Obesity

Excessive weight gain can happen over time, and it can be hard to tell if your child is overweight just by appearance.

Body mass index, or BMI, is a measurement of someone’s weight compared to their height. BMI provides a quick estimate of a person’s body fat. BMI is measured with a number, which can be used to describe if a person is underweight, normal weight, overweight, or obese.  

Your doctor can measure your child’s BMI. If your child’s BMI is greater than the 85th percentile, they are considered overweight and at risk for obesity. If your child’s BMI is at or above than the 95th percentile, they are considered obese.

BMI is not a perfect measurement, so your doctor may consider other measurements like waist circumference as well as looking at family history and overall health to determine if your child’s weight is healthy.

Studies show that children with obesity are more likely to become teenagers with obesity. These teenagers may then become adults with obesity, unless lifestyle changes are made.

Many health issues are associated with obesity such as asthma, heartburn (called gastroesophageal reflux), sleep apnea, high cholesterol, and joint pain. Type 2 diabetes, high blood pressure (called hypertension), and non-alcoholic fatty liver disease (NAFLD) are chronic diseases that used to be seen mainly in adults but are now being seen in children with obesity. Obesity can even increase the risk for cancer and later infertility. 

It is not only physical health that can suffer but also mental health. Children with obesity are more likely to be bullied, have lower self-esteem, and be depressed.

Many factors can increase the risk for becoming obese. These include: 

• Genetics
• Types of food eaten (processed foods like soda, sports drinks, sweets, and fast foods increase the risk)
• Amount of food eaten
• Activity
• Screen time (television or device viewing)
• Poor sleep habits or sleep apnea
• Mental health
• Medications

The way to prevent or resolve obesity is to balance energy in (food and drink) with energy out (activity level).

Take small steps. Look at your child’s environment, activity, and food to see where healthy changes can be made. 

Environment

• Out of sight/out of mind: 
  • Take all food off the counters if possible.
  • Plan ahead when you go to the market and buy only what is on your list.
  • Keep good food choices easily available. They should be the first foods you see when you open the refrigerator or cabinets. 

• Don’t let screen time be all of the time.
  • Limit TV, video, device, and computer time (except for school).
  • Move the TV and computer out of the bedroom.

Activity 

• Make it part of your day. Start slowly as you build up strength and endurance.
• A mix of activities keeps it fun: walking, house cleaning, bike riding, dancing, active video games, dog walking, swimming, team sports, yoga, or playing at the park. Take advantage of yoga, exercise, and dance programs on TV and the internet. Find what you enjoy.
• When you can, walk instead of driving or taking public transportation.
• Join exercise options with friends or take advantage of a community group to increase motivation.
• Plan an activity as the focus, NOT the food. Go for a walk with a friend instead of having a meal.   

Food 

• Make mealtime mindful.
  • Plan meals and snacks ahead so you know what you are going to eat. Eat only what is planned.
  • Don’t skip meals. Make sure to eat regularly throughout the day.
  • Stick to the balanced plate (Myplate.gov) for meals. Avoid serving buffet or family-style to help with portions.
  • Create a space to eat, and only eat in that place. 
  • Turn off the TV, tablet, or computer during mealtimes.
  • Enjoy eating meals together as often as possible. 
  • Practice mindful eating: sit down, slow down, savor each bite.

• Encourage meals and snacks that include a balance of lean proteins and high-fiber foods. 
  • High-fiber foods include vegetables, fruits, nuts, beans, and whole grains (foods made from whole wheat, cornmeal, oats, barley, brown rice, or quinoa).
  • Lean proteins are beans, chicken, or fish (not fried) and low-fat dairy or unsweetened dairy alternatives. 

• Avoid sugar-sweetened drinks like soda, sports drinks, energy drinks, juices, punch, sweet tea, and flavored coffees. Research shows that these beverages may increase the risk for obesity-related health problems like liver disease and diabetes.

Choose fresh foods in their most natural states:

• Non-starchy vegetables
• Fruits
• Whole grains
• Legumes
• Lean proteins such as chicken, lean beef, fish, and eggs
• Low-fat dairy
• Healthy fats, especially plant-based fats, such as olive oil, nuts, seeds, and avocado (in sensible portions)

Minimize added sugars:

• Read labels and look for foods containing the least amount of added sugars.  Aim for less than 3 grams of sugar per serving for crackers and breads, less than 6 grams of sugar per serving for cereals and bars, and less than 8 grams of sugar per serving for Greek yogurts.
• Encourage drinking water, either plain or bubbly water. Try flavoring the water with slices of fruit, mint, or cucumber. 
• Don’t keep soda, juice, or other high-sugar beverages in the house.

Be positive in words and actions.

• Avoid punishing, blaming, bribing, yelling, screaming, teasing, or making comments about size, weight, or food, which can make the problem worse. Praise and encouragement can help solve the problem.
• Don’t negotiate at every meal. Make a plan together, agree on it, and stick to it.

Be an advocate. 

• Check-in with your child. Get help if needed, especially if your child is experiencing bullying.
• All caregivers need to be in agreement and have good communication. 

Be a role model.

• Eating vegetables, whole grains, fresh fruits, and lean proteins is good for EVERYBODY.
• Join along with your child in making the decision to be active and eat for health.

• CDC Healthy Weight Calculator
• CDC: About Child & Teen BMI
• MyPlate
• FDA: The New Nutrition Facts
• Mediterranean Diet
• Mayo Clinic: Healthy Fats
• Heart.org: Added Sugars
• Action for Healthy Kids: Sweetened Drinks

Authors: Patricia Novak MPH RD CLE LD and Sharon Weston MS RD CSP LDN
Editor: Riha Bhatt, MD
November 2021