Preventing Childhood Obesity: How to Help Your Child Grow Healthy and Strong

Childhood obesity is a topic foremost on the minds of many of my patients and their parents, and with good reason: studies have shown pediatric obesity rates have more than tripled in the past 30 years. Even more troubling, extra pounds early on in life often start children on the path to health problems including diabetes, hypertension and coronary artery disease later on. The good news? Some congenital and genetic predispositions aside, simple dietary lifestyle changes should be all one needs to achieve and maintain a healthy body habitus.

Know the numbers, and what they mean.

          Each child’s body is different. Weight alone is unable to take into account a patient’s age, height, body shape and developmental stage. A better barometer to assess body habitus is the body mass index, or BMI. BMI is calculated as one’s body mass in kilograms divided by one’s height in meters squared. (Using US units, it can be calculated as mass in pounds x 703, divided by height in inches squared.) Unlike adults where people are classified as “underweight”, “healthy weight”, “overweight” and “obese”, children’s BMI’s are compared to typical values for other children. Therefore, instead of set thresholds for underweight and overweight, the BMI percentile allows comparison with children of the same sex and age. That said, certain cutoffs are helpful in identifying overweight and obese children: children with BMI-for-age between 85th and 94th percentiles classify as overweight; those with BMI >95%, as obese.

Look at the growth chart.
          At each of my patient’s check-ups, I make sure to review the growth chart with their parent or caregiver. Aside from giving a visual depiction of their child’s weight gain, it allows for a longitudinal assessment of growth. When evaluating a growth chart, it is important to remember the “big picture”: making sure the child is not only growing, but doing so consistently. Keeping track of percentiles is an easy way to trend this. A child who had been growing with their weight along the 75th percentile since birth (meaning that when compared to other children of the same age and gender, the child is heavier than 75% of peers) should be expected to continue along this trajectory. It is important to compare this measure with the percentile for height, as a child who is 75th percentile for weight paired with 75th percentile for height, is more proportional as opposed to a child with the same weight but growing along 10th percentile for height (this is where BMI as a marker for overall body type is helpful). A change in height or weight spanning two or more percentiles (in either direction) may warrant further discussion and/or testing by your pediatrician.

…But it’s morethan just the numbers. 
          Knowing your child’s height, weight and BMI is helpful, but ultimately its the significance of these numbers that have the lasting sequelae. Being classified as “overweight” or “obese” has both immediate and long-term effects on the child’s health and well-being. The first issues to occur in obese children are usually emotional or psychological including depression, poor body image and low self-esteem. In addition, obese youth are more likely to have risk factors for cardiovascular disease, including high blood pressure, high cholesterol and diabetes. In a population-based study of 5- to 17-year-olds, 70% of obese youth had at least one of these risk factors. Some of the other disorders affecting this population include liver disease, early puberty, skin infections, asthma and other respiratory problems.

Dietary and Lifestyle Changes- No time like the present.
          There are no medications currently approved for the treatment of obesity in children, therefore lifestyle changes are crucial. Whether or not your child falls into the overweight categories, it is never too soon to implement healthy choices to help or keep your child on the right track. What constitutes a “healthy diet” differs depending on age. From birth, breastfeeding as shown to protect against obesity in later life with the duration of breastfeeding inversely associated with the risk of being overweight later on (meaning the longer an infant is breastfed, the less the risk of obesity in the future). Later in infancy, studies have demonstrated holding off from giving solid foods until at least six months of age and not adding cereal or other ingredients to the bottle can decrease one’s obesity risk. In toddlerhood, it is important to limit or dilute juice, as well as switch to 1% or 2% milk (instead of whole milk) after the age of 2. Later in childhood, restrict sugary and salty snacks and drinks (sodas, juices, sport drinks) and encourage meals with fruits, vegetables, lean proteins and grains.

          Nowadays, children 8-18 years of age spend an average of 7.5 hours a day using entertainment media, including TV, computers, video games, cell phones, and movies. Simply put, children gain weight when they eat more calories than they expend. It is imperative to encourage your child to be active; regardless of age, physical activity is a must! It is recommended that children get at least sixty minutes of aerobic activity per day. This means limiting sedentary activity in exchange for walking, playing sports, bike riding, swimming and the like. These can be great activities to do as a family; remember, children internalize and mimic what they see around them so being a good role model is key!

Together with your pediatrician, you can start your child on the road to a healthy body and lifestyle. Remember, for the most part healthy children become healthy adults! Knowing and understanding these issues as well as ingraining healthy lifestyle and dietary choices in childhood can be beneficial both now and for years to come.

Dr. Corey Wasserman is a resident pediatrician at New York Presbyterian Hospital-Weill Cornell Medical Center. She received her undergraduate degree in psychology with an emphasis on child development at Bucknell University and went on to attend Jefferson Medical College in Philadelphia, where she received her M.D. and graduated with high honors.

Sources:

Barlow SE, et al. Expert committee recommendations regarding the prevention, assessment and treatment of child and adolescent overweight and obesity: Summary report. Pediatics 2007;120:S164.

Dietz WH. Overweight in childhood and adolescence. New England Journal of Medicine 2004;350:855-857.

Ogden CL, Carroll MD, Curtin LR, Lamb MM, Flegal KM. Prevalence of high body mass index in US children and adolescents, 2007–2008. Journal of the American Medical Association 2010;303(3):242–249.

Quak SH, et al. Obesity in children and adolescents. Journal of Pediatric Gastroenterology and Nutrition 2008; 47:254–259.