Lost at sea? The perils of childhood obesity

In the last 10 years, the number of overweight people in industrialized countries has increased significantly - so much so that obesity has been called an "epidemic" by the World Health Organization (WHO).

In the past, many people thought that obesity was simply caused by over-eating and under-exercising due to a lack of will power and self-control. Today, doctors recognize that obesity is a serious medical problem due to multiple factors: genetic, environmental, behavioural, and social. All these factors play a role in determining a person's weight. It is estimated that 26% of Canadian children and youth ages 2 to 17 are considered overweight or obese.

Research has shown that television viewing has been associated with obesity in children of all ages (preschool-aged, school-aged, and adolescents). Obesity is even more common if there is a television in the child's bedroom.

Obesity is associated with many different complications:

  • psychological problems (lack of self-esteem, depression)
  • breathing disorders (especially while asleep)
  • bone and joint problems
  • diabetes
  • high cholesterol
  • gall bladder or liver disease
  • high blood pressure
  • stroke (mainly in adults)
  • heart disease (mainly in adults)
  • some kinds of cancer (mainly in adults)

The diagnosis of obesity is usually based on physical examination and a patient history (i.e., eating and exercise habits). Children are considered "medically obese" when their weight poses health risks. The degree of obesity is often measured using the body mass index (BMI). BMI is calculated as follows:

BMI = body weight (kg) ÷ height² (m)
Example: if your 4-year-old son weighs 40 lbs., which is 18 kg, and is 38 inches tall, which is 95 cm or 0.95 m, you divide 18 by (0.95 × 0.95). The result is 19.9.

The normal ranges for BMI are different for boys and girls of different ages. If you are concerned about your child's weight, you should consult your doctor or healthcare professional. He or she will compare your child's BMI result to a standard growth chart, and will then be able to tell whether your child should start weight loss therapy.

Food, fitness, and fun for the whole family

The dietary goals for children and their families are well-balanced, healthy meals and a healthy approach to eating. These changes should be considered permanent rather than a temporary eating plan for rapid weight loss.

Here are some tips for eating a healthy, well-balanced diet:

  • Avoid skipping meals (especially breakfast).
  • Try to include foods from at least 3 of the 4 food groups (breads and cereals, fruits and vegetables, meat and meat substitutes, milk and milk products) in each meal. Plan your meals and snacks so that you choose a variety of nutritious, tasty foods.
  • Limit the serving size for snacks (maximum 1 to 2 snacks per day). Choose fresh fruit and yogurt or cheese, muffin or cereal and milk, half a sandwich, or crackers and cheese.
  • Allow your child to enjoy favourite foods in moderation without feeling guilty. Choose low-energy treats (maximum 1 to 2 treats per week) such as sugar-free gum, 1 to 2 hard candies, 1 licorice stick, or Gummi Bears.
  • Avoid having anything more than fruit after dinner so your child will be hungry for breakfast.
  • Choose sugar-free drinks (e.g., sugar-free pop and Kool-Aid®, Crystal Light®, soda water, ice water). Avoid regular soda pop, juice, fruit drinks, regular Kool-Aid®, lemonade, honeydew, and flavoured waters. Remember it is better for your child to eat his or her calories than to drink them.
  • Ensure that you meet the requirements for milk and milk products (2 to 4 servings per day).

Exercise and activity level are just as important as calorie intake. Children (and adults for that matter) should be more active, not only for weight control, but also for general health and well-being. Here are some ways to help your child lead a healthy, active lifestyle:

  • Encourage your child to aim for at least 60 minutes of moderate- to vigorous-intensity physical activity each day. Many different activities count. Bike riding, skating, and going to the playground after school are examples of moderate intensity physical activities. More intense or vigorous-type activities, like running, swimming, or rollerblading, should be done at least 3 days per week (after consultation with your child's doctor).
  • Choose a variety of activities your child enjoys.
  • Choose some activities that can be done from home, like walking, bike riding, dancing to music, and playing games outside.
  • Limit television, video games, and computer games to 1 to 2 hours per day. Most doctors recommend less than 2 hours per day.
  • If applicable, take the television out of your child's bedroom to limit viewing. One research study showed that children with a television set in their bedroom watched nearly 5 hours per week more than those without a bedroom television.
  • Be a good role model - exercise with your child.

No child is an island

All children should have a medical evaluation by a doctor before starting weight loss therapy. The goals of therapy are to:

  • lose weight slowly (e.g., approximately 0.5 kg or 1 lb a month)
  • maintain normal childhood growth (e.g., growing taller in height) with no weight gain
  • change diet, exercise, and behaviour
  • involve family in counseling and support
  • keep the weight off once it is lost

Recent research has shown that diet, exercise, and behaviour modification are most effective when the whole family is involved. A weight loss program may be futile and actually harmful if the family is not ready to make changes, because unsuccessful efforts may lower a child's self-esteem even further.

Since family support is such an important part of therapy, several "parenting" principles should be followed in the management of eating and activity behaviours:

  • Find reasons to praise your child's behaviour.
  • Offer rewards for positive changes in behaviour. Never use food as a reward.
  • Establish daily family meal and snack times.
  • Determine what food is offered and when. Let your child decide whether to eat.
  • Offer only healthy options.
  • Remove temptations.
  • Be a role model.
  • Be consistent.

Drug therapy and surgery are sometimes used to treat obesity in adults. However, they are not routinely recommended for children and are generally not considered unless obesity is life-threatening.

Keep your ship on course

Childhood obesity programs can lead to sustained weight loss when treatment focuses on behaviour changes. There are several techniques available for behaviour therapy, including the following:

  • Keep a daily food diary. Help your child record the type and amount of food eaten, when, with whom, and where it was eaten. This will allow your child and healthcare professional to recognize and eventually change eating behaviour patterns. For example, avoid eating while your child is watching television, doing homework, or playing computer games.
  • Distinguish between hunger and appetite. Teach your child cues to control appetite and schedule meals regularly.
  • Identify activities that will divert attention from food.
  • Build self-esteem by changing negative to positive goals. Avoid weighing your child at home more than once a week, and focus on the changes you have made in behaviour rather than on the numbers on the scale.
  • Reinforce positive new behaviour by offering rewards for behaviour and not weight loss. Avoid any food rewards - be creative!