**Note: The topics discussed here in “Caring for Your Child” are for your general information and are not a substitute for medical advice. You should contact your physician or other healthcare provider with any questions about your health, treatment, or care, or to discuss the information you have read here.

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  • How prevalent is childhood obesity?
  • The US Dept of Health and Human Services conducted a recent survey that was shocking
  • They reported that the prevalence of obese/overweight in children has doubled over the past 20 years in the US
  • Also,  ~15% of 6-19 year olds are obese/overweight – meaning they had BMI’s greater than the 95 percentile (off the chart)
  • Sadly, ~10% of 2-5 year old are considered obese
  • Many experts say that obesity now rivals smoking as the leading cause of major medical problems and deaths
  • Medical costs for overweight-related illnesses increased from $35mill in 1979-1981 to $127mill from 1997-1999; Wow
  • What is considered “overweight” in children?
  • At 2 yrs of age and above, pediatricians look at BMI or Body Mass Index (kg/m²)
  • The BMI lets us see if children weigh more than they should for their height at a specific age or that the child has more fat than they should for their height
  • boys and girls have separate charts
  • 2 years old and above
  • BMI > 95 percentile is considered obese/overweight
  • BMI 85-94 percentile is considered “at risk” for being overweight
  • BMI  5 to 84 percentile is considered normal
  • BMI < 5 percentile is considered underweight
  • Once a person reaches adult age a BMI over 30 is considered obese
  • Your doctor can help you determine if your child’s weight is right for them.
  • BMI GROWTH CHART FOR BOYS 2 – 20
  • EXAMPLE OF TYPICAL OBESE PATTERN
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  • Causes of being overweight in children
  • *Most common cause in children taking in more calories than they are burning; Eating too much and exercising too little
  • Genetic syndromes (rare) – Prader-Willi syndrome, Bardet-Biedel syndrome, Cohen syndrome
  • Endocrine/hormone disorders (rare) – Cushing syndrome, Hypothyroidism, pseudohypoparathyroidism, Type 2 diabetes
  • Medications – risperidone/anti psychotics, tricyclic antidepressants, some anti seizure medications, long term steroid use,
  • Central Nervous system disorders (very rare) – Tumors, trauma, inflammation
  • Misc – Binge eating disorder, Bulimia nervosa
  • What are the risk factors for children becoming overweight adults?
  • *Like many diseases obesity/overweight is a combination of genetics, environment and behavioral components
  • Family history
  • Elevated parental BMI
  • Minorities
  • Early childhood obesity
  • children are less physically active
  • 2% increase in the prevalence of obesity for each extra hour of TV watched for teenagers
  • Schools have dropped their PE programs
  • Don’t forget “adiposity rebound” – Children gain most of the fat cells they will ever have around 3-5 years of age; We want to keep that number at a minimum;
  • What conditions can result from a child being overweight?
  • High Blood Pressure
  • Diabetes / insulin resistance
  • High cholesterol
  • Liver disease – gallbladder, liver inflammation
  • Breathing problems, especially while sleeping, like obstructive sleep apnea; also asthma
  • Musculoskeletal problems- Crooked spine, Flat feet, Bowed legs/Blount disease, hip problems/slipped capital femoral epiphysis
  • Skin problems- acanthosis,
  • Irregular menstrual cycles/ Polycystic ovarian syndrome
  • Psychiatric disorders – poor self-esteem, depression, eating disorders
  • Social ostracism/isolationism
  • What can we do to prevent and treat overweight children?/
  • Simple helpful suggestions to healthier habits:
  • *THE WHOLE FAMILY MUST BE INVOLVED and must be mentally prepared for a change of lifestyle
  • Components of treatment (for child AND the family):
  • Dietary modification
  • ***NEVER PUT YOUR CHILD UNDER A CALORIE RESTRICTIVE DIET UNLESS UNDER THE DIRECTION OF YOUR DOCTOR OR SPECIALIST; IT COULD SERIOUSLY IMPAIR THEIR GROWTH***
  • Consider meeting with a registered dietician – can find one at www.eatright.org
  • There are special eating programs to help children make good choices like the “traffic light” diet - “green”, “yellow” , and “red” foods; Lets children put foods into different categories easily, then they can choose what’s healthy themselves
  • Be careful not to feed too much
  • Child’s stomach is the size of their fist
  • Let a child start with a small portion (1/3-1/2 adult size) and let him serve himself
  • **DON’T FORCE FEED
  • Avoid being too controlling of how much your child eats- start with small servings and let them ask for more- don’t push them;
  • “It’s a parents job to offer foods and the child’s job to eat”
  • Don’t tell children to “clean their plates”
  • Eat at the table – an added bonus is that you also get more “family time” with your child
  • Help your child eat healthier foods by offering many fruits and vegetables at every meal ( even if your child has turned them down in the past)
  • Let your child help you choose them while shopping at the store
  • Have a daily meal schedule – Breakfast every day
  • Keep fast food meals to a minimum
  • Make sure all snacks in the house are low in fat
  • Limit sugary sodas and juices; encourage low fat milk to children over 2 yrs of age
  • **BREASTFEEDING**-has a protective effect against obesity – try to breastfeed for 12 months if possible
  • Promoting increased physical activity
  • Make sure your child has had a recent physical exam with their pediatrician before starting any new exercise program
  • Consider meeting with a physical therapist to design an exercise plan for your child
  • 60 min of physical activity 5 days a week
  • Use stairs instead of elevator
  • walk to school
  • Let your child help w/active chores – raking leaves, walking the dog, etc)
  • Promote outdoor playing
  • Parents, exercise with your children! Motivate them by example
  • Behavioral modification
  • record food intake and activity level
  • keep hi calorie foods out of house
  • reduce vending machine use – e.g, at school
  • change poor thinking/encourage child positively with your words
  • Accept your child at whatever weight they are at
  • Remind your child how much you love them and accept them
  • Listen to your child’s worries and concerns about their weight
  • Don’t use food as a reward – e.g. give color books and crayons or stickers or have a family outing instead
  • plan ahead for parties
  • Turn the television off at mealtime
  • Limit TV throughout the day; No more than 1-2 hours of TV/computers/video games
  • Child may need to be screened for psychological risk factors that are associated with over eating
  • Support groups/group programs to help modify behavior may be helpful. They also let children interact with others struggling with the same issues.
  • Is bariatric surgery an option to treat my child if they are severely overweight and have complications of being overweight?
  •  May be helpful for a very small number of older adolescents that are morbidly obese and have severe health problems because of it. Right now there is still not enough research data to advocate it on a large scale. If it is considered it should be done in consultation with a pediatric overweight specialist.
  • There are several types of surgery – gastroplasty (making a smaller stomach pouch) and gastric bypass (food bypasses parts of the small intestine)
  • Texas Children’s Hospital in Houston has a program and an ongoing research study
  • Does being overweight in childhood increase the likelihood that my child will be an obese adult?
  • Yes! Children greater than 3 years of age who are obese/overweight have a very high chance of being obese adults.
  • Does a parent being overweight or obese increase their child’s risk of obesity later in life?
  • Parental obesity more than doubles a child’s risk of  being an obese adult
  • If the child is less than 10 years old at the time the parent is obese, this is particularly true – even if the child is of normal weight at that time

  Helpful websites:
  American Heart Association http://www.americanheart.org/presenter.jhtml?identifier=1200000
  American Diabetes Association
   http://www.diabetes.org/home.jsp
  Dept of Agriculture Food pyramid
   http://www.mypyramid.gov/kids/index.html
  Centers for Disease Control http://www.cdc.gov/nccdphp/dnpa/bmi/childrens_BMI/about_childrens_BMI.htm