By Christine L. Williams, MD, MPH
Over the past 40 years, both children and adults in the U.S. have become increasingly overweight, with large numbers of U.S. children and teens already overweight or obese. This extra weight can strain bones and joints, raise blood pressure and blood fats like cholesterol and triglycerides, escalating the likelihood of developing associated health problems, such as diabetes, high blood pressure, high levels of blood lipids, and increased risk of heart disease.
Overweight and obesity can also make the child the object of teasing and discrimination, which leads to low self-esteem and social problems. Although an individual's genetic makeup may make him or her more or less susceptible to develop obesity, the prevailing reason for excess weight gain is primarily an imbalance between "energy in" (calories in the food and beverages we eat and drink), and "energy out" (the number of calories our bodies burn off in physical activity, or use for metabolism or growth). Effective weight-control strategies and treatment are important to improve or eliminate the problem for each child.
Parents Can Help
Parents are in a unique position to help their children adopt a healthful lifestyle that supports energy balance, and to make it a high-priority goal for the whole family. The material summarized in the following series of articles highlights a wide range of strategies designed to help families adopt and practice healthy eating habits and engage in adequate physical activity. In a way, it's a road map to the kinds of healthful habits that contribute to healthy weight.
Parents of overweight children wonder what caused the problem. Is this an inherited problem? Is their child's metabolic rate too low? Do they eat too much? Do they exercise too little? Is it caused by stress? They may ask their child's doctor for advice, or they may keep their concerns to themselves and look for self-help articles and books on childhood obesity and try to make changes that will help improve the child's weight status. Even doctors differ in their approach to the problem, but increasingly they are recognizing the health effects of too much weight in childhood — and routinely diagnose, evaluate, and treat the problem. Although there are some relatively uncommon medical and genetic causes of obesity in children, the vast majority (more than 95%) of cases are due to more calories "taken in" as food and beverages than "burned off" as physical activity.
Parents as Positive Role Models
As parents, we share both genes and environment with our children. Heredity certainly makes some children more susceptible to excess weight gain — but we cannot change their genetic make-up. We can only try to influence the physical, social, and emotional environment that our children live in, and try to make it as healthful as possible. Children "learn what they live" and this begins at home. Parents can help their overweight children the most by being positive role models, with healthy attitudes toward food, exercise, and body image, good eating habits, and a positive outlook on physical activity.
Overweight in a child usually reflects the family environment. Children often gain too much weight at the same time that parents gain excess pounds. This means, the most effective weight control strategies for an overweight child include healthful lifestyle changes for the whole family. Importantly, with family interventions, the overweight child is not singled out for special treatment. A healthful diet that emphasizes vegetables, fruits, whole grains, lean protein, and low-fat dairy products, and that avoids excessive calories, added sugar and fat is appropriate for all family members, regardless of weight status. The amount of food — the size of food portions will vary depending on calorie needs; but the basic healthful pattern is the same.
Christine L. Williams, MD, MPH is professor of Clinical Pediatrics, and director of the Children's Cardiovascular Health Center in the Department of Pediatrics and Institute of Human Nutrition at Columbia University, College of Physicians and Surgeons.