Dual approach against childhood obesity

Melissa Southern-Garcia, Dietitian, Jakarta, SouthernDietitian@yahoo.com

Dear Melissa, I am very concerned with my son's excess weight. He is 6 years old and weighs 60 kilograms (132 pounds). I hope you can advise me on how to reduce his weight in a very gentle way. Thanks. --Rani

Dear Rani,

Your question addresses such an important topic that I would like to focus my entire article today on the subject.

Childhood obesity is a problem of growing proportions. An estimated 22 million children under the age of 5 are overweight worldwide. In the United States, the number of obese children has doubled in the past 30 years and in Britain it has doubled in the past 10.

Countries such as Egypt, Mexico, Italy and Australia have a rate of childhood obesity greater than 25 percent.

In many cultures an overweight child has traditionally been equated with a healthy or happy child, however, an increasing number of studies indicate that an overweight child has a significantly higher risk of becoming an overweight adult, thus increasing risks for heart disease, diabetes, some forms of cancer and arthritis.

More and more overweight children are being diagnosed everyday with type II diabetes, once considered a disease of the old. It is becoming increasingly clear that childhood obesity is a serious public health problem that needs to be addressed. So what can we, as parents, do to help our children stay fit and healthy?

The first place to look is the energy balance equation. All the food we eat is burned by the body either for its basic metabolic needs or through physical activity. The rest is stored as fat.

In order to maintain a healthy balance, we must look at both sides of the equation: the food that goes in, and the energy that is expended.

With children, it is especially important to remember that "cutting back on food" is not the answer. Children are growing and have high nutrient requirements which should not be restricted.

However, certain changes can still be made on the food side of the equation. When choosing a meal or snack for your child, rather than limiting foods, provide healthy choices. Many children will snack on what is readily available.

Stocking your shelves and refrigerator with fruits, vegetables, and good sources of fiber such as whole wheat bread will help take away some of the temptation to eat high-fat, high- sugar foods.

Place ready-to-eat snacks such as carrot sticks, low-fat yogurt, or watermelon cubes on refrigerator shelves at your child's eye-level. No food should be "forbidden", instead try to encourage children to eat more of the healthy foods and smaller portions of the high-calorie, low-nutrient choices that are often marketed to children.

Several studies have indicated that an adequate intake of calcium may also be helpful in reducing fat deposition in childhood. Make sure your child is getting enough calcium by offering good sources such as low-fat milk, tofu or green leafy vegetables.

It is also important to get everyone involved in the commitment to healthy eating. If the whole family is making healthier choices, the child will have a good parental role model to follow and will not feel singled-out or left out by having to eat different foods.

Talk to baby-sitters or family members such as grandparents or aunts that may spend time with the child. Explain that food should not be offered as a reward, prize or comfort and ask them to help encourage your child with positive messages to boost self-esteem.

Many overweight children may have problems with self-esteem and may even be tempted to try dieting on their own. Talk to your child and explain the importance of a healthy, well-balanced diet and warn of the consequences to health and growth of unsafe dieting.

Now onto the other side of the equation: physical activity. Since it is not wise to limit the caloric intake of a growing child, an important part of the weight loss approach is to increase the amount of calories burned through physical activity.

As we have become more urbanized, and technology has presented us with more computer games and movies for entertainment, children have become more sedentary.

Multiple studies have shown a direct correlation between obesity and the amount of hours of television that a child watches. It is not television itself that is a problem, but what watching TV implies: inactivity and mindless snacking.

In our modern society, children need to be encouraged to participate in physical activity. Provide your child with age- appropriate toys that encourage activity such as skates, bicycles, balls or jump ropes.

The whole family should become involved in physical activities such as swimming, soccer or just running around in the park. Make physical activity something fun and enjoyable for your child.

Of course, your child will still want time to watch television or play video games. Try to set reasonable time limits for these activities. Always encourage your child to turn off the television and sit at the table when eating so that he is aware of when he is full and does not continue eating just because he is distracted by the television.

Children should learn to listen to the body's natural hunger cues instead of eating as a distraction or as a response to schedules, emotions or pressures which can lead to further eating problems.

Remember that you will have to be patient. Healthy weight loss should be accomplished slowly in a child. Your main goals should be to teach your child life-long skills of healthy eating and exercise within a positive context.

Finally, if you detect any unusual changes in your child's weight, slowed growth, fatigue, dry skin or other unusual symptoms accompanied with weight gain, make sure to consult your pediatrician.