes be. They may be told by classmates (and even adults) that being heavy is their own fault. They might be called names and be subjected to teasing and bullying. Their former friends may avoid them, and they may also have trouble making new friends. They could be the last ones chosen when teams are selected in physical education classes.

With all this turmoil in a child’s life, he may feel as though he doesn’t belong or fit in anywhere. He may see himself as different and an outcast. He’ll often feel lonely and is less likely than his peers to describe himself as popular or cool. And when this scenario becomes ingrained as part of his life—month after month, year after year—he can become sad and clinically depressed and withdraw into himself.

In an ironic twist, some children might seek emotional comfort in food, adding even more calories to their plates at the same time that their pediatrician and parents are urging them to eat less. Add to that the other emotional peaks and valleys of life, including the stress of moving to a new community, difficulties in school, the death of a parent, or a divorce, and some children routinely turn to food in times of stress.

There are other obesity-related repercussions that continue well into adolescence and beyond. Teenagers and adults with obesity might face discrimination based solely on their weight. Some research suggests that they are less likely to be accepted for admission by a prestigious university. They may also have a reduced chance of landing good jobs than their thinner peers. Women with obesity have been found to have a decreased likelihood of dating or finding a marriage partner. In short, when heavy children become heavy adults, they tend to earn less money and marry less often than their friends who are of average weight.

GENETICS

The following statistics are for young children and indicate the importance of genetics and family lifestyle in a child’s risk of developing obesity:

If one parent has obesity a child has a 3-fold greater risk of developing obesity than a child whose parents are both of average weight.

If both parents have obesity the child’s risk rises by more than 10-fold.

For a child younger than 3 years, the presence of obesity in his parents is a stronger predictor of whether he will develop obesity in adulthood than his own current weight.

Childhood Obesity: What Are the Common Misconceptions?

Everyone, it seems, has an opinion about obesity. Some may insist that they know what causes it. Or they might have a dozen or more suggestions on how to conquer it. Yet even though it seems that our culture is obsessed with diets and a belief that you can never be too thin, there are more than enough myths and misunderstandings about childhood weight to go around. Unfortunately, some of this misinformation can get in the way of your child succeeding in his own weight-loss efforts.

To help you and your child get on the right path toward normalizing his weight, let’s separate fiction from facts. See if you believe in any of the following misconceptions, and then read what the truth about them is:

My child and I deserve the blame for his weight problem. Not true. Thanks to the media and many high-profile diet gurus, many children and adults believe that obesity occurs in people who are self-indulgent or weak-willed. With those kinds of attitudes so prevalent, no wonder there’s so little empathy and support for individuals who need to lose weight. The fact is that children gain excess weight for a variety of reasons. Some tend to develop obesity because it runs in their families. Others may not make the best selections of foods or portion sizes, often because healthier choices aren’t available or perhaps because their parents or grandparents put too much food on their plates. Some children live in communities where it is hard to get enough healthy food. Throughout this book, you’ll find descriptions of other culprits and contributors to your child’s weight problem that should remove self-blame. Once you understand the causes of obesity a little better, you and your child will be able to manage his obesity more effectively and realistically.

My child’s weight problem needs a quick fix. Yes, you and your child may wish for an instantaneous solution for losing his excess pounds, and there are plenty of diets in bookstores that promise fast results. But let’s face it—there are no instant cures to weight problems (or to most other things in life), but there are answers, as you will see in this book. Obesity is not a problem that can be resolved overnight or even in a few weeks. (If you’ve ever tried to lose weight yourself and keep it off, you know that’s the case.) In fact, some of the most popular quick fixes, from diet pills to herbal teas, may be hazardous to your child’s health. Many of the natural supplements that teenagers might be attracted to, as well as the near-starvation diets that are promoted in newspaper ads and popular magazine articles, are risky and, in some cases, even potentially deadly. Where should you turn instead? Working with your child’s pediatrician and using plans and programs, like the one in this book, that are based on credible, scientific evidence offers the best chance for safe and long-term weight-loss success.

My child will ‘grow into’ the excess pounds that he has. Some parents tell their pediatricians that their child will outgrow their weight problems. However, that’s not something you can count on. In fact, depending on your child’s eating habits and activity level, he is just as likely to continue to gain weight, and not lose it, as he grows. Don’t depend on routine growth spurts to compensate for his weight problem.

My child may seem overweight according to the growth charts, but our entire family is big-boned, so I don’t think he has a weight problem at all. Pediatricians often hear parents say, We’re not worried about our child’s weight. Everyone in our family is big, and we’ve always been like this. In truth, you need to keep your focus on the growth and body mass index charts. If your child’s weight exceeds the normal range for his age and height, he meets the definition of having obesity (see growth charts in Chapter 8). Knowing this, you and your child’s pediatrician can address his health risks and help him get back on track to a healthy weight.

There are certain metabolic or hormonal (endocrine) imbalances that often get blamed for weight problems. However, they are responsible for fewer than 1% of the cases of childhood obesity. Yes, hypothyroidism (a deficit in thyroid secretion) and other rarer and more severe genetic and metabolic disorders (eg, Prader-Willi syndrome, Turner syndrome, Cushing syndrome) can cause weight gain (and, in some cases, other severe problems, such as hearing and vision impairments). You should certainly speak with your child’s pediatrician about these concerns and have a complete medical evaluation performed. But because these syndromes are uncommon, they account for very few cases of obesity. More likely, your child’s excess weight is associated with unhealthy eating and activity habits, which we will be addressing in the following chapters of this book.

Because my child is heavy, he actually needs to eat more food to stay healthy. Based on this belief, many families may give bigger portions to the heavier children because of their size. Nothing could be more counterproductive. You need to rely on the growth charts and your pediatrician’s advice and make sure that your child is consuming portion sizes that allow him to maintain an average healthy weight. The sensible nutritional principles described in Chapter 2 should help keep your child’s weight just where it should be.

Assessing Your Child’s Weight

Beginning with Chapter 2, we’ll address your child’s weight problem with specific strategies and approaches. We’ll start with a discussion of good nutrition and how you can ensure that he eats well-balanced meals that can contribute to normal weight. You’ll find some specific recommendations on issues like meal planning, food groups, and portion sizes that can help keep your child traveling along the right path to good health.

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Chapter 2

What’s to Eat? The Importance of Good Nutrition

When parents think of the most important strategy for managing their children’s weight, their attention often turns to the food they put on their children’s plate and perhaps a formal diet or two that they’ve read about. This book takes a different approach than you might expect. Yes, your child’s food consumption is a key factor in attaining a healthy weight. As you’ll read, however, we are much more interested in good nutrition than in calorie counting or food