"Kids' Health" supplement in the October 18-20, 2002 weekend edition of USA Today

OBESITY

Studies show that today's children tend to be heavier than their counterparts were a generation ago, and that over 30 percent of America's school-age youngsters are now overweight. The nation's pediatricians say that being overweight can contribute to physical problems such as high blood pressure, limit a child's athletic abilities and impair self-esteem.

"We live in a society that emphasizes thinness, and an overweight child is likely to be teased by peers. But even more important than that are the health risks; over 60 percent of overweight children between five and 10 years of age already have at least one risk factor for cardiovascular disease," says Dr. Nancy Krebs, M.D., FAAP, chair of the American Academy of Pediatrics' (AAP) Committee on Nutrition.

Dr. Krebs says you should start by talking with your pediatrician, who will look at growth charts to determine the most appropriate weight range for your child based on gender, age, height and body build. Children tend to gain weight at a fairly steady rate through the middle years, with an increase in weight gain and growth during, and just prior to, puberty. Your child's need for calories rises during times of rapid growth, gradually increasing as she moves through middle childhood into puberty. Parents and their children should not automatically become alarmed by this increase in weight. The growth charts account for this increase, and your pediatrician can use them to determine if a child's weight gain during this time is too rapid or excessive.

After determining if your child is overweight, your pediatrician will want to know why. "A family history of obesity increases your youngster's chances of weight problems," says Dr. Krebs. "A child who is physically inactive is more likely to have a weight problem. If your family's meals tend to emphasize high-calorie foods, that can cause excess weight gain." Although certain metabolic and endocrine disorders may contribute to obesity, they are the culprits in only about five percent of obese children. Stress can also play a role, causing children to overeat as their moods and behavior change - for instance, when they are bored, anxious, depressed or even extremely happy.

Once your pediatrician determines the causes behind your child's weight problem, he or she will discuss treatment. "The most successful programs concentrate not only on dietary modifications and physical activity, but also on boosting a youngster's self-esteem," says Dr. Krebs. "The goals you agree upon should not be principally about weight, but rather about healthy living - eating appropriate amounts and kinds of food, physical activity, and dealing with personal and social factors that encourage poor lifestyle habits.

Obese youngsters should avoid fad diets and instead consume a variety of foods relatively low in calories but high in nutritional value. Vegetables especially are often "underconsumed" by children. Eating meals together as a family as often as possible is also important. Dr. Krebs says family meals are associated with children eating more fruits and vegetables, and fewer fried foods and soft drinks, than those who don't eat with their families. This can also help children learn appropriate portion sizes, which are often exaggerated in foods purchased outside the home. Support your child by your own good eating habits. You cannot expect your youngster to successfully change his eating and exercise habits on his own, particularly if others in the household are not setting good examples.

Also, encourage your overweight child to become more physically active. One of the most important ways to do this is to limit television time and other sedentary activities. Parents should encourage their children to find TV alternatives, including unstructured active play at home, school, and day care. Regular physical activity can play an important role in the maintenance of a healthy weight over the long term. Parents and caregivers can become good role models for physical activity, even involving children in their own exercise programs, including bicycling, swimming or brisk walking as a family. Parents can also encourage children to be active as an important part of healthy habits, not as part of a diet. Diets are short-lived, but fitness is a lifelong goal.