Healthy Eating for Children

Helping the Overweight Child

Medical considerations

"Overweight" and "at risk of overweight" are terms sometimes used when referring to children who weigh more than expected. Doctors use the U.S. Centers for Disease Control and Prevention growth charts or the body mass index (BMI) to measure a child's weight in relation to his or her height. To find out your child's BMI, use this Interactive Tool: Is Your Child at a Healthy Weight?.

If you have concerns that your child is overweight or at risk of becoming so, first ask your doctor to review your child's growth charts and medical history with you.

• If your child's BMI has been high on the growth chart from birth, this may be his or her healthy size and growth rate. He or she may simply be bigger than other children of the same gender and age.
• If your child's BMI pattern has suddenly jumped from a lower range to a higher range on the growth chart, your child may be at risk of becoming overweight. Your doctor will carefully track growth over time, watching for a change in the rate of weight gain.
• If your family has a history of obesity, your child has a higher risk of becoming overweight.

Sometimes a child's BMI and weight can increase without a child being at risk of having too much body fat. For instance, before and during puberty it is normal for children to have a significant gain in weight before they begin to grow in height. Also, children who are very muscular (such as children who are very active in sports), may have a high BMI but have normal or even lower-than-normal amounts of body fat.

If your child's BMI and growth pattern suggest a weight problem, your doctor will give your child an exam that looks for health problems that can cause weight gain. This may include questions about eating and physical activity habits. Regular checkups for health problems will also be important over time.

Weight management goals for the overweight child

Use the division of responsibility. Your job is to offer nutritious food choices at meals and snack times. You decide what, where, and when your family eats. Your child's job is to choose how much he or she will eat of the foods you serve. Your child even gets to decide whether to eat.

Do not restrict food. Food restriction causes children to ignore their internal hunger gauges. Children who have their food restricted often end up heavier, because they become anxious about food and eating. Anxiety about not getting enough to eat will often lead a child to overeat whenever he or she gets a chance. This causes the child to become less in touch with how hungry or full he or she is, and the child becomes more likely to eat more than his or her body needs. This can also happen when children or teens follow weight-loss diets. It doesn't work to put a child on a diet—you get the opposite effect.

Pay attention to behaviors that may be adding to weight gain and then work to correct them. Then trust that your child will develop the weight that is right for him or her.

If you are concerned about your child's weight, talk to your child's doctor. He or she can tell you if your child is gaining weight too quickly and can give you steps to take to help your child have a healthy weight.

How you can help your child

As a parent, your job is to give your child the tools for a healthy lifestyle and remain as relaxed as possible about the result.

To help your overweight child eat well, use the same healthy eating approach with everyone in your family:

• Follow the division of responsibility.
• Eat together as a family as much as possible. The entire family, regardless of each family member's weight, should be offered the same food choices at meals.
• Choose water instead of sugary drinks, such as sport drinks, soft drinks, and fruit-flavored drinks. For some kids, cutting back on sugary drinks makes a big difference in balancing the calories your child takes in and burns off.
• Remember that all foods, even less nutritious foods in small amounts, can fit into a healthy diet. Do not make any food item completely off limits. This may increase the desire for the forbidden food and can lead children to overeat when they get the chance.³
• Avoid power struggles over food. Your job is to provide healthy choices at specific snack and mealtimes. It's your child's job to choose to eat or not eat.
• Stick to a regular meal and snack routine instead of snacking throughout the day. Schedule snacks for when your child is most hungry, such as after school or exercise.
• Offer nutritious food choices.
• Keep foods moderate in calories to help your child avoid getting too many calories. But don't make meals so low-calorie that your child can't feel full.
• Avoid using food as a reward, whether for an achievement, or for eating all of one's green beans. (The "nutritious food, then dessert" tactic makes the healthier food seem like a less desirable food.)
• Serve dessert as part of the meal to avoid the "dessert struggle." Offer healthier desserts, such as yogurt and fruit, more often than rich desserts. When you serve a rich dessert, it's okay to set out a single portion for each person.

To help your overweight child develop a balance between the calories he or she takes in and burns off:

• Shift the focus away from pounds and toward a healthy lifestyle by avoiding weighing your child daily. Consider not even using the bathroom scale.
• Move more. Make physical activity a part of your family's daily life.
• Keep total TV and computer "screen time" to 2 or fewer hours a day.² Encourage outdoor play as often as possible. Children should have at least 1 hour of active play a day.

As for any child with health concerns, make sure your child has all of the well-child checkups and treatment that your doctor recommends.

Helping your child with social and emotional concerns

It doesn't take long for children to figure out that our culture and their peers idealize thinness. As a result, surprising numbers of school-aged children and teens are unhappy with their bodies. This includes many who are not even at risk of being overweight.⁵ Children who are overweight are especially at risk of being teased and feeling alone. This can result in low self-esteem and depression.

For information about helping a child who is being teased, see the topic Bullying.

Regardless of a child's size, pediatric experts want every child to lead a healthy lifestyle and appreciate his or her body as it is.⁵ You can help your child develop greater health, confidence, and self-esteem by:

• Not talking in terms of your child's weight. How you talk about your child's body has a big impact on your child's self-image. Instead, talk in terms of your child's health, activity level, and other healthy lifestyle choices.
• Being a good role model by having a healthy attitude about food and activity. Even if you struggle with how you feel about your own body, avoid talk in front of your child about "being fat" and "needing to diet." Instead, talk about and make the same healthy lifestyle choices you'd like for your child.
• Encouraging activities, such as sports and drama. Physical activity helps build physical and emotional confidence. Try different types of sports and activities until your child finds one he or she likes. Drama can help a child project strength and confidence, even if he or she doesn't feel it at first.
• Encouraging social involvement in community, church, and school activities, which build social skills and confidence.
• Helping your child eat well by providing healthy food choices. Consider seeing a registered dietitian for guidance and new food ideas.
• Not allowing any child (yours included) to tease another child about weight. Talk to your child's teachers and/or counselors, if necessary.

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Author:	Caroline Rea, RN, BS, MS	Last Updated: September 13, 2007
Medical Review:	Ruth Schneider, MPH, RD - Diet and Nutrition Joanne P. Ikeda, MA, RD - Nutrition Education Specialist and Lecturer
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