Helping Your Overweight Child to Lose Weight

Obesity is the most common chronic disease in childhood. One in five children in the U. S. is overweight or obese. And that number continues to rise. Children with obesity have several weight-related health and mental wellness issues. It is a chronic, progressive disease and places them at a higher risk of having obesity as adults.

Children that have obesity face other chronic diseases early on in life such as heart disease, high blood pressure, liver disease, orthopedics issues (hip/knee/back pain), and diabetes. They are also more prone to develop stress, sadness, bullying, social isolation, and low self-esteem.

Obesity is a complex disease and children develop obesity for a variety of reasons. The strongest factors that contribute to this condition are genetic factors, as well as hormonal, metabolic, psychological, cultural, and behavioral factors like a lack of physical activity, unhealthy eating patterns, or a combination of these causes. A physical exam and some blood tests can rule out the possibility of a medical condition as the cause of obesity.

Although weight problems run in families, not all children with a family history of obesity will be overweight. Children whose parents or siblings are overweight may be at an increased risk of becoming overweight themselves, but this can be linked to shared family behaviors such as eating and activity habits.

A child’s diet and activity level play an important role in determining a child’s weight. Today, many children spend a lot of time being inactive. For example, the average child spends about 4 hours a day watching television. Add computers and video games, and the number of hours of inactivity may increase.

There is also a socioeconomic component. Those in lower-income communities may not have access to or be able to afford healthy food and only have options of cheaper prepackaged or fast food. Access to safe locations in which to spend free time or exercise may also be limited.

If you’re concerned your child may be at risk for developing childhood obesity, know that it can be prevented.

• Make sure your child’s meals are healthy, with 30% or fewer calories from fat.
• Respect your child’s appetite. Kids don’t have to finish everything on their plates or finish the entire bottle.
• Wait at least 15 minutes before offering a second serving.
• Avoid buying snacks with lots of sodium and foods and drinks with extra sugar.
• Provide enough fiber.
• Limit the amount of high-calorie foods kept in the home.
• Make fresh fruits and vegetables  easily accessible and in plain sight (on the counter, in the front of the refrigerator)
• Don’t reward the completion of meals with sweet desserts.
• Talk you your pediatrician about replacing whole milk with skim milk at about 2 years of age, or at 1 year of age if you are concerned about obesity.
• Limit TV and non-school-related media viewing. Don’t watch TV during meals or snacks.
• Encourage your entire family (child) to be physically active together on a regular basis.  Even small activities can count such as dancing or going for short walks.
• Plan, prepare and provide healthy meals and snacks on a regular basis.  Engage your children in meal planning.
• Encourage good sleeping habits and create a nighttime routine. Avoid putting small children to bed with cups or bottles and remove or cups, and remove televisions or computers from their room.

The best person to determine whether your child has obesity is your child’s doctor. They will measure your child’s weight and height and compute their BMI, or body mass index, and compare it to standards. The doctor will also consider your child’s age and growth patterns.

If you do have a child that is overweight or has obesity, they must know you are supportive. Children’s feelings about themselves often are based on their parents’ feelings about them. If you accept your children at any weight, they will be more likely to feel good about themselves. It is also important to talk to your children about their weight, allowing them to share their concerns with you. Your child’s doctor can also help you set an overall healthy weight goal for your child’s height. The doctor can even guide you on a timeline to achieve that healthy weight.

To approach your child’s weight loss seriously, you can:

• Set goals. Just like with adult weight loss, the weight loss goals in children should be attainable, allowing for normal growth. The goals should be small weight loss so that the child doesn’t become discouraged or overwhelmed. A 5- to 10-pound weight loss is a reasonable first goal – about 1 to 4 pounds per month. Some doctors focus less on losing weight than on not gaining more so that weight catches up with expected height gains. 
• Food diary. Work with your child to keep a food diary. This should include not just the type and quantity of food eaten, but where it was eaten, and who else was present. The diary is not meant to help calculate calories eaten. Rather, it is useful in determining eating patterns and problem foods.
• Diet. Work with your child’s doctor to ensure that your child is receiving a balanced diet. Consider also working with a dietitian.
• Physical activity. Exercise is an essential part of any long-term weight loss. Start small, to avoid discouraging the child. Work up to 20 to 30 minutes of moderate – and preferably fun – activity per day. That’s in addition to what your child gets in school. Making it fun and full of variety will help create lifelong patterns.
• Medication. The FDA has approved liraglutide (Saxenda, Victoza), orlistat (Alli, Xenical), and phentermine (Qsyma) to help treat obesity in adolescents. Liraglutide is to treat obesity in children over 12 and works to decrease appetite and control blood sugars. Orlistat is approved for children over the age of 12; phentermine can be used over the age of 16. Orlistat blocks the absorption of dietary fat, and phentermine is a stimulant that decreases appetite.
• Behavior modification. It’s important to help your child learn the skills to modify the behaviors that may be causing the weight problem. Consider sending your child to a nutritional counselor.
• Parental role. Help your child by limiting the amount of processed, sugary, and fattening foods in the house, eating all meals at the dinner table at designated times, and discouraging second helpings.

If your family’s routines need some tweaking, focus on gradually changing exercise and eating habits. By involving the whole family in buying and preparing healthy foods, everyone is taught healthful habits and the overweight child does not feel singled out.

Including the entire family in healthy habits is helpful. And increasing the family’s physical activity is especially important. Some ways to do this include:

• Lead by example. If your children see that you are physically active and having fun, they are more likely to be active and stay active for the rest of their lives.
• Plan family activities that provide everyone with exercise, like walking, biking, or swimming.
• Be sensitive to your child’s needs. Overweight children may feel uncomfortable about taking part in certain activities. It is important to help your child find physical activities they enjoy that aren’t embarrassing or too hard.
• Cut the amount of time you and your family spend in sedentary activities, such as watching TV or playing video games. The AAP recommends limiting screen time to 2 hours or less per day. 
• Make healthy meals together often and shop together for healthy food choices.

If your efforts at home are unsuccessful in helping your child reach a healthy weight and your doctor thinks your child’s health is at risk unless they lose weight steadily, you may want to consider a formal weight loss program. The overall goal of a weight loss program should be to help the entire family adopt healthy eating and physical activity habits.

When choosing a weight loss program for your child, keep in mind the program should:

• Be staffed with a variety of health professionals: The best programs may include registered dietitians, exercise physiologists, pediatricians or family doctors, and psychiatrists or psychologists.
• Perform a medical evaluation of your child: Before being enrolled in a program, your child’s weight, growth, and health should be reviewed by a doctor. During enrollment, your child’s weight, height, growth, and health should be monitored by a health professional at regular intervals.
• Focus on the whole family, not just the overweight child.
• Be adapted to the specific age and capabilities of the child: Programs for 4-year-olds are different from those developed for children 8 or 12 years of age when it comes to the responsibilities of the child and parents.
• Focus on behavioral changes: Teach the child how to select a variety of healthy foods in appropriate portions. Encourage daily activity and limit sedentary activity, such as watching TV.
• Include a weight loss maintenance program and other support and referral resources. This will reinforce the new behaviors and deal with hidden issues that contributed to the child becoming overweight.

Surgical procedures for weight loss are being used in teenagers, but their safety and effectiveness have not been widely studied in children. Talk to your child’s doctor to determine if weight loss surgery for your child should be considered.

Whatever approach you choose to help your overweight child, the aim is to make a healthy, active lifestyle fun. Make the most of the opportunities you and your family have to make positive changes.