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Harvard Commentaries
Harvard Commentaries
Reviewed by the Faculty of Harvard Medical School

A Parent's Life A Parent's Life

Fighting Childhood Obesity

September 12, 2013

By Henry H. Bernstein D.O.

You probably have heard that there is an obesity epidemic in the United States (and in many other nations), meaning that the number of people who are very overweight has increased steadily in recent years. But did you know that this is a problem for children as well as adults? According to recent data from the National Center for Health Statistics, approximately one child of every three in the United States is overweight.

What Does It Mean To Be Overweight?

Although it may look easy to tell when someone is overweight, that isn't really true. In fact, obesity is not diagnosed simply by looking at someone, because each of us has a unique body shape that carries our weight in a special way. Being overweight means having too much body fat for a particular body shape. This is measured best by the body mass index (BMI), which is calculated by using a person's weight and height. BMI gives an estimate of the amount of body fat relative to lean body mass.

Since total body fat in children normally changes with age, BMI is then compared with age- and sex-specific standards based on large national surveys of children up to age 20. Based on the current recommendations of expert committees, children with BMI values greater than the 85th percentile for their age and sex are considered overweight, while children at or above the 95th percentile of the sex-specific BMI growth charts are considered obese.

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What Causes Obesity?

While there is some evidence to suggest that genetic factors (those passed down from parent to child) play a role in the obesity epidemic, personal behavior and dietary habits are probably the most important factors. There is no question that children (and adults) are consuming more calories, especially calories from fat, than they really need each day.

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What Are The Complications Of Obesity?

Besides the social and emotional difficulties, being obese puts children at risk of lots of health problems during both childhood and adulthood, such as orthopedic problems, sleep disturbances, menstruation problems and diabetes. Some researchers even think there is a relationship between asthma and obesity. In addition, children who are overweight are more likely to develop high blood pressure, high cholesterol, heart disease, arthritis and certain kinds of cancer as adults.

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What Can Be Done?

If you think your child may be overweight, first talk with his or her pediatrician. After measuring your child’s height and weight, your child's BMI can be calculated and compared with the national growth charts. Knowing your child's sex, age and body type, the pediatrician can use these charts to see if your child is overweight. This can help him or her to suggest a good target weight range for your child.

If there is a problem, sit down together as a family and make a plan. The whole family must be involved, as well as any regular caregivers; children cannot do it alone. In general, the goal is for the whole family to get lots of exercise and eat a healthy, well-balanced diet. The message to kids should never be, "You're fat and need to lose weight." Instead, it should be, "We all need to eat right and be active so that we can be healthy."

Here are some things that parents can do to help their children (and themselves) prevent and treat obesity.

Get Moving!

  • Try to do something active every day for at least 60 minutes on most days.
  • Walk whenever possible: to school, to the store, to the library, at the mall, and around the block after dinner.
  • Take the stairs instead of the elevator.
  • Plan family activities that involve exercise, such as bicycling, dancing, hiking and swimming.
  • Limit television, computer and video-game time to two or fewer hours per day on average.

Eat Healthfully!

  • Eat meals together as a family whenever possible.
  • Do not watch television while eating.
  • Except for special occasions, offer only healthy foods. For example, at snack time, ask your child to choose between an apple and unbuttered popcorn, not between an apple and a cookie.
  • Teach your child to not skip meals; we tend to eat more at the next meal.
  • Try to eat at least five servings of fruits and non-starchy vegetables each day.
  • Limit foods with lots of fat or sugar, such as fast food, pizza, fatty meats, cakes, cookies, candy, soda and juices.

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Final Tips

Make small and gradual changes and try to make them permanent. Do not look for quick fixes and do not follow short-term diets or exercise programs that aim for rapid weight loss.

Be patient! Children, like adults, do not become overweight overnight, and it can take many months and even years to switch from unhealthy habits to healthier ones. Even small changes can have big rewards. Burning an extra 100 calories each day (or replacing one small juice box with water) could lead to a 10-pound weight loss in one year!

Be a role model. Remember, your child will do as you do, and not as you say. Your child is much more likely to eat healthfully and exercise regularly if you do. Of course, you will be healthier, too!

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Henry H. Bernstein, D.O. is a Senior Lecturer in Pediatrics at Harvard Medical School. In addition, he is chief of General Academic Pediatrics at Children's Hospital at Dartmouth and Professor of Pediatrics at Dartmouth Medical School. He is the former associate chief of General Pediatrics and director of Primary Care at Children's Hospital Boston.

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